Nine in 10 operations to remove children's tonsils 'unnecessary'
More than 88% of surgeries to remove children’s tonsils are unnecessary, according to new research, with experts warning the procedure could do more harm than good.
According to researchers, about 37,000 tonsillectomies were performed on children in England by the NHS between April 2016 and March 2017, carrying a bill of £42m.
However the new study, based on an analysis of more than a decade of records from a large group of GP surgeries, reveals that the vast majority of children undergoing such a procedure either on the NHS or privately did not appear to need it.
What’s more, thousands of children who would have met the requirements to have their tonsils out have not had the operation.
“If your child is very severely affected there is a modest benefit [to having the operation], but the bottom line is that even the most severely affected children don’t always have their tonsils out and they seem to grow out of [sore throats] – it doesn’t lead to any long-term problems,” said Tom Marshall, professor of public health and primary care at the University of Birmingham and a co-author of the research.
Earlier this year the NHS announced that the removal of tonsils was among a list of procedures that would be reduced in a bid to save money.
However, others say the operation offers many children and adults relief from episodes of acute tonsillitis, and that reductions in the use of the procedure have been accompanied by a rise in complications from the condition.
Writing in the British Journal of General Practice, Marshall and colleagues describe how they scoured a research database that contains anonymous electronic medical records from 739 general practices around the UK, looking at records between 2005 and 2016 for children up to 15 years old. In total, data from more than 1.6 million children was considered.
Over the course of this period, 18,281 children had their tonsils removed. However the team discovered few of the youngsters had been recorded as having clear signs that the operation was necessary.
The team deemed that the operation was evidence-based if the child had had at least one of either a tonsillar tumour, a rare condition called PFAPA, or a particular pattern of frequent, serious sore throat episodes.
Marshall said the team deliberately took a very broad view of what could indicate a sore throat episode – including counting consultations for any upper respiratory tract infection.
Even so, Marshall and colleagues found that only 2,144 out of 18,281 tonsillectomies were carried out on children who had an evidence-based need for the operation.
The team also found only 13.6% of children who could be considered for a tonsillectomy were having the operation.
Marshall said that was not such a big concern. “If you have repeated sore throats and you have your tonsils out, these children get about one fewer sore throat in the next year,” he said, adding that studies suggest sore throats simply become less frequent as children grow up.
Marshall said the operation is probably overused. “What emerges from what we found is most of the tonsillectomies that are being done in children at the moment, there isn’t really an evidence base that says they will [see a] benefit so … they are probably at risk of being harmed more than benefiting,” he said. Marshall also noted that 2–4% of children are readmitted to hospital after the operation, typically with bleeding, while about one child a year in the UK dies from the procedure.
Martin Birchall, professor of laryngology at University College London who was not involved in the study, said the research had limitations. “For example, the data misses the majority of episodes that occur either at home, with no GP contact, or present to emergency centres,” he said.
Prof Nirmal Kumar and Prof Carl Philpott of ENT UK said surgeons base their decision on whether to offer a tonsillectomy to a child on a number of sources, including a referral letter from the child’s GP and a careful discussion of the child’s history with the parents.
They say there is good evidence that the operation can help sleep apnoea and sleep-breathing problems, while a drop in tonsillectomies since 2011, after a change to guidelines, has been followed by an increase in the rate of admissions of patients with various complications of acute tonsillitis.