Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996–2006

Abstract

OBJECTIVE Determine changes in rates for pediatric adenotonsillar procedures over time with attention to infectious indications. STUDY DESIGN Historical cohort study. SETTING Academic medical center. SUBJECTS AND METHODS The National Survey of Ambulatory Surgery and the National Hospital Discharge Survey 1996 and 2006 releases were examined, extracting all cases of pediatric tonsillectomy, adenotonsillectomy, and adenoidectomy. The aggregate numbers and rates of adenotonsillar procedures performed overall and specifically for chronic infectious etiologies were determined. These procedure rates were then compared to determine differences in performance rates between 1996 and 2006. RESULTS In 1996, an estimated 441,870 ± 23,315 children underwent some form of adenotonsillar surgery in the ambulatory and inpatient settings (60,034 ± 6994 tonsillectomies, 255,217 ± 18,960 adenotonsillectomies, and 126,619 ± 11,627 adenoidectomies), while in 2006, the total rose to 695,029 ± 36,979 children (58,111 ± 9645 tonsillectomies, 506,778 ± 32,054 adenotonsillectomies, and 129,540 ± 15,714 adenoidectomies). However, when examined according to infectious indications, a notable decline in the population rate of tonsillectomy from 0.62 per 1000 children in 1996 to 0.53 per 1000 in 2006 was found ( P = 0.252). Moreover, the larger decline in the rate of adenotonsillectomy for infectious indications from 2.20 per 1000 to 1.46 per 1000 was significant ( P = 0.003). There was no significant change adenoidectomy rates for chronic infectious etiologies (0.25 versus 0.21 per 1000, P = 0.326). CONCLUSION Although there was an overall increase in the rate of performance of adenotonsillar surgery, population adjusted performance rates of these procedures specifically for infectious indications declined from 1996 to 2006.