Incidence of indications for tonsillectomy and frequency of evidence-based surgery: A 12-year retrospective cohort study of primary care electronic records

Background Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based are known. Aim Determine the incidence of indications for tonsillectomy in UK children and the proportion of tonsillectomies meeting evidence-based criteria. Design & Setting A retrospective cohort study of electronic medical records of children aged 0-15 years registered with 739 UK general practices contributing to a research database. Method Children with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy were then identified. Among children who had undergone tonsillectomy the numbers with evidence-based and non-evidence-based indications for surgery were determined. Results We included 1,630,807 children, followed up for 7,200,159 person years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years: 13.6% (2,144/15,760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years: 11.7% (2,144/18,281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: 5 to 6 sore throats (12.4%) or 2 to 4 sore throats (44.6%) in one year; sleep disordered breathing (12.3%) or obstructive sleep apnoea (3.9%). Conclusion In the UK, few children with evidence-based indications undergo tonsillectomy and 32,500 children annually undergo tonsillectomies from which they are unlikely to benefit.