Public Health services question the Indications for adenotonsillectomy in Children

At a recent Medical Executive meeting the following topic was presented.

4.1             Atlas of Healthcare Variation 

·        Originally scheduled for publication by 30 June, now delayed till later in July.

·        Atlas will highlight variation in health service provision and outcomes between different geographic areas of New Zealand.

·        Information to be displayed in maps, graphs and tables, and displayed on the HQSC (Health Quality and Safety Commission) website.

·        Atlas to be organised into ‘domains’ with 10 domains to be published each year.

·        First 3 domains will be :

-         Maternity, ie vaginal deliveries, c-section rates

-         Surgical Procedures of Potentially Questionable Usefulness, ie tonsillectomies/grommets

-         Life Expectancy, and other demographic variables

Now I wasn't at this meeting and although have requested more detail, non is forthcoming. Having researched what the Atlas of Healthcare Variation is, it appears to have been directly "borrowed" from the NHS in UK.
For those GP's and Specialists who like me are concerned by the statement that "Tonsillectomies/grommets may be of questionable usefulness", I direct you to a Joint Position paper of the Paediatrics and Child Health Division of the Royal Australian College of Physicians and The Society of Otolaryngology, Head and Neck Surgery(July 2008).


It states
Conclusion 2
Current Suboptimal rates of adenotonsillectomy for OSA in Australia and New Zealand
     The incidence of adenotonsillectomy in Australia and New Zealand for OSA is significantly below that expected. The analysis suggests that only 1 in 7-10 children who could benefit from adenotonsillectomy is being treated.


I wont go onto discuss the indications for grommets but there is plenty of similar research to confirm its usefulness. Unfortunately there are going to plenty of more pushes to save money in our health service and worryingly many may be directed towards children. (editor)