Low-value Care

New study reveals long-term risks of tonsillectomy

By Judith Garber | June 11, 2018

The long-term effectiveness of taking out childrens’ tonsils to relieve tonsil infections and sleep apnea has been in question for many years. In the 1960s, pioneering research from Jack Wennberg and Alan Gittelson showed that the rate at which children were getting their tonsils removed varied greatly, not based on patient characteristics, but due to differences in opinion and practices between doctors in each community. In one Vermont town, 20% of children had their tonsils taken out before age 15; in the next town over, 60% of children had their tonsils removed. 

In one Vermont town, 20% of children had their tonsils taken out before age 15; in the next town over, 60% of children had their tonsils removed. 

The frequency of tonsillectomies has decreased over the decades, in part due to Wennberg and Gittelsohn’s discovery and dissemination of data. However, there are still more than 530,000 performed per year, and the variation between communities persists. An update to the Dartmouth Atlas shows that the rate of tonsillectomies from 2007-2010 in three New England states ranged from 2.7 per 1000 in Bangor, ME to 10.9 per 1000 in Littletown, VT.

This variation suggests that physician opinions, clinical inertia, and patient demands continue to affect the number of tonsillectomies children are getting. That’s why new evidence like this study in JAMA is so important. Researchers followed two groups of children born in Denmark between 1979 and 1999 for up to 30 years; about 60,000 had tonsillectomies or adenoidectomies and about one million had not. They found that people who had tonsillectomies or adenoidectomies as a child had a 2-3 times greater risk of upper respiratory tract diseases, compared with people who did not have either procedure, controlling for other health factors.

People who had tonsillectomies or adenoidectomies as a child had a 2-3 times greater risk of upper respiratory tract diseases.

The adenoids and tonsils are parts of the immune system, so taking them out is not without risk. While tonsillectomy and adenoidectomy can be effective for treating children with tonsil infections and sleep apnea in the short term, we have to start thinking long term when making these decisions.

And even the perceived benefits may not be any better than doing nothing. “Both of these conditions [recurring tonsil infections and obstructive sleep apnea in children] normally get better over time without surgery,” said Dr. Art Curtis, a Chicago otolaryngologist and member of the Right Care Alliance. According to the Cochrane Collaborative review of tonsillectomy for obstructive sleep apnea, almost half of the children who didn’t get surgery were sleeping normally seven months later. Similarly, in a study of tonsillectomy for throat infections in the New England Journal of Medicine, the incidence of throat infection during the first two years of follow-up was significantly lower in the group that had surgery, but many patients in the control group were experiencing fewer and more mild infections in the follow-up years as well.

“Given the increased number of respiratory infections and other concerns after tonsillectomy and adenoidectomy, we should be reserving these procedures for only the worst cases, particularly in children,” said Curtis.

Judith Garber is a Senior Policy Analyst at the Lown Institute. She holds a masters degree in public policy from the Heller School of Social Policy and Management.

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