Variations in performance of outpatient tonsillectomy in the US

Abstract

Using a 2006 National Survey of Ambulatory Surgery database and population estimates from the 2006 Census Bureau and the National Health Interview Survey, Boss et al queried geographic and demographic variations in performance of tonsillectomy in US children. More than half a million tonsillectomies were performed in outpatient settings (where >95% of such procedures currently are performed) in 2006. Seeming differences from earlier reported ages and indications for tonsillectomy were that younger children (0 through 6 years) underwent tonsillectomies more often than older children (7 through 12 years) (rates per 10 000 of 102.9 versus 91.3 versus 33.8, respectively), and obstructive symptoms alone (sleep-disordered breathing and obstructive sleep apnea) trumped infection alone (61% versus 52%) as declared indication for surgery. Rate of tonsillectomy was lower in the Western US compared with other regions, and higher in small/medium metropolitan areas compared with large central metropolitan areas. In contrast to previous reports, rates of tonsillectomy by payor group (Medicaid/State Children's Health Insurance Program compared with private insurers) were similar. In the discussion, the authors opine that children with lower socioeconomic status are likely to have higher risk for obstructive symptoms and infection, suggesting that utilization/access still may be disparate. These data provide a nationally representative baseline for subsequent studies under universal healthcare. The authors acknowledge limitations of the study appropriately and suggest that regional analyses exploring the association of otolaryngologist supply and socioeconomic variables with tonsillectomy utilization may provide additional insight into reasons for geographic and demographic variations. The findings of the report are put into perspective in the editorial by Goodman and Challener, which concludes that tonsillectomy is a procedure in search of evidence. Article page 814▶ Editorial page 716▶