S Clerc1, D Soldati. 1. Clinique ORL et chirurgie cervico-faciale, CHUV, Lausanne.
Abstract
OBJECTIVE: To determine which treatment for quinsy is the most cost-effective option. MATERIAL AND METHOD: 277 quinsies were diagnosed in 262 patients in our institution between 1.1.1991 and 31.12.1998. Median age was 29 years (1-89 years), and sex ratio was 3 males:2 females. 82 quinsy tonsillectomies (AC), 91 drainages with interval tonsillectomy (DAF) and 104 drainages of the abscess without tonsillectomy (D) were carried out. RESULTS: Median hospital stay was 3 (1-7) days for quinsy tonsillectomy, and 10 (4-18) days for drainages with interval tonsillectomy (hospital stay after drainage added to hospital stay after tonsillectomy). If interval tonsillectomy is performed as an outpatient procedure, median hospital stay decreases to 5 (2-8) days. For patients who refused tonsillectomy, median hospital stay was 3 (0-14) days. Median disability after treatment was 15 (7-30) days for quinsy tonsillectomy. For drainages with interval tonsillectomy (disability succeeding the drainage added to that following interval tonsillectomy), the median is 20 (15-52) days. For patients who refused tonsillectomy it is 6 (0-15) days. In the AC group we counted 9 late haemorrhages (11%). In the DAF group 14 patients (15%) presented a late haemorrhage; 6 patients (6%) presented a postoperative superinfection of the tonsillar fossae. DISCUSSION: On the basis of the tariffs of our institution (CHUV), and of statistical data obtained from the National Institute for Social Insurance (SUVA) with regard to the economic impact of each day of disability, the cost of the various treatment options is presented. CONCLUSION: It results from our study that in the absence of a significant difference in the rate of complications, and even considering the possibility of carrying out interval amygdalectomy on an outpatient basis, the most cost-effective treatment of peritonsillar abscess is quinsy tonsillectomy.
OBJECTIVE: To determine which treatment for quinsy is the most cost-effective option. MATERIAL AND METHOD: 277 quinsies were diagnosed in 262 patients in our institution between 1.1.1991 and 31.12.1998. Median age was 29 years (1-89 years), and sex ratio was 3 males:2 females. 82 quinsy tonsillectomies (AC), 91 drainages with interval tonsillectomy (DAF) and 104 drainages of the abscess without tonsillectomy (D) were carried out. RESULTS: Median hospital stay was 3 (1-7) days for quinsy tonsillectomy, and 10 (4-18) days for drainages with interval tonsillectomy (hospital stay after drainage added to hospital stay after tonsillectomy). If interval tonsillectomy is performed as an outpatient procedure, median hospital stay decreases to 5 (2-8) days. For patients who refused tonsillectomy, median hospital stay was 3 (0-14) days. Median disability after treatment was 15 (7-30) days for quinsy tonsillectomy. For drainages with interval tonsillectomy (disability succeeding the drainage added to that following interval tonsillectomy), the median is 20 (15-52) days. For patients who refused tonsillectomy it is 6 (0-15) days. In the AC group we counted 9 late haemorrhages (11%). In the DAF group 14 patients (15%) presented a late haemorrhage; 6 patients (6%) presented a postoperative superinfection of the tonsillar fossae. DISCUSSION: On the basis of the tariffs of our institution (CHUV), and of statistical data obtained from the National Institute for Social Insurance (SUVA) with regard to the economic impact of each day of disability, the cost of the various treatment options is presented. CONCLUSION: It results from our study that in the absence of a significant difference in the rate of complications, and even considering the possibility of carrying out interval amygdalectomy on an outpatient basis, the most cost-effective treatment of peritonsillar abscess is quinsy tonsillectomy.