A 20 year observational cohort of a 5 million patient population - tonsillectomy rates in the context of two national policy changes

Douglas, C M and Altmyer, U and Cottom, L and Young, D and Redding, P and Clark, L J (2018) A 20 year observational cohort of a 5 million patient population - tonsillectomy rates in the context of two national policy changes. Clinical Otolaryngology. ISSN 1749-4478

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    Abstract

    AIM: To report national trends for tonsillectomy, tonsillitis, peri-tonsillar abscess and deep neck space infection in secondary care. To report national trends in sore throat consultations in primary care. To report national trends in antibiotic prescribing in both primary and secondary care between 2011 and 2015. DESIGN: Retrospective nationwide cohort study. Data requested from Information Statistics Department (ISD) Scotland for tonsillectomy, tonsillitis admissions, peri-tonsillar abscess admissions and deep neck space infection (DNSI) admissions in Scotland, between 1993/94 and 2015/16. Data for antibiotic prescriptions in general practice and hospital admissions between 2011 - 2015. SETTING: Scottish ENT departments and GP practices. PARTICIPANTS: Scottish patients who underwent tonsillectomy, or were admitted to hospital with tonsillitis, peritonsillar abscess or deep neck space infection. Scottish patients that attended their GP with tonsillitis. RESULTS: Tonsillectomy rates between 1993/94 and 2015/16 decreased by 48% (p<0.001). Over the same time period there has been a corresponding 136% increase in tonsillitis admission(p<0.001) and a 167% increase in peri-tonsillar abscess admissions, (p<0.001). Between 1996/97 and 2015/16 there was a 500% increase in deep neck space abscesses (p<0.001). CONCLUSION: There has been a significant decrease in tonsillectomy rates over the past two decades. Over the same time period there has been a significant increase in admissions to secondary care with tonsillitis, peri-tonsillar abscess and deep neck space infection. These changes have happened in the context of two separate national policies being introduced - SIGN guidelines for management of sore throat and the Scottish Reduction in Antibiotic Prescribing.