Tonsillectomy and acute throat infections in children

Abstract

Background: Tonsillectomy is among the most common operations performed on children in the UK. Yet little was known about the socio-demographic profile of children who undergo the operation and how the recent decline in tonsillectomy rates has influenced the rates of severe acute throat infections (ATI). Many children with mild ATI disease also undergo tonsillectomy despite a lack of evidence of its benefit in this group, particularly in the longer-term. The aims of this thesis were to characterise the socio-demographic profile of children who undergo tonsillectomy and investigate the clinical impact of the operation on ATI in primary and secondary care settings.

Methods: The clinical spectrum of ATI in relation to tonsillectomy was investigated using a combination of retrospective time-trend analyses and a retrospective cohort study. I analysed routine data from the Hospital Episodes Statistics and Clinical Practice Research Datalink databases to investigate secondary care and primary care settings, respectively.

Results: There was a 76% increase in ATI hospital admission rates among children between 1999/2000 and 2009/10 from 107.3 to 188.4 admissions per 100,000 children, respectively. However, the majority of these children did not stay overnight and admission rates for peritonsillar abscess (PTA) remained stable. By contrast, tonsillectomy rates fluctuated over the first three years of the study period, but declined overall from 367 to 294 per 100,000 children during the same study years. In general practice, tonsillectomy only modestly reduced the frequency of subsequent ATI consultations among children with low baseline ATI consultation rates.

Conclusions: There does not appear to be a relationship between trends in tonsillectomy operations and admissions for ATI or PTA at a population level, which suggests that clinicians should continue to restrict the operation to children who are more severely affected by ATI disease. Additionally, tonsillectomy does not appear to have a clinically significant benefit in reducing ATI consultations among children with mild ATI disease in the longer-term, which further supports reserving the operation for children with severe ATI disease.