Every year, hundreds of small children in the United Kingdom undergo an operation they do not need.
This is the conclusion of a study recently published in the British Journal of General Practice, conducted by a group of scientists from the University of Birmingham. The study showed that in 2005-2016, 88.3% of children who received tonsillectomies in the United Kingdom did not reach the medical threshold in this procedure and probably would not take it.
The tonsils are not without risk
According to the medical guidelines known as the Paradise Criteria, the American Academy of Otolaryngology and other important medical associations recommend that children receive only tonsillectomies if they have at least seven sore throats in the previous year, at least five throat pains in the last two years, or at least three sore throats in each of the previous three years. However, most children with childhood tonsillectomies in recent years have children who did not meet these criteria.
Researchers at the University of Birmingham have come to this conclusion after analyzing the medical records of more than 1.6 million children from over 700 British general practices within the health improvement network (THIN) in 2005 and 2016. Of the 18 271 children who removed the tonsils during this only 2,144 (11.7%) suffered from throat pain to justify the onset of surgery.
This is worrying because – although tonsils are a frequent phenomenon – surgery is associated with the risk of complications. According to a case study of Canadian administrative health data used by Birmingham researchers, 2.7% of children who received tonsils are re-admitted within 30 days and 12.4% go to the emergency department. 2014 review in Pediatrics showed that 7.8% of children undergoing tonsillectomies in the US end up in hospital with complications within 30 days. Another study showed that the most common causes of rehospitalisation were: excessive bleeding, severe pain, fever, vomiting and dehydration.
Even if the children qualify for the procedure, parents may want to consider a strategy of "careful waiting," according to Nicholas Balakar of The New York Times. This is because although the removal of the tonsils may be beneficial to children who are severely affected, recent studies of over 60,000 Danish children have shown that the procedure is associated with a much higher risk of upper respiratory tract illness.
The risk of unnecessary surgery in children
Tragic but rare cases, such as the death of 13-year-old Jahi McMath after tonsillectomy in 2013, have highlighted the importance of ensuring that children undergo only the operations they need. According to the Pacific Standard Magazine, "thousands of children die each year in America because of doubtful medical interventions and poor observation."
Unnecessary surgical procedures are also a burden on public health systems: for example, the United Kingdom National Health Service (NHS) has performed approximately 37,000 spleen fission in children from April 2016. By March 2017, at a cost of 42 million pounds.
The analysis conducted by the National Health Service in Birmingham showed that it is accurate, but explained that digital medical records do not always reflect the reasons why it is recommended to have the tonsils out – which means that there are other reasons why the doctors decided to undergo surgery in a specific case. cases.
Tom Marshall, author of research and professor of public health at the University of Birmingham, says that his team is more likely to overstate and not underestimate the number of sore throats that children had before surgery because they used a broad definition of what tonsillitis was. or sore throat caused by infected tonsils. However, even after an analysis with a more severe definition of sore throat, the researchers found that "it is still true that the vast majority of children with frequent sore throats do not have their tonsils removed," says Marshall.
Researchers from Birmingham also noted that among British children who done they meet the criteria for tonsils and have seven or more severe sore throats during the year, only 14% actually received the surgery. Marshall says that he made him wonder if "children can be more hurt than the tonsils helped them".
"We have found that even among children affected by serious diseases, only a small minority has never had their tonsils," he said. "It makes you wonder if tonsillectomy [is] really important in every child. "