title: Tonsillectomy is not a procedure of limited value - the unseen costs of tonsillitis and quinsy on hospital bed consumption.
abstract: OBJECTIVE
  To assess the impact of the introduction of the SIGN Clinical guidelines in 1999 and subsequent revision in 2005 on tonsillectomy, hospital admission with tonsillitis and peritonsillar abscess rates in four countries.
  
  
  METHODS
  Retrospective analysis using English, Welsh, Australian and New Zealand National healthcare hospital admission databases between 2000 and 2013. Primary outcomes measures included tonsillectomy rates and hospital admission rates for tonsillitis and peritonsillar abscess. Secondary outcome measures included bed-day usage in England and Wales. Linear forecasting was used to identify the potential impact of any trends.
  
  
  RESULTS
  Following guideline introduction for tonsillectomy, a significant decline in tonsillectomy rates in England (P < 0.01) and Wales (P < 0.05) was seen. Hospital admissions for acute tonsil infections increased in England (P < 0.01) and Wales (P < 0.01). In Australia and New Zealand, tonsillectomy and admission for tonsillitis rates both increased (P < 0.01). During this time, the increased rate of admission for tonsillitis in England and Wales was significantly greater than Australasia (P < 0.01).
  
  
  CONCLUSIONS
  Following the introduction of these Clinical guidelines, there was a decrease in the rate of tonsillectomy in England and Wales and a presumed associated increase in admissions with tonsillitis. This did not occur in Australasia where tonsillectomy rates rose over time. If these trends continue, it is likely that they will have a significant deleterious impact on healthcare spending in the future.
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: R
authors.initials: R
authors.lastname: Mcleod
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: P
authors.identifier: http://orcid.org/0000-0003-1228-5798
authors.initials: P
authors.lastname: Brahmabhatt
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: D
authors.initials: D
authors.lastname: Owens
mesh_terms: D001315:Australia / Q000453:epidemiology; D003365:Costs and Cost Analysis; D004739:England / Q000453:epidemiology; D006742:Hospital Bed Capacity / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000639:trends*; D015994:Incidence; D009520:New Zealand / Q000453:epidemiology; D000039:Peritonsillar Abscess / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D014069:Tonsillitis / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D014852:Wales / Q000453:epidemiology