Trends in tonsillectomy surgery in children in Scotland 2000‐2018

Abstract

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.

Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

“…Erickson et al further characterized this shift [15] noting 12% of patients underwent tonsillectomy for obstructive symptoms in 1970, increasing to 77% in 2005. Despite this observation, indications for tonsillectomy remain fraught with challenges as there can be marked practice variation at local, regional and international levels [1,16,17].…”

“…Obstructive sleep apnea in children has a reported incidence of up to 5.7% in childhood [16,18,19] and in obese children, the prevalence rises to 60% [20]. This is a spectrum of disease ranging from primary snoring, upper airway resistance syndrome, to OSA.…”

“…Adenotonsillectomy, the removal of the adenoids and tonsils, is the primary treatment for pediatric OSA [13,[28][29][30]. It is difficult to only assess children who undergo tonsillectomy, without adenoidectomy, as the literature often does not distinguish between adenotonsillectomy and tonsillectomy alone [6,12,[14][15][16]. There is little evidence to support adenoidectomy for treatment of recurrent tonsil infections [14]; however, for obstructive symptoms, tonsillectomy or adenotonsillectomy are often discussed interchangeably [14][15][16].…”

“…It is difficult to only assess children who undergo tonsillectomy, without adenoidectomy, as the literature often does not distinguish between adenotonsillectomy and tonsillectomy alone [6,12,[14][15][16]. There is little evidence to support adenoidectomy for treatment of recurrent tonsil infections [14]; however, for obstructive symptoms, tonsillectomy or adenotonsillectomy are often discussed interchangeably [14][15][16]. As discussed above, the surgical indications for tonsillectomy have shifted from infections to obstructive symptoms over the last several decades.…”

The changing face of tonsillectomy

“…In the first, Kubba and Downie 1 analysed routinely collected data from all 14 Scottish health boards, to determine trends on number of procedures performed in children, their ages and type of hospital. Between 2000 and 2018, the number of tonsillectomies per year remained constant, despite a falling population.…”