Tonsillectomy is one of the most common surgical procedures performed in children but there has long been an element of debate, even controversy, about the indications for the procedure. Research evidence has led to a refinement in indications over recent decades. Traditionally, the most common reason for removing the tonsils has been recurrent episodes of tonsillitis. A number of randomised controlled trials 1-4 have established the frequency and duration of recurrent tonsillitis which might justify surgical intervention and clinicians have been encouraged to follow national guidance based on this research evidence. 5 Such evidence-based guidance might be expected to lead to a reduction in the number of tonsillectomies performed.

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Tonsillectomy is the most common operation in children in the UK, with 37 000 procedures performed between 2016 and 2017 in the UK. 1 With such a common procedure, it is important to ensure parents and patients are correctly informed of the risks involved.Personal and departmental audit data are important, of course, but in order to produce reliable estimates of uncommon complications, very large data sets are required.National audits and registries have produced useful data based on large numbers of cases, 2-5 but they rely on surgeons completing data forms for each case, and this inevitably means that some data will be lost, particularly follow-up data on complications such as readmissions and bleeds. Studies based on routine health service data 6-8 may be more complete as long as the coding of hospital episodes is accurate.Though data exist on the risks of tonsillectomy in children, the quality of the data varies. Estimates of risk for rare events such as death rely on large amounts of data, so additional studies are always useful.The purpose of this study was to produce estimates for the most important complications of tonsillectomy in children, namely readmission to hospital, surgical arrest of haemorrhage, blood transfusion and death, based on national, routinely collected data from Scotland, in order to inform decision-making in clinical practice.

Background Tonsillectomy is one of the commonest operations in children. Routinely collected national data were used to assess variations in the paediatric tonsillectomy rate across Scotland, and to determine if socio-economic deprivation is the cause. Method The Scottish Morbidity Records were reviewed for all children (0–16 years) undergoing tonsillectomy from 2001 to 2018. Results The mean annual tonsillectomy rate was 2.64 per 1000 children. Rates in each health board area varied from 1.24 to 3.9 per 1000. Half of this variation resulted from transfers between regions. There was a 1.75-fold difference between tonsillectomy rates in the most and least deprived population quintiles, but this did not account for the geographical variation. Conclusion Half the variance in paediatric tonsillectomy rates is associated with children being transferred between regions for treatment. After accounting for this, there is a 1.5-fold difference in rate between health board areas, which is not related to socio-economic deprivation and is currently unexplained.