Abstract
Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation. This paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected. Twenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications. No evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.
Highlights
Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years
An adenotonsillectomy was considered a cure for a variety of disorders early in the twentieth century, such as anorexia, rheumatism, nephritis, mental retardation and enuresis.[18]
Children were 28% more likely to have tonsils removed if living in a rural location, compared to city Procedure numbers dropped over 25.0% between 1995 & 1999 among children, but significant regional variation existed in all years Compared with the South, paediatric tonsillectomy rates were lower in the was 11.7 (East) vs 3.3 (West) (29 vs 125 per 10 000 children)
Summary
Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years These procedures were the first for which Glover discovered large practice variation, in 1938, that could not be explained by differences in patients’ needs.[1] this variation was possibly driven by differences in physicians’ beliefs about the effectiveness of surgery and the lack of high-quality evidence on indications for surgery.[1] Glover’s report is considered the foundation of research on practice variation. These procedures were the first for which unwarranted regional variation was discovered, in 1938. International efforts are needed to reconsider why we are still unable to tackle this variation
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