Is $11m wasted on ton­sil surgery?

Taranaki Daily News - - National News - De­brin Fox­croft de­brin.fox­croft@stuff.co.nz

Other coun­tries are look­ing at ditch­ing ton­sil surgery, while New Zealand spends an av­er­age $11.5 mil­lion on the med­i­cal pro­ce­dure ev­ery year.

Re­search pub­lished this month in the British Jour­nal of Gen­eral Prac­tice has found seven in ev­ery eight chil­dren who have their ton­sils out were un­likely to ben­e­fit from the op­er­a­tion.

This fol­lowed an an­nounce­ment from the Na­tional Health Ser­vice in the United King­dom that listed the throat surgery as one of 17 rou­tine pro­ce­dures deemed ‘‘in­ef­fec­tive or risky’’, ac­cord­ing to re­ports in the BBC and The Guardian.

How­ever, As­so­ciate Pro­fes­sor Pa­trick Dawes, an ear, nose and throat spe­cial­ist at the Univer­sity of Otago’s Depart­ment of Sur­gi­cal Sciences, said a sim­i­lar shift was un­likely here.

‘‘I don’t think you can nec­es­sar­ily make the com­par­i­son in terms of the pop­u­la­tions and clin­i­cal ap­proach.’’

In New Zealand, both adults and chil­dren had rel­a­tively high bars to cross be­fore surgery is an op­tion, he said.

‘‘One is that they meet the HealthPath­ways guide­lines. The pa­tient has to meet those guide­lines and then have to score suf­fi­cient points on the na­tional pri­ori­ti­sa­tion scheme to cross the thresh­old for surgery,’’ Dawes said.

HealthPath­ways are a map or guide­line for pro­fes­sion­als to fol­low in man­ag­ing med­i­cal con­di­tions.

Over the past decade, in­ter­na­tional pol­icy and aca­demic de­bate has raged over the short and long-term ef­fec­tive­ness of ton­sil­lec­tomy surgery.

How­ever fig­ures re­leased by the Min­istry of Health un­der the Of­fi­cial In­for­ma­tion Act show a con­sis­tent num­ber of such surg­eries in New Zealand.

In 2012/2013 there were 4165 hos­pi­tal dis­charges list­ing ton­sil­lec­tomy and/or ade­noidec­tomy as the pri­mary rea­son for the hos­pi­tal stay.

Five years later, in 2016/2017, this num­ber was 3923. On av­er­age $11.5m was spent on the pro­ce­dures each year.

Ac­cord­ing to data pub­lished by the Health Qual­ity and Safety Com­mis­sion in New Zealand, four in ev­ery 1000 Kiwi chil­dren will have a ton­sil­lec­tomy.

While the surgery re­lieved symp­toms re­lated to ton­sili­tis, a grow­ing body of lit­er­a­ture pointed to is­sues later in life.

In the June, 2018, is­sue of Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion, Oto­laryn­gol­ogy – Head and Neck Surgery, re­searchers pub­lished a study that con­cluded that hav­ing ton­sils out as a child made a per­son three times more likely to suf­fer from com­mon colds and res­pi­ra­tory in­fec­tions.

Peo­ple with­out their ton­sils were also found to have a greater sus­cep­ti­bil­ity to par­a­sitic in­fec­tions, skin ail­ments and eye com­plaints, ac­cord­ing to the re­searchers.

The study was based on health records from 1.2 mil­lion Dan­ish chil­dren be­tween 1979 and 1999, of which 60,400 had a ton­sil­lec­tomy, ade­noidec­tomy or both.

The Min­istry of Health was con­tacted for a com­ment on the fu­ture of ton­sil­lec­tomies in New Zealand.

A spokesper­son said it was up to pro­fes­sional clin­i­cal col­leges and as­so­ci­a­tions to over­see the train­ing and pro­fes­sional devel­op­ment of sur­geons.

It did not reply to ques­tions on whether there would be any change to pub­lic fund­ing of ton­sil­lec­tomies in light of re­cent re­search or in­ter­na­tional tends.

‘‘The pa­tient has to meet those guide­lines and then have to score suf­fi­cient points on the na­tional pri­ori­ti­sa­tion scheme to cross the thresh­old for surgery.’’

Ear, nose and throat spe­cial­ist Pa­trick Dawes

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