An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010-2015: Changing indications and lack of effect of hospital volume on inter-hospital transfers.

Abstract

To describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence rate over 2010-2015 and investigate factors associated with inter-hospital transfer. Retrospective population-based study. Multicentre study in the state of Victoria, Australia. From the Victorian Admitted Episodes Dataset, which included all patients aged 0-19years who underwent adenoidectomy and/or tonsillectomy in Victoria, Australia between 2010 and 2015. Annual incidence rate, hospital volume, inter-hospital transfer. Between 2010 and 2015, 59008 patients underwent 61281 procedures, with highest number performed in males (52.7%), children aged under 10years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4 and 23.2% in quintile 5). Seventy-five cases (0.12%) resulted in inter-hospital transfer, which was significantly associated with young age (under 5years). More than a third of hospitals (35.7%) performed an average rate of <1 procedure per week. Hospital volume was not associated with risk of inter-hospital transfer. The incidence rate of adenotonsillectomy procedures significantly increased over the study period (P<.001), driven by a significant increase in the rate of surgery performed for obstructive symptoms (P<.001). The rate of adenoidectomy/tonsillectomy procedures is rising, with a higher proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given the literature supporting higher rates of obstructive sleep-disordered breathing and sore throat in lower socioeconomic groups. A third of hospitals performed small numbers of procedures, but we found no association between hospital volume and inter-hospital transfers.