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T alone remained relatively lower than T&amp;A rates, evolving from 3.6 in 2003 to 3.9 in 2015 (0.3 points per 10\u2009000 inhabitants). Most of the risk variation was captured at the HCAs level in both procedures (FV: 55.3% in T&amp;A and 72.5% in T). The ACs level explained 27.6% of the FV in the risk in T&amp;A versus 8% in T. The interaction ACs year was similar in both procedures (FV: 15.5% in T&amp;A and 17.5% in T). The average trend hardly explained 1.46% and 1.83% of the variation, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study showed wide persistent variations with a steady increase in rates and risk of T&amp;A and a stagnation of T alone, where most of the variation risk was explained at HCA level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064009","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T13:53:00Z","timestamp":1669902780000},"page":"e064009","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Revisiting systematic geographical variations in tonsils surgery in children in the Spanish National Health System: spatiotemporal ecological study on hospital administrative 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