Every year, hundreds of young children in the United Kingdom are getting surgery that they don’t need.
That’s the conclusion of a study recently published in the British Journal of General Practice, conducted by a group of researchers at the University of Birmingham. The study found that, between 2005 and 2016, 88.3% of the kids who got tonsillectomies in the UK didn’t meet the medical threshold for the procedure, and were unlikely to benefit from it.
Under medical guidelines known as the Paradise Criteria, the American Academy of Otolaryngology and other major medical associations recommend that kids only get tonsillectomies if they suffer from at least seven sore throats in the previous year, at least five sore throats in the past two years, or at least three sore throats in each of the previous three years. But most childhood tonsillectomies in the UK in recent years were performed on kids who didn’t meat that criteria.
The University of Birmingham researchers came to this conclusion after analyzing the medical records of over 1.6 million children from more than 700 UK general practices within the country’s Health Improvement Network (THIN) between 2005 and 2016. Out of 18,271 children who had their tonsils removed during that period, only 2,144 (11.7%) had enough sore throats to justify getting the surgery.
That’s worrisome because—although tonsillectomies for kids are commonplace—the surgery comes with risks of complications. According to a case study of Canadian health administrative data used by the Birmingham researchers, 2.7% of children who receive tonsillectomies are readmitted within 30 days, and 12.4% go to an emergency department. A 2014 review in Pediatrics showed that 7.8% of children who undergo tonsillectomies in the US end up back at the hospital with complications within 30 days. And another study showed the most common causes of readmission were excessive bleeding, acute pain, fever, vomiting, and dehydration.
Even when kids qualify for the procedure, parents may want to consider a strategy of “watchful waiting,” according to Nicholas Balakar in The New York Times. That’s because, while tonsillectomy can be beneficial to kids who are severely affected, a recent study of more than 60,000 Danish kids showed that the procedure is associated with a much higher risk of diseases of the upper respiratory tract.
Tragic, but uncommon, cases, like the death of 13-year-old Jahi McMath following a tonsillectomy in 2013, have highlighted the importance of ensuring that kids only go through surgeries they actually need. According to Pacific Standard Magazine, “each year in America, thousands of children die because of questionable medical interventions and poor follow-up.”
Unnecessary surgical procedures also represent a burden on public health systems: In the UK, for example, the National Health Service (NHS) performed about 37,000 childhood tonsillectomies from April 2016 to March 2017, at a cost of £42 million.
An National Health Service analysis of the Birmingham study deemed it accurate, but clarified that digital medical records don’t always reflect the reasons why a tonsillectomy is recommended—meaning that it’s possible there were other reasons why doctors chose to go ahead with surgery in specific cases.
Tom Marshall, a study author and professor of public health at the University of Birmingham, says it is more likely that his team overestimated rather than underestimated the number of sore throats children had before surgery, since they used a broad definition of what constituted a tonsillitis, or sore throat caused by infected tonsils. However, even after conducting the analysis with a stricter definition of a sore throat, the researchers found that it was “still true that the great majority of children with frequent sore throats do not have their tonsils removed,” according to Marshall.
The Birmingham researchers also noted that, among UK children who did meet the criteria for tonsillectomies and had seven or more severe sore throats within a year, only 14% actually received the surgery. Marshall says this made him wonder if “children may be more harmed than helped by a tonsillectomy.”
“We found that even among severely affected children only a tiny minority of ever have their tonsils out,” he said. “It makes you wonder if tonsillectomy [is] ever really essential in any child.”