National results of tonsillectomy safety published – Paediatric tonsillectomy in England: A cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008-2019)

Approximately 30,000 paediatric tonsillectomy procedures are conducted in England each year. There are several methods and techniques in use.  Staff from NMPCE have collaborated with clinical coding within NuTH, NHS Digital, ENTUK, the British Association for Paediatric Otolaryngology and surgeons across England to investigate the safety of tonsillectomy in children.

The recently published analysis (doi:10.1111/coa.13707) of Hospital Episode Statistics (HES) is the largest study of paediatric tonsillectomy in England: including 318,453 procedures conducted over 11 years, with a median per-patient follow-up of 6 years. It reports that 98.7% of children experienced no inā€hospital complications but that rates of readmission for bleeding within 28 days are increasing; with significant differences in safety outcomes (bleeding, pain and return to theatre) identified between coblation and dissection tonsillectomy across the study period.

The need for further tonsil surgery at 5 years following coblation tonsillectomy is double that of dissection tonsillectomy, 1.4% and 0.6%, respectively.

Coblation use has increased from 7.2% to 27.1% between 2007/08 and 2018/19.  Mortality associated with the procedure (during procedure or within 28 days) is 0.0037%. While the data provides overall trends, it does not allow specific surgical methods or techniques (such as near-total or complete tonsillectomy) to be differentiated- key information for informing the consent process, improving patient safety and guiding the most efficient use of NHS resource. In light of the changing trends, prospective research is essential to determine the outcomes associated with each technique and method.