Increased rates of ENT surgery among young children: have clinical guidelines made a difference?
OBJECTIVE
To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery.


METHODS
Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15.


RESULTS
ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%.


CONCLUSIONS
The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare.
Centre for Health Informatics, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
M I
MI
Rob
J I
JI
Westbrook
R
R
Taylor
R l
Rl
Rushworth
D000233:Adenoidectomy / Q000592:standards / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000453:epidemiology / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014068:Tonsillectomy / Q000592:standards / Q000706:statistics & numerical data*