Silva S, Ouda M, Mathanakumara S, Ridyard E, Morar P
Department of Otolaryngology - Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK.
J Laryngol Otol. 2012 Jun;126(6):609-11. doi: 10.1017/S0022215112000643.
The 2009 McKinsey National Health Service report considered that tonsillectomy was relatively ineffective and often unjustified, and that its frequently could be greatly reduced. ENTUK argued against this, for severe recurrent tonsillitis. This study audited clinical indications for tonsillectomy. CRITERIA AND STANDARDS: Current guidelines state that patients with recurrent tonsillitis must have disabling sore throat episodes five or more times per year, and symptoms for at least a year, to justify tonsillectomy.
Seventeen recurrent tonsillitis patients receiving tonsillectomy were audited prospectively. Indications were poorly documented in the referral letter, so surgeons agreed to list specified tonsillectomy criteria when scheduling patients for tonsillectomy. A pro forma reminder was distributed to all clinics, and the next 100 scheduled tonsillectomy patients were audited.
In the first audit, all 17 tonsillectomies were justified but only two (11.8 per cent) had documented indications. In the second audit, 85 per cent of patients had all essential criteria, which were documented in the listing letter.
Tonsillectomy risks being removed from the UK essential otolaryngological surgical register, risking increased patient morbidity and work absence, despite valid supporting evidence of efficacy for recurrent tonsillitis. All UK otolaryngology units should strictly adhere to the ENTUK and Scottish Intercollegiate Guidelines Network recommendations for tonsillectomy, and should document essential criteria in the listing letter, to strengthen the advocacy argument for tonsillectomy as essential, valid treatment for recurrent tonsillitis.
2009年麦肯锡国民医疗服务体系报告认为扁桃体切除术相对无效且常常不合理，其实施频率可大幅降低。英国耳鼻喉科医师协会对此表示反对，认为对于严重复发性扁桃体炎该手术是必要的。本研究对扁桃体切除术的临床指征进行了审核。
现行指南指出，复发性扁桃体炎患者每年必须有五次或更多次导致功能障碍的咽痛发作，且症状持续至少一年，才有理由进行扁桃体切除术。
对17例行扁桃体切除术的复发性扁桃体炎患者进行前瞻性审核。转诊信中对手术指征的记录不佳，因此外科医生同意在为患者安排扁桃体切除手术时列出特定的扁桃体切除标准。向所有诊所发放了一份预印本提醒，对接下来计划进行扁桃体切除手术的100名患者进行了审核。
在首次审核中，所有17例扁桃体切除术都有合理依据，但只有两例（11.8%）有记录在案的指征。在第二次审核中，85%的患者具备所有基本标准，这些标准记录在列手术通知单中。
尽管有证据表明扁桃体切除术对复发性扁桃体炎有效，但该手术仍有可能从英国耳鼻喉科基本外科手术登记中被剔除，从而增加患者发病风险和误工情况。英国所有耳鼻喉科单位都应严格遵循英国耳鼻喉科医师协会和苏格兰校际指南网络关于扁桃体切除术的建议，并应在列手术通知单中记录基本标准，以强化扁桃体切除术作为复发性扁桃体炎必要且有效治疗手段的主张依据。
