This retrospective study sought to determine the effect of reduced rates of tonsillectomy in England and Wales, over a 13-year period, on rate of hospital admissions for the complications of acute tonsil infection (acute tonsillitis and quinsy), and hospital bed-day usage. The reduction in rate of tonsillectomy in England and Wales was postulated to be due to the introduction of the SIGN tonsillectomy guidelines in 1999, and the adoption of tonsillectomy as a procedure of limited clinical effectiveness (PoLCE) in 2005 by Primary Care Trusts. The England and Wales results were compared to those in Australasia, where PoLCE policies have not been introduced. Following the introduction of the SIGN guidelines, there was a significant reduction in the rate of tonsillectomy in England and Wales, whilst in Australasia, they increased over the same time period. The rates of tonsillitis were greater in England and Wales when compared to Australasia. There was no significant change in rates of quinsy. Bed-day usage reduced dramatically for tonsillectomy (96% England, 61% Wales), with large increases in bed-day use for tonsillitis (175% England, 80% Wales). The healthcare economics of this were briefly mentioned in the study, but a more in-depth evaluation would be very useful in determining the impact of these policies.

Tonsillectomy is not a procedure of limited value – the unseen costs of tonsillitis and quinsy on hospital bed consumption.
Mcleod R, Brahmabhatt P, Owens D.
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Serge Latis

Liverpool Hospital, Sydney, NSW, Australia.

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