Variations in rates of tonsillectomy, adenoidectomy and myringotomy in Quebec - nonsystematic review
Conseil d'Evaluation des Technologies de la Sante du Quebec
Record ID 31997008313
To confirm the findings of a previous report in which large geographic variations in the rates of tonsillectomy and adenoidectomy were found in Quebec in the years 1990 and 1991, and to extend these observations. To determine whether there were comparable variations in the rates of myringotomy and to explore the association between the rates of these operations and factors which might influence them such as the health or socio-economic status of the populations concerned, the number of doctors or hospital beds in relation to the population concerned and the extent to which that population lives in a rural or urban environment.
Authors' results and conclusions:
From 1988 to 1993, the age-standardized rates of all three operations studies, that is for tonsillectomy with or without adenoidectomy, adenoidectomy alone and myringotomy, have remained fairly constant.
However, the large variations in the rates for tonsillectomy and adenoidectomy previously reported in Quebec (1990-1991) were still present in 1993. Even greater variations were observed for myringotomy. The coefficient of variation of rates for the three different operations ranged from 26% to 41% and the external quotient (ratio of highest/lowest rate) from 3.0 to 6.8 (i.e., in one DSC adenoidectomies alone (male) were carried out 6.8 times more frequently than in the DSC with the lowest rate for that procedure).
No significant association was found between the rates of any of these operations and the health of the population as reflected by the rates of medical visits for upper respiratory infections or for otitis media or the socio-economic status of the population as measured by the median household income. The number of acute care beds (per 10,000 persons) was inversely associated with the rates of adenoidectomy alone and the number of otolaryngologists (per 10,000 persons) was positively associated with rates of adenoidectomy alone among males.
One DSC characteristic, the index of urbanization, was highly correlated (negatively) with the frequency of myringotomy such that this operation was carried out more frequently in less urban DSCs. In effect, children living in Montreal based DSCs received this operation much less frequently than children elsewhere, including Quebec city.
DSCs with high rates for any one of these operations tended to have high rates for the other procedures. Thus, whatever factors may cause low or high rates appear to apply to all three operations and to both sexes.
For tonsillectomy (with or without adenoidectomy), it was possible to compare Quebec rates with those observed in other Canadian provinces. The comparison showed that the overall rate of this operation in Quebec is very slightly below the Canadian average.
English language abstract:
An English language summary is available
- Otitis Media with Effusion
Conseil d'Evaluation des Technologies de la Santé du Québec
Conseil d'Evaluation des Technologies de la Santé du Québec, 2021, avenue Union, #1040, Montréal, Québec H3A S29, Canada. Tel: 514-873-2563; FAX: 514-873-1369
Conseil d'Evaluation des Technologies de la Sante du Quebec (CETS)