A new audit prodecure applied to an old question: Is the frequency of T&A justified?

A unique medical audit procedure has been employed to combine the scope of population data with the detail of case histories. All tonsillectomy and adenoidectomy (T&As) in Manitoba for one year were studied. A group of individuals treated for respiratory illness but not having T&As were also identified. Individual histories were reconstructed from medical insurance claims. These cases were reviewed to test conformity between practice and authoritative standards for surgical intervention. The quality of the data on which this procedure depends withstood a battery of challenges. The analysis indicates that most cases selected for surgery lack evidence of meeting authoritative standards. However, a sizeable group of individuals not selcted for surgery perhaps should have been, if the same standards are applied. Also, those physicians performing the most operations had the highest criteria for patient selection.