The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011

Abstract

INTRODUCTION Sore throats and tonsillitis represent a considerable health burden as well as a significant source of expenditure for the National Health Service (NHS). As part of the recent NHS savings drive, the introduction of 'procedures of low clinical effectiveness' (PoLCE) lists has reinforced a large reduction in the number of tonsillectomies performed. We carried out a crosssectional study of trends in emergency sore throat admissions in the context of the number of tonsillectomies performed. METHODS Hospital Episode Statistics (HES) data were extracted. Office for National Statistics data were also used. RESULTS Between 1991 and 2011, the overall tonsillectomy rate fell by 44%. In the same time, the admission rate for tonsillitis rose by 310% (Pearson's r=-0.67, p=0.01). The peritonsillar abscess admission rate rose by 31% (r=-0.79, p<0.01). Between 1996 and 2011, the overall tonsillectomy rate fell by 41% and the retro and parapharyngeal abscess admission rate rose by 39% (r=-0.55, p=0.026). There was a 14% overall increase in tonsillectomy and sore throat associated bed days. This was despite the large fall in tonsillectomy numbers and the reduction in length of hospital stay. CONCLUSIONS Efforts to reduce the tonsillectomy rate are correlated with a significant rise in emergency admissions. The rise in the retro and parapharyngeal abscess rate is perhaps most alarming given the very high mortality of these conditions. Bed day data suggest that no net saving has been made despite the new measures.

Identifying and treating group A streptococcal pharyngitis in children

“…11,12 In the United Kingdom, a reduction in prescribing antibiotics may have been a contributing factor for increased admissions for peritonsillar and retropharyngeal abscesses. 13 Currently, many European guidelines recommend antibiotic treatment only for high-risk patients, whereas North American guidelines focus on treatment for all patients with group A streptococcal pharyngitis. 10 So, which patients with sore throat should receive treatment?…”

Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

“…4 Over the same period, there has been a significant increase in the number of hospital admissions for tonsillitis and peritonsillar abscess in the UK. 5,6 This paper aims to describe and discuss the trend in patients admitted to secondary care for tonsillitis and associated infections in the context of the number of tonsillectomies performed each year in Wales.…”

“…2 In 2006, some primary care trusts categorised tonsillectomy as a 'procedure of low clinical effectiveness' or 'procedure of limited clinical value' (PLCV). 5 A Royal College of Surgeons Briefing says that PLCV is a term that NHS managers have applied to a range of elective surgical procedures that they no longer wish to fund. 18 Traditionally, it included complimentary or alternative medicine, aesthetic treatment or treatments without NICE guidance over cost effectiveness.…”

“…19 As part of the report on efficiency savings that could be made in NHS, tonsillectomy was regarded as a "relatively ineffective intervention". 5 The publication of these documents may explain the reduction in number of tonsillectomies performed during the study period. Although our study cannot establish cause and effect, the negative correlation between the number of tonsillectomies performed and admissions for tonsillitis would suggest that the bar for tonsillectomy is being set too high.…”

“…These findings have also been observed in England. 5,6 ENT UK states that tonsillectomy, in appropriately selected patients, is not only a treatment for severe recurrent tonsillitis but leads to an improvement in the patient's quality of life. 1 There is currently no published data to suggest that tonsillectomy is overused or abused in the UK.…”