An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010-2015: Changing indications and lack of effect of hospital volume on inter-hospital transfers.

OBJECTIVE: To describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence rate over 2010-2015 and investigate factors associated with inter-hospital transfer. DESIGN: Retrospective population-based study. SETTING: Multicentre study in the state of Victoria, Australia. PARTICIPANTS: From the Victorian Admitted Episodes Dataset, which included all patients aged 0-19 years who underwent adenoidectomy and/or tonsillectomy in Victoria, Australia between 2010 and 2015. MAIN OUTCOME MEASURES: Annual incidence rate, hospital volume, inter-hospital transfer. RESULTS: Between 2010 and 2015, 59 008 patients underwent 61 281 procedures, with highest number performed in males (52.7%), children aged under 10 years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4 and 23.2% in quintile 5). Seventy-five cases (0.12%) resulted in inter-hospital transfer, which was significantly associated with young age (under 5 years). More than a third of hospitals (35.7%) performed an average rate of <1 procedure per week. Hospital volume was not associated with risk of inter-hospital transfer. The incidence rate of adenotonsillectomy procedures significantly increased over the study period (P < .001), driven by a significant increase in the rate of surgery performed for obstructive symptoms (P < .001). CONCLUSIONS: The rate of adenoidectomy/tonsillectomy procedures is rising, with a higher proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given the literature supporting higher rates of obstructive sleep-disordered breathing and sore throat in lower socioeconomic groups. A third of hospitals performed small numbers of procedures, but we found no association between hospital volume and inter-hospital transfers.