Adherence to ENT UK indications for Tonsillectomy
George Barrett and Christian Potter
Department of ENT, Head and Neck Surgery, Torbay Hospital, Lawes Bridge, Devon, UK george.barrett@nhs.net
Summary
Introduction
•Clinical and Economic value of
tonsillectomy is being questioned
•200,000 tonsillectomies per year in
1930s1
•50,000 tonsillectomies in
20092
•Clear guidelines exist providing indications for performing Tonsillectomy
•The current economical climate necessitates surgical procedures are performed
only where there is a clear indication
•Introduction of a simple sticker improved documentation of a valid indication for
tonsillectomy from 62% to 84%
Patient listed for tonsillectomy as per
1
ENT UK
Complication rate within agreed levels
2
(Indicator papers5 = 3 - 6%)
•35 million days per year of school and
work missed due to sore throats in UK4
•£65million per year on GP consultations
for sore throats in UK4
3 Evidence that Consent correctly taken
Evidence that risks and benefits have
4
been discussed with patient
Evidence that information has been
5
given to patient
Methods
•Retrospective review of 42 randomly
selected sets of notes over 3 months 2010
•Results presented at departmental
meeting
•Results emailed to staff listing patients
•Sticker introduced to clinic rooms
•Prospective review of 31 randomly
selected sets of notes over 3 months 2011
62
84
4.8
3.2
100
100
100
100
100
100
•Average age at surgery 15 years
•Age range for surgery 2-56 years
•Valid documentation improved from 62%
to 84% after intervention
•2 secondary haemorrhages and 1 case of
post op pain and vomiting occurred
Discussion
•Sample size adequate for assessing
indications for surgery but not
complications
•Results correlate with National
Prospective Audit Data5 which found 76%
of patients were listed due to recurrent
tonsillitis
18
•Patients not meeting guidelines still had
“valid” indication for surgery
16
14
•58% procedures were on females
•27% of GP referrals met criteria for
surgery
Indications for Tonsillectomy
Frequency
•Intervention:
% 1st % 2nd
Cycle Cycle
Standard
•SIGN3 and ENT UK4 guidelines exist to
guide referal and listing
•Cases assessed according to standards
(adjacent table)
Results
Cycle 1
Cycle 2
•20% increase in hospital admission for
quinsy over past 9 years
12
10
8
6
References
4
2
0
8 episodes Malignancy
< 1 year
OSA
5 episodes
> 1 year
Other
1. Glover JA. The incidence of tonsillectomy in school children.
Proc R Soc Med 1938; 31:1219–36
2. Department of Health. Hospital Episode Statistics 2009–2010.
London: DH; 2010. http://hesonline.nhs.uk [cited June 2011]
3. Scottish Intercollegiate Guideline Network. Management of
sore throats and indications for tonsillectomy: quick
reference guide. 2010. http://www.sign.ac.uk/pdf/qrg117.pdf
[cited June 2011]
4. Indications for Tonsillectomy Position Paper. ENT UK 2009.
www.entuk.org [cited June 2011]
5. Clinical Effectiveness Unit. National Prospective
Tonsillectomy Audit. London: The Royal College of Surgeons
of England; 2005.