Scott Stevenson
Canterbury DHB

Patient selection for tonsillectomy: Canterbury vs “best practice”
D S Stevenson*, R C Heron**

* Otolaryngology-Head & Neck Surgery, Canterbury DHB
**Trainee Intern, University of Otago, Christchurch

Introduction:
Tonsillectomy has been under the Ministry of Health’s spotlight for some years; tonsillectomy and ventilation tube insertion rates are the only surgical procedures investigated by the HQSC and reported in the Atlas of Healthcare Variation (AoHV). Canterbury’s intervention rate was accurately established in an earlier year-long project; we have referral guidelines (for recurrent tonsillitis) and intervention guidelines. So do we follow the guidelines and do our records show this?   
   
Aims:
Review all CDHB-funded paediatric tonsillectomies performed in January-March 2016, comparing surgical indication with local and international guidelines.

Methods:
All children undergoing tonsillectomy in January-March 2016 were identified and included in the analysis. Electronic and hardcopy records were reviewed to identify the primary surgical indication, documentation supporting the decision to operate was assessed. If sufficient information was not available, private practice records were obtained to complete the data. 

The decision to offer surgery was compared to RACP-AOHNS and AAONHS guidelines for sleep disordered breathing (SDB). CDHB and SIGN/RACP-ASOHNS guidelines were used to assess treatment of recurrent tonsillitis.  

Results:
100 paediatric tonsillectomies were performed during the study period. 

               Primary indication: SDB - 64 cases
                               Recurrent tonsillitis - 25 
                               Both indications - 5 
                               Other indications - 5 cases (excluded from further analysis).

          SDB group:   
          Congruence with guidelines: Clearly met - 64 patients (93%) 
                                                        Not met - 3 (4%) - snoring alone
                                                        Unclear 2 cases (3%) 

         Recurrent tonsillitis group: 
         Congruence with CDHB guidelines: Clearly met - 24 cases (80%)
                                                                   Not met - 0
                                                                   Unclear - 6 (20%). 

        Congruence with SIGN/RACS-AOHNS criteria:  Clearly met – 19 cases (63%)
                                                                                      Not met - 2 (7%)
                                                                                      Unclear - 9 (30%)
                                                                              
Conclusion:
The majority of children undergoing tonsillectomy in the CDHB meet local selection guidelines and international ‘best practice’. Documentation of the decision to offer surgery was sometimes hard to find, this aspect of our practice should be improved.