ORIGINAL ARTICLE

An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010-2015: Changing indications and lack of effect of hospital volume on inter-hospital transfers

Aimy H.L. Tran

orcid.org/0000-0002-7240-3867

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

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Rosemary S.C. Horne,

Rosemary S.C. Horne

orcid.org/0000-0003-3575-0461

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

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Danny Liew,

Danny Liew

orcid.org/0000-0002-0131-623X

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Joanne Rimmer,

Joanne Rimmer

Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia

Department of Surgery, Monash University, Melbourne, Victoria, Australia

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Gillian M. Nixon,

Corresponding Author

Gillian M. Nixon

[email protected]

orcid.org/0000-0003-4944-7754

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia

Correspondence

Gillian M. Nixon, Melbourne Children’s Sleep Centre, Monash Children’s Hospital, 246 Clayton Road, Melbourne, Vic. 3168, Australia.

Email: [email protected]

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Aimy H.L. Tran,

Aimy H.L. Tran

orcid.org/0000-0002-7240-3867

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

Search for more papers by this author

Rosemary S.C. Horne,

Rosemary S.C. Horne

orcid.org/0000-0003-3575-0461

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

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Danny Liew,

Danny Liew

orcid.org/0000-0002-0131-623X

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Joanne Rimmer,

Joanne Rimmer

Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia

Department of Surgery, Monash University, Melbourne, Victoria, Australia

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Gillian M. Nixon,

Corresponding Author

Gillian M. Nixon

[email protected]

orcid.org/0000-0003-4944-7754

The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Victoria, Australia

Correspondence

Gillian M. Nixon, Melbourne Children’s Sleep Centre, Monash Children’s Hospital, 246 Clayton Road, Melbourne, Vic. 3168, Australia.

Email: [email protected]

Search for more papers by this author

First published: 20 September 2019

https://doi.org/10.1111/coa.13436

Citations: 7

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Abstract

Objective

To describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence rate over 2010-2015 and investigate factors associated with inter-hospital transfer.

Design

Retrospective population-based study.

Setting

Multicentre study in the state of Victoria, Australia.

Participants

From the Victorian Admitted Episodes Dataset, which included all patients aged 0-19 years who underwent adenoidectomy and/or tonsillectomy in Victoria, Australia between 2010 and 2015.

Main Outcome Measures

Annual incidence rate, hospital volume, inter-hospital transfer.

Results

Between 2010 and 2015, 59 008 patients underwent 61 281 procedures, with highest number performed in males (52.7%), children aged under 10 years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4 and 23.2% in quintile 5). Seventy-five cases (0.12%) resulted in inter-hospital transfer, which was significantly associated with young age (under 5 years). More than a third of hospitals (35.7%) performed an average rate of <1 procedure per week. Hospital volume was not associated with risk of inter-hospital transfer. The incidence rate of adenotonsillectomy procedures significantly increased over the study period (P < .001), driven by a significant increase in the rate of surgery performed for obstructive symptoms (P < .001).

Conclusions

The rate of adenoidectomy/tonsillectomy procedures is rising, with a higher proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given the literature supporting higher rates of obstructive sleep-disordered breathing and sore throat in lower socioeconomic groups. A third of hospitals performed small numbers of procedures, but we found no association between hospital volume and inter-hospital transfers.

CONFLICT OF INTEREST

None to declare.

Open Research

DATA AVAILABILITY STATEMENT

Research data are not shared due to legal restrictions.

Supporting Information

REFERENCES

1Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019; 160: S1-S42.
10.1177/0194599818801757
PubMed Web of Science® Google Scholar
2Marcus CL, Brooks LJ, Ward SD, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130(3): e714-e755.
10.1542/peds.2012-1672
PubMed Web of Science® Google Scholar
3 Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017; 389(10083): 2005-2030.
10.1016/S0140-6736(17)30873-5
PubMed Web of Science® Google Scholar
4Boss EF, Marsteller JA, Simon AE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr. 2012; 160(5): 814-819.
10.1016/j.jpeds.2011.11.041
PubMed Web of Science® Google Scholar
5Croxford R, Friedberg J, Coyte PC. Socio-economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996–2000. Acta Paediatr. 2004; 93(9): 1245-1250.
10.1111/j.1651-2227.2004.tb02757.x
CAS PubMed Web of Science® Google Scholar
6Juul ML, Rasmussen ER, Rasmussen S, Sorensen CH, Howitz MF. A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991–2012. Clin Otolaryngol. 2018; 43(1): 274-284.
10.1111/coa.12959
PubMed Web of Science® Google Scholar
7Thomas K, Boeger D, Buentzel J, et al. Pediatric adenoidectomy: a population-based regional study on epidemiology and outcome. Int J Pediatr Otorhinolaryngol. 2013; 77(10): 1716-1720.
10.1016/j.ijporl.2013.07.032
PubMed Web of Science® Google Scholar
8Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Population-based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997–2012. Int J Pediatr Otorhinolaryngol. 2018; 108: 55-62.
10.1016/j.ijporl.2018.02.021
PubMed Web of Science® Google Scholar
9Douglas-Jones P, Fagan JJ. Tonsillectomy rates in the South African private healthcare sector. S Afr Med J. 2016; 106(11): 1134-1140.
10.7196/SAMJ.2016.v106i11.10842
CAS PubMed Google Scholar
10Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O. Pediatric adenoid surgery in Sweden 2004–2013: Incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol. 2016; 87: 61-66.
10.1016/j.ijporl.2016.05.020
PubMed Web of Science® Google Scholar
11 Department of Health and Human Services. Victorian Admitted Episodes Dataset (VAED) manual – 28th edition 2018–19. Melbourne, Vic.: DHHS; 2018.
Google Scholar
12 Australian Bureau of Statistics. 3101.0 – Australian Demographic Statistics, Jun 2015. http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3101.0Jun%202015?OpenDocument. Accessed January 10, 2019.
Google Scholar
13Pink B. Socio-Economic Indexes for Areas (SEIFA) 2011 technical paper. Canberra, ACT: Australian Bureau of Statistics; 2013. Contract No.: 2033.0.55.001.
Google Scholar
14Falagas ME, Mourtzoukou EG, Vardakas KZ. Sex differences in the incidence and severity of respiratory tract infections. Respir Med. 2007; 101(9): 1845-1863.
10.1016/j.rmed.2007.04.011
PubMed Web of Science® Google Scholar
15Schuez-Havupalo L, Toivonen L, Karppinen S, Kaljonen A, Peltola V. Daycare attendance and respiratory tract infections: a prospective birth cohort study. BMJ open. 2017; 7(9):e014635.
10.1136/bmjopen-2016-014635
PubMed Web of Science® Google Scholar
16Katz ES, D'Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5(2): 253-262.
10.1513/pats.200707-111MG
PubMed Google Scholar
17Spilsbury JC, Storfer-Isser A, Kirchner HL, et al. Neighborhood disadvantage as a risk factor for pediatric obstructive sleep apnea. J Pediatr. 2006; 149(3): 342-347.
10.1016/j.jpeds.2006.04.061
PubMed Web of Science® Google Scholar
18Factor SH, Levine OS, Harrison LH, et al. Risk factors for pediatric invasive group A streptococcal disease. Emerg Infect Dis. 2005; 11(7): 1062-1066.
10.3201/eid1107.040900
PubMed Web of Science® Google Scholar
19Glover JA. The incidence of tonsillectomy in school children. Proc R Soc Med. 1938; 31(10): 1219-1236.
CAS PubMed Google Scholar
20 Department of Health. On the State of the Public Health: Annual report of the Chief Medical Officer; 2005. https://webarchive.nationalarchives.gov.uk/20130105045527http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4137367.pdf. Accessed January 15, 2019.
Google Scholar
21Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970–2005. Otolaryngol Head Neck Surg. 2009; 140(6): 894-901.
10.1016/j.otohns.2009.01.044
PubMed Web of Science® Google Scholar
22 Paediatrics & Child Health Division of The Royal Australiasian College of Physicians, The Australian Society of Otolaryngology – Head and Neck Surgery. Indications for tonsillectomy and adenotonsillectomy in children. Sydney, Vic.: Royal Australasian College of Physicians and Australian Society of Otolaryngology Head and Neck Surgery; 2008.
Google Scholar
23Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984; 310(11): 674-683.
10.1056/NEJM198403153101102
CAS PubMed Web of Science® Google Scholar
24Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: characteristics and outcomes. J Hosp Med. 2016; 11(4): 245-250.
10.1002/jhm.2515
PubMed Web of Science® Google Scholar
25Belyea J, Chang Y, Rigby MH, Corsten G, Hong P. Post-tonsillectomy complications in children less than three years of age: a case-control study. Int J Pediatr Otorhinolaryngol. 2014; 78(5): 871-874.
10.1016/j.ijporl.2014.02.029
PubMed Web of Science® Google Scholar
26Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002; 137(6): 511-520.
10.7326/0003-4819-137-6-200209170-00012
PubMed Web of Science® Google Scholar
27Hernandez-Meza G, McKee S, Carlton D, Yang A, Govindaraj S, Iloreta A. Association of surgical and hospital volume and patient characteristics with 30-day readmission rates. JAMA Otolaryngol Head Neck Surg. 2019; 145(4): 328-337.
10.1001/jamaoto.2018.4504
PubMed Web of Science® Google Scholar

Citing Literature

Volume44, Issue6

November 2019

Pages 1037-1044

An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010-2015: Changing indications and lack of effect of hospital volume on inter-hospital transfers

Abstract

Objective

Design

Setting

Participants

Main Outcome Measures

Results

Conclusions

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Information

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An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010-2015: Changing indications and lack of effect of hospital volume on inter-hospital transfers

Abstract

Objective

Design

Setting

Participants

Main Outcome Measures

Results

Conclusions

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Related

Information