Pediatric adenotonsillectomy and postoperative hemorrhage: Demographic and geographic variation in the US

A nationwide registry‐based cohort study of incidence of tonsillectomy in Denmark, 1991‐2012

“…Mueller et al also found that the highest incidence of surgery was in children 3‐4 years old. These findings are consistent with our and previous results . An American study showed a similar gender distribution with a mean age of 6 years for ambulatory and in‐patients …”

“…In 1980, a substantial regional variation regarding the incidence of adenoidectomy in Denmark was identified; we found that this geographical variance was also present concerning tonsillectomy incidence rates decades later. Such geographical variance has been identified in other studies . The explanation is not clarified, but the authors expect it to be multifactorial.…”

“…We identified a highly significant change in the setting in which tonsillectomies were performed, that is 26.6% of tonsillectomies in 2012 were performed in private ORL offices compared to 5.5% in 1991. One reason might be that studies have verified that the procedure can be performed safely in private ORL offices . Another reason could be an increasing incidence of tonsillotomy in private ORL offices, as this procedure has less risk of bleeding and is likely less painful, compared to tonsillectomy …”

“…This likely explains why most children are 3 years and older. The procedure has also proven safer for this age group regarding risk of postoperative dehydration . Also, the hyperplasia of tonsils and adenoids might peak around that age, but a decrease in tonsillectomy due to infections has been reported .…”

“…One hypothesis could be that they worry about bad breath, but gender differences in number of tonsillitis episodes could also explain the difference. However, the indication for the surgery should be carefully considered, as patients above the age of 11 years have the highest incidence of postoperative haemorrhage …”