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Increased rates of ENT surgery among young children: have clinical guidelines made a difference?
M I Rob1, J I Westbrook, R Taylor
1Centre for Health Informatics, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Despite guidelines, ear, nose, and throat (ENT) surgery for young children increased, particularly for those under five. This rise in pediatric ENT procedures may be linked to increased childcare use.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Public Health Policy
Background:
- Paediatric ear, nose, and throat (ENT) surgery guidelines were introduced to standardize care.
- Understanding the impact of these guidelines on procedure rates and children's surgical risk is crucial.
Purpose of the Study:
- To examine the association between the introduction of paediatric ENT surgery guidelines and population procedure rates.
- To determine changes in children's risk of undergoing ENT surgery.
Main Methods:
- Trend analysis of myringotomy, tonsillectomy, and adenoidectomy incidence in NSW children (0-14 years) from 1981 to 1999.
- Poisson regression and lifetable methods were used to analyze rates and surgical risk by age 15.
Main Results:
- Overall ENT surgery rates increased by 21% during the study period.
- Children's risk of undergoing ENT surgery rose from 17.9% to 20.2% by 1998/99.
- Increases were most pronounced in children aged 0-4, correlating with increased formal childcare use.
Conclusions:
- The risk of paediatric ENT surgery significantly increased over two decades, despite guideline implementation.
- Surgery rates for conditions like otitis media did not show a corresponding increase.
- The rise in surgery among the youngest children may be associated with increased childcare attendance.
Objectives:
To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery.
Methods:
Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15.
Results:
ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%.
Conclusions:
The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare.
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