Tonsillectomy a waste of time?
New research study today reports that 7 out of 8 children having tonsillectomy are unlikely to benefit from surgery, based on a large study of GP databases. However, they seem to have forgotten about sleep apnoea to a large extent.
The authors talk about tonsillectomy for recurrent tonsillitis, but do not see tonsillectomy for sleep apnoea as being evidence based. However, there is a large amount of data showing the beneficial effect of treating OSA in children, and even CCGs fund it (assuming certain criteria are met)!
At my unit, the vast majority of tonsillectomies are done for OSA, not tonsillitis; yet in this paper only 16.2% were for OSA. I don't understand why there is such a difference, it doesn't make sense.
It's a shame that I could only read the abstract (summary). Paper is not open access, and access is not available via my University institutional access either. Shame that we cannot see the full paper and subject it to full scientific scrutiny.
I quite agree we should follow guidelines and evidence. I'm sure that some people don't, and that needs to be improved. However, if one is looking for evidence-based practice, then evidence should be the starting point (tonsillectomy does benefit OSA, and OSA is the main indication for surgery in many hospitals).
I hope that papers like this won't be used to deny surgery to those that need it in the future. We have to be careful to apply research to the population it is relevant to; this research doesn't seem to be relevant to the patients that I serve. I hope this won't be used to further support rationing disguised as evidence; let's make sure that we tell the patients the truth, whatever the truth is!