title: Changing indications and socio-demographic determinants of (adeno)tonsillectomy among children in England--are they linked? A retrospective analysis of hospital data.
abstract: OBJECTIVE
  To assess whether increased awareness and diagnosis of obstructive sleep apnoea syndrome (OSAS) and national guidance on tonsillectomy for recurrent tonsillitis have influenced the socio-demographic profile of children who underwent tonsillectomy over the last decade.
  
  
  METHODS
  Retrospective time-trends study of Hospital Episodes Statistics data. We examined the age, sex and deprivation level, alongside OSAS diagnoses, among children aged <16 years who underwent (adeno)tonsillectomy in England between 2001/2 and 2011/12.
  
  
  RESULTS
  Among children aged <16 years, there were 29,697 and 27,732 (adeno)tonsillectomies performed in 2001/2 and 2011/12, respectively. The median age at (adeno)tonsillectomy decreased from 7 (IQR: 5-11) to 5 (IQR: 4-9) years over the decade. (Adeno)tonsillectomy rates among children aged 4-15 years decreased by 14% from 350 (95%CI: 346-354) in 2001/2 to 300 (95%CI: 296-303) per 100,000 children in 2011/12. However, (adeno)tonsillectomy rates among children aged <4 years increased by 58% from 135 (95%CI: 131-140) to 213 (95%CI 208-219) per 100,000 children in 2001/2 and 2011/2, respectively. OSAS diagnoses among children aged <4 years who underwent surgery increased from 18% to 39% between these study years and the proportion of children aged <4 years with OSAS from the most deprived areas increased from 5% to 12%, respectively.
  
  
  CONCLUSIONS
  (Adeno)tonsillectomy rates declined among children aged 4-15 years, which reflects national guidelines recommending the restriction of the operation to children with more severe recurrent throat infections. However, (adeno)tonsillectomy rates among pre-school children substantially increased over the past decade and one in five children undergoing the operation was aged <4 years in 2011/12.The increase in surgery rates in younger children is likely to have been driven by increased awareness and detection of OSAS, particularly among children from the most deprived areas.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Koshy
authors.affiliation: Doctor Foster Unit, Imperial College London, London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
authors.forename: Joanna
authors.initials: J
authors.lastname: Murray
authors.affiliation: Paediatric Infectious Diseases Unit, St George's Hospital NHS Trust, London, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000233:Adenoidectomy / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004739:England; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis; D014068:Tonsillectomy / Q000706:statistics & numerical data*; D014069:Tonsillitis / Q000601:surgery
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