{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T16:31:22Z","timestamp":1788107482590,"version":"build-2803163510"},"reference-count":24,"publisher":"Royal College of Surgeons of England","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits. <\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p> A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1\u20132%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period. <\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p> The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around \u00a373 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is \u00a356 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at \u00a371 million with tonsillitis and its complications accounting for a further \u00a38 million. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2020.7030","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T12:02:08Z","timestamp":1614600128000},"page":"208-217","source":"Crossref","is-referenced-by-count":14,"title":["Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management"],"prefix":"10.1308","volume":"103","author":[{"given":"M","family":"Pankhania","sequence":"first","affiliation":[{"name":"The Rotherham Foundation Trust, Moorgate Road, Rotherham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Rees","sequence":"additional","affiliation":[{"name":"The Rotherham Foundation Trust, Moorgate Road, Rotherham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Thompson","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals, Glossop Road, Sheffield"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Richards","sequence":"additional","affiliation":[{"name":"The Rotherham Foundation Trust, Moorgate Road, Rotherham"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","reference":[{"key":"C2","volume-title":"National Prospective Tonsillectomy Audit: Final report of an audit carried out in England and Northern Ireland between July 2003 and September 2004.","author":"Royal College of Surgeons of England.","year":"2005"},{"key":"C3","volume-title":"Management of Sore Throat and Indications for Tonsillectomy. SIGN Guideline 34","author":"Scottish Intercollegiate Guidance Network","year":"1999"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1080\/21548331.1976.11706503"},{"key":"C5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197802232980801"},{"key":"C6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198403153101102"},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.1308\/003588414X13946184900363"},{"key":"C8","volume-title":"Management of Sore Throat and Indications for Tonsillectomy. SIGN Guideline 117","author":"Scottish Intercollegiate Guidance Network","year":"2010"},{"key":"C9","first-page":"6","volume":"12","author":"Fountaine T","year":"2012","journal-title":"Health Int"},{"key":"C10","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X699833"},{"key":"C11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1450"},{"key":"C12","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.07.013"},{"key":"C13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.01.016"},{"key":"C14","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215107001557"},{"key":"C16","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12773"},{"key":"C17","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-013-2345-z"},{"key":"C18","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2017.0193"},{"key":"C19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006686"},{"key":"C20","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215106001940"},{"key":"C21","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215116008173"},{"key":"C22","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3490"},{"key":"C23","volume-title":"Tonsillectomy for Obstructive Sleep-Disordered Breathing or Recurrent Throat Infection in Children","author":"Francis DO"},{"key":"C24","doi-asserted-by":"publisher","DOI":"10.1308\/003588411X579793"},{"key":"C25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0117535"},{"key":"C26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193913"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2020.7030","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:40:39Z","timestamp":1684147239000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2020.7030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1308\/rcsann.2020.7030"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2020.7030","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}