Objective: To assess whether increased awareness and diagnosis of obstructive sleep apnoea syndrome (OSAS) and
national guidance on tonsillectomy for recurrent tonsillitis have influenced the socio-demographic profile of children who
underwent tonsillectomy over the last decade.
Method: Retrospective time-trends study of Hospital Episodes Statistics data. We examined the age, sex and deprivation
level, alongside OSAS diagnoses, among children aged ,16 years who underwent (adeno)tonsillectomy in England
between 2001/2 and 2011/12.
Results: Among children aged ,16 years, there were 29,697 and 27,732 (adeno)tonsillectomies performed in 2001/2 and
2011/12, respectively. The median age at (adeno)tonsillectomy decreased from 7 (IQR: 5–11) to 5 (IQR: 4–9) years over the
decade. (Adeno)tonsillectomy rates among children aged 4–15 years decreased by 14% from 350 (95%CI: 346–354) in 2001/
2 to 300 (95%CI: 296–303) per 100,000 children in 2011/12. However, (adeno)tonsillectomy rates among children aged ,4
years increased by 58% from 135 (95%CI: 131–140) to 213 (95%CI 208–219) per 100,000 children in 2001/2 and 2011/2,
respectively. OSAS diagnoses among children aged ,4 years who underwent surgery increased from 18% to 39% between
these study years and the proportion of children aged ,4 years with OSAS from the most deprived areas increased from 5%
to 12%, respectively.
Conclusions: (Adeno)tonsillectomy rates declined among children aged 4–15 years, which reflects national guidelines
recommending the restriction of the operation to children with more severe recurrent throat infections. However,
(adeno)tonsillectomy rates among pre-school children substantially increased over the past decade and one in five children
undergoing the operation was aged ,4 years in 2011/12.The increase in surgery rates in younger children is likely to have
been driven by increased awareness and detection of OSAS, particularly among children from the most deprived areas