The “Right Rate” of Tonsillectomy

To the Editor Tonsillectomy has been performed for thousands of years. In modern times, the operation went from being needed rarely to becoming almost routine. In New York, a random sample of 1000 school children was examined; reported in 1934, 60% were found to have undergone tonsillectomy. The remaining children were examined by school physicians; 45% were recommended for tonsillectomy. A second group of physicians examined those who were not; then a third group, the remainder. In each of the 3 successive rounds, 44% to 45% of children examined were recommended for tonsillectomy. At the end of the experiment, 94% of the children had either had or were recommend for the operation. By the 1980s, tonsillectomy was labeled a dangerous fad. In the absence of sound scientific evidence, preferences dominate clinical decision-making. Variation in rates of procedures stems from many factors, chief among them surgeons' attitudes, a well-known factor. In her insightful commentary, Dr Chen raises 2 important questions: (1) why is there so much variation despite the proliferation of clinical practice guidelines (CPG); (2) how can unwanted variation in rates be reduced?
Source: JAMA Otolaryngology - Head and Neck Surgery - Category: ENT & OMF Source Type: research