3.1 Tonsillectomy hospitalisations, 17 years and under

Tonsillectomy is the surgical removal of a person’s tonsils. It is one of the most common surgeries done in children in Australia.

Tonsillectomy is used to treat infections of the tonsils and throat that keep coming back (tonsillitis). Increasingly, it is also used to treat a breathing condition called obstructive sleep apnoea (OSA).

It is not clear if children with these conditions always benefit from surgery, or whether they would get better without surgery.

In 2017–18:

• There were 42,509 hospitalisations for tonsillectomy, representing 750 hospitalisations per 100,000 people aged 17 years and under (the Australian rate)
• The number of hospitalisations for tonsillectomy across 320 local areas ranged from 305 to 1,836 per 100,000 people
• The rate was 6.0 times as high in the area with the highest rate compared with the area with the lowest rate
• Rates for tonsillectomy hospitalisations were higher in inner regional areas than outer regional areas, major cities and remote areas
• There was no clear pattern according to socioeconomic status in major cities and inner regional areas. In outer regional areas, rates were higher in areas of socioeconomic disadvantage. In remote areas, rates were lower in areas of socioeconomic disadvantage
• The rate for Aboriginal and Torres Strait Islander children (620 per 100,000 people) was 18% lower than the rate for other Australians (759 per 100,000 people)
• 60% of tonsillectomy hospitalisations were for privately funded patients.

Between 2012–13 and 2017–18:

• The rate of hospitalisation for tonsillectomy nationally increased by 3%
• For Aboriginal and Torres Strait Islander children, the rate of tonsillectomy hospitalisation nationally increased by 58%.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of tonsillectomy is likely to be due to differences in:

• Rates of underlying disease – rates of sore throat and rates of snoring and other symptoms that suggest obstructive sleep problems may be higher in areas of severe socioeconomic disadvantage
• Clinical decision-making – there are no current Australian evidence-based guidelines for tonsillectomy in children. Differences in diagnosing OSA may also contribute to variation
• Affordability – people in areas of socioeconomic disadvantage may not be able to pay out-of-pocket costs
• Access to services – some people may need to travel a long way to see a specialist, so they may have surgery to avoid them having to come back again. Improved access to ENT surgeons through outreach programs may have contributed to the increase in tonsillectomy rates for Aboriginal and Torres Strait Islander children between 2012-13 and 2017-18.
• Rates of private health insurance and waiting times – access to a hospital bed is likely to be one of the biggest influence on variation in care
• Parents’ preferences – consumers’ understanding of the medical conditions and how symptoms may change over time may affect rates.  Consumer understanding of options for treatment, and risks and benefits of surgery, may also affect variation.

Further develop the ear, nose and throat data registry of the Australian Society of Otolaryngology Head and Neck Surgery. This could help to:

• Capture information on eligible patients
• Provide information for effective peer review of tonsillectomy
• Add to the knowledge base about outcomes for specific patient groups.

Update clinical guidelines.

Encourage shared decision making.

Provide information to parents about the risks and benefits of surgery, and the opportunity to discuss them.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

3a. The Australian and New Zealand Society of Paediatric Otorhinolaryngology to work with relevant clinical colleges to develop clinical guidelines on tonsillectomy in children, and subsequent to this the Commission to develop a clinical care standard with safety and quality indicators.

3b. Health service organisations to:



i. Conduct audits of indications for tonsillectomy and tonsillectomy rates to monitor variation and provide the results back to clinicians to act upon in line with Action 1.28 of the National Safety and Quality Health Service (NSQHS) Standards. 



ii. Incorporate individual clinicians’ audit data as part of re-credentialing processes. 

Download the tonsillectomy hospitalisations, 17 years and under section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• Recurrent tonsillitis
• Obstructive sleep apnoea
• Potential harms of tonsillectomy
• Why revisit variation in tonsillectomy?

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Analysis by patient funding status
• Trends over time

Interpretation

• Rates of underlying disease
• Clinical decision-making
• Access to tonsillectomy services
• Rates of private health insurance and waiting times
• Parents’ preferences

Addressing variation

• Improve evidence base, and access to diagnosis and appropriate treatment
• Improve data about access
• Improve shared decision making

Resources

• Resources for GPs

Australian initiatives

• ENT surgical registry
• Shared decision-making resources
• HealthPathways
• Paediatric sleep unit in Darwin

References