Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

Abstract

BackgroundNeither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.AimTo determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.Design and settingA retrospective cohort study of electronic medical records of children aged 0–15 years registered with 739 UK general practices contributing to a research database.MethodChildren with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined.ResultsThe authors included 1 630 807 children followed up for 7 200 159 person–years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%).ConclusionIn the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.

Impact of COVID-19 on healthcare activity in NSW, Australia

“…In the case of low-value procedures, the COVID-19 pandemic presents an opportunity to revisit and potentially prevent the resumption of such activities. For example, tonsillectomy has been found to have been performed when not indicated 23 , and the number of procedures performed in NSW public hospitals in April dropped precipitously (but then started to increase again).…”

Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

“…A 12-year retrospective cohort study of children in the UK undergoing tonsillectomy included over 1.6 million patients, and focused on the indication for the procedure. 13 This study concluded that the majority of tonsillectomies (seven out of eight) were not evidence-based.…”

<p>Familial and Environmental Risk Predisposition in Tonsillectomy: A Case–Control Study</p>

“…24 One study stated that the indications for tonsillectomy were sleep apnea, 22.2%, followed by peritonsillar abscess, 14.8%, and sleep disordered breathing, 14.8%. 25 The cause of tonsillar disease was associated with the age of the patient in that tonsillar hyperplasia was the most frequent cause in children younger than 10 years, while in teenagers the cause of tonsillar disease was most frequently related to abscesses and acute infections, and chronic tonsillitis was the most frequent in individuals older than 20 years. 26 In this study, the most clinical indications were recurrent tonsillitis and sleeping problems.…”