Variation in selected childhood surgical procedures: The case of tonsillectomy and management of middle ear disease

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Abstract
We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years of age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P < 0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P < 0.01) from 53 to 60%. We found significant (P < 0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasing.