title: Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study.
abstract: OBJECTIVE
  To investigate the effectiveness of tonsillectomy in reducing acute throat infection (ATI) consultation rates over 6 years' follow-up among children with low baseline ATI consultation rates.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  UK general practices from the Clinical Practice Research Datalink.
  
  
  METHODS
  Children aged 4-15 years with ≤3 ATI consultations during the 3 years prior to 2001 (baseline). 450 children who underwent tonsillectomy (tonsillectomy group) and 13 442 other children with an ATI consultation (comparison group) in 2001.
  
  
  METHODS
  Mean differences in ATI consultation rates over the first 3 years' and subsequent 3 years' follow-up compared with 3 years prior to 2001 (baseline); odds of ≥3 ATI consultations at the same time points.
  
  
  RESULTS
  Among children in the tonsillectomy group, the 3-year mean ATI consultation rate decreased from 1.31 to 0.66 over the first 3 years' follow-up and further declined to 0.60 over the subsequent 3 years' follow-up period. Compared with children who had no operation, those who underwent tonsillectomy experienced a reduction in 3-year mean ATI consultations per child of 2.5 (95% CI 2.3 to 2.6, p<0.001) over the first 3 years' follow-up, but only 1.2 (95% CI 1.0 to 1.4, p<0.001) over the subsequent 3 years' follow-up compared with baseline, respectively. This equates to a mean reduction of 3.7 ATI consultations over a 6-year period and approximates to a mean annual reduction of 0.6 ATI consultations per child, per year, over 6 years' follow-up. Children who underwent tonsillectomy were also much less likely to experience ≥3 ATI consultations during the first 3 years' follow-up (adjusted OR=0.12, 95% CI 0.08 to 0.17) and the subsequent 3 years' follow-up (adjusted OR=0.24, 95% CI 0.14 to 0.41).
  
  
  CONCLUSIONS
  Among children with low baseline ATI rates, there was a statistically significant reduction in ATI consultation rates over 6 years' follow-up. However, the relatively modest clinical benefit needs to be weighed against the potential risks and complications associated with surgery.
authors: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors: Elizabeth
authors: E
authors: Koshy
authors: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors: Hilary
authors: H
authors: Watt
authors: Department of Primary Care and Public Health Sciences, Kings College London, London, UK.
authors: Vasa
authors: V
authors: Curcin
authors: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors: Alex
authors: A
authors: Bottle
authors: Paediatric Infectious Diseases Research Group, St George's University London, London, UK.
authors: Mike
authors: M
authors: Sharland
authors: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors: Sonia
authors: S
authors: Saxena
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010612:Pharyngitis / Q000453:epidemiology / Q000601:surgery*; D010614:Pharynx / Q000473:pathology*; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D014068:Tonsillectomy; D006113:United Kingdom
keywords: PRIMARY CARE
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