Every year, hundreds of children in the United Kingdom undergo surgery they do not need.
This is the conclusion of a study recently published in the British Journal of General Practice, conducted by a group of researchers from the University of Birmingham. The study found that between 2005 and 2016, 88.3% of children who received tonsillectomies in the UK did not reach the medical threshold for the procedure, and are unlikely to benefit from it.
Tonsillectomies are not risk-free
Under the medical guidelines known as the criteria of paradise, the American Academy of Otolaryngology and other important medical associations recommend that children receive only tonsillectomies if they suffer from at least seven sore throats in the previous year, at least five of throat in the last two years, or at least three sore throats in each of the previous three years. But most of the childhood tonsillectomies in the UK in recent years have been performed on children who have not met these criteria.
The researchers at the University of Birmingham came to this conclusion after analyzing the medical records of over 1.6 million children from over 700 British general practices in the country's health improvement network (THIN) among 2005 and 2016. Of 18,271 children who removed tonsils during that period, only 2,144 (11.7%) had enough sore throat to justify surgery.
This is worrying because, although tonsillectomies for children are on the agenda, surgery involves risks of complications. According to a case study of Canadian health care data used by Birmingham researchers, 2.7% of children receiving tonsillectomies are readmitted within 30 days and 12.4% go to an emergency room. A review of 2014 a Pediatrics showed that 7.8% of children who undergo tonsillectomy in the United States end up in the hospital again with complications within 30 days. And another study showed that the most common causes of readmission were excessive bleeding, acute pain, fever, vomiting, and dehydration.
Even when children qualify for the procedure, parents may want to consider a "watchful waiting" strategy, according to Nicholas Balakar in the New York Times. This is because while tonsillectomy may be useful for children who are severely affected, a recent study of over 60,000 Danish children has shown that the procedure is associated with a much higher risk of diseases of the upper respiratory tract.
The risks of unnecessary surgery for children
Tragic but uncommon cases, such as the death of 13-year-old Jahi McMath following a tonsillectomy in 2013, have highlighted the importance of ensuring that children go through the surgical interventions they actually need. According to Pacific Standard Magazine, "Every year in America, thousands of children die from questionable medical interventions and poor follow-up."
Even unnecessary surgical procedures represent a burden on public health systems: in the United Kingdom, for example, the National Health Service (NHS) performed about 37,000 tonsillectomies for children from April 2016 to March 2017, at a cost of £ 42 million. .
An analysis of the Birmingham National Health Service considered it accurate, but made it clear that digital medical records do not always reflect the reasons why a tonsillectomy is recommended, which means there may be other reasons for which doctors have chosen to go ahead with a specific case intervention.
Tom Marshall, author of a study and professor of public health at the University of Birmingham, states that his team is more likely to overestimate rather than underestimate the number of sore throats that children have suffered prior to surgery. surgery, since they used a broad definition of what constituted a tonsillitis, or sore throat caused by infected tonsils. However, even after conducting the analysis with a more rigid definition of sore throat, the researchers found that it was "still true that the vast majority of children with frequent sore throats did not remove their tonsils", according to Marshall.
The Birmingham researchers also noted that, among the children of the United Kingdom, who done meeting the criteria for tonsillectomies and had seven or more sore throats within a year, only 14% actually received surgery. Marshall says that this led him to wonder if "children could be more damaged than helped by a tonsillectomy".
"We found that even among severely affected children, only a small minority of all time have their tonsils," he said. "You wonder if tonsillectomy [is] never really essential in every child. "