Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records|
A retrospective cohort study that looked at the incidence of tonsil removal (tonsillectomy) in children aged 0-15 years has found that the majority of these operations were not evidence-based. The main criteria for tonsillectomy are
- more than seven documented sore throats in a year
- more than five sore throats per year for two successive years
- three sore throats per year for three successive years
According to the study’s findings 2,144 tonsillectomies out of 18,281 were evidence-based. Of those children who had their tonsils removed 12.4 per cent had reported five to six sore throats in a year; 44.7 per cent had suffered two to four sore throats in a year; and one in ten children (9.9 per cent) had just one sort throat in a year with experiencing one sore throat before having the procedure.
The researchers from the University of Birmingham show that showed every year over 32,000 children undergo needless tonsillectomies, which costs the NHS of £36.9 million. They also underline that of the 15,764 children who might benefit from the operation hat of children who had records showing sufficient sore throats to undergo a tonsillectomy, just 2,144 (13.6 per cent) actually went on to have the operation.
Read the full University of Birmingham press release here
Background Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.
Aim To determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.
Design and setting A retrospective cohort study of electronic medical records of children aged 0–15 years registered with 739 UK general practices contributing to a research database.
Method Children 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.
Results The 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%).
Conclusion In 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.
Source British Journal of General Practice
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In the media:
BBC News ‘Too many children’ have tonsils removed unnecessarily
The Guardian Nine in 10 operations to remove children’s tonsils ‘unnecessary’