Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study

Anna Borgström, Pia Nerfeldt, Danielle Friberg, Ola Sunnergren, Joacim Stalfors, Anna Borgström, Pia Nerfeldt, Danielle Friberg, Ola Sunnergren, Joacim Stalfors

Abstract

Objectives: The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.

Setting: A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.

Participants: All Swedish children 1-<18 years registered in the NPR with a tonsil surgery procedure 1987-2013.

Results: 167 894 tonsil surgeries were registered in the NPR 1987-2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1-3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.

Conclusions: There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1-3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.

Keywords: register; tonsil surgery; tonsillectomy; tonsillotomy.

Conflict of interest statement

Conflicts of Interest: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
The incidence and indications of tonsil surgery in children aged 1–

Figure 2

(A and B) Joinpoint regression…

Figure 2

(A and B) Joinpoint regression analyses showing the trends in the incidence rate…

Figure 2
(A and B) Joinpoint regression analyses showing the trends in the incidence rate of tonsil surgery for boys (A) and girls (B) 1987–2013. For both genders, two joinpoints were observed (1994 and 2001 for boys, 1995 and 2001 for girls). The crude rate is the incidence rate/100 000 person years. APC, annual percentage change.

Figure 3

(A and B) Incidence of…

Figure 3

(A and B) Incidence of tonsil surgery procedures for boys (A) and girls…

Figure 3
(A and B) Incidence of tonsil surgery procedures for boys (A) and girls (B) aged 1–

Figure 4

Distributions of the percentage of…

Figure 4

Distributions of the percentage of TE and TT procedures, with or without simultaneous…

Figure 4
Distributions of the percentage of TE and TT procedures, with or without simultaneous adenoidectomy, performed between 1987 and 2013. The proportion due to an obstructive/SDB indication is shadowed for each method. TE, tonsillectomy. TT, tonsillectomy.
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References
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Figure 2
Figure 2
(A and B) Joinpoint regression analyses showing the trends in the incidence rate of tonsil surgery for boys (A) and girls (B) 1987–2013. For both genders, two joinpoints were observed (1994 and 2001 for boys, 1995 and 2001 for girls). The crude rate is the incidence rate/100 000 person years. APC, annual percentage change.
Figure 3
Figure 3
(A and B) Incidence of tonsil surgery procedures for boys (A) and girls (B) aged 1–

Figure 4

Distributions of the percentage of…

Figure 4

Distributions of the percentage of TE and TT procedures, with or without simultaneous…

Figure 4
Distributions of the percentage of TE and TT procedures, with or without simultaneous adenoidectomy, performed between 1987 and 2013. The proportion due to an obstructive/SDB indication is shadowed for each method. TE, tonsillectomy. TT, tonsillectomy.
Figure 4
Figure 4
Distributions of the percentage of TE and TT procedures, with or without simultaneous adenoidectomy, performed between 1987 and 2013. The proportion due to an obstructive/SDB indication is shadowed for each method. TE, tonsillectomy. TT, tonsillectomy.

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