This article examines Hospital Episode Statistics and Office for National Statistics data to investigate the change in rates of tonsillectomy and admissions for tonsillitis and its complications, over a 20-year period. Between 1991 and 2011, 44% fewer tonsillectomies were performed. This was accompanied by a 310% increase in admissions for tonsillitis. Admissions for retropharyngeal and parapharyngeal abscesses rose by 39% between 1996 and 2011. The trends were most pronounced in paediatric patients. It was identified that ‘Procedures of Limited Clinical Effectiveness’ guidance varies regionally by clinical commissioning group (CCG), with some adhering to Scottish Intercollegiate Guidelines Network (SIGN) guidelines, and others being more stringent. The authors rightly state that these data cannot imply causation, and are subject to some limitations in terms of accuracy. However it is likely that they represent sobering evidence of the erroneous economic and clinical logic behind surgical rationing. Whilst the authors caution that a return to historical rates of tonsillectomy is not desirable, they conclude that deliberate disregard of the evidence for the efficacy of tonsillectomy, in the pursuit of monetary savings alone, may be endangering patients.

The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991-2011.
Lau AS, Upile NS, Wilkie MD, et al.
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Thomas Jacques

Royal National Throat, Nose and Ear Hospital, London, UK.

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