Does Adenotonsillectomy really reduced clinic visits for pediatric upper respiratory tract infections? A national database study in Taiwan Yung-An Tsou a,c,g,1 , Che-Chen Lin d,e , Chih-Ho Lai b , Ching-Yuan Wang a , Chia-Der Lin a,c,1 , Pei-Chun Chen f , I.-Ju Tsai d,e , Chuan-Mu Chen g , Fung-Chang Sung d,e, *, Ming-Hsui Tsai a,c a Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan b Department of Microbiology, China Medical University, Taichung, Taiwan c Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan d Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan e Department of Public Health, China Medical University, Taichung, Taiwan f Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan g Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan 1. Introduction Tonsillectomy and adenoidectomy (T/A) are widely used surgical procedures for chronic or recurrent upper respiratory tract infections (URIs) in children. However, the effectiveness of those procedures is still uncertain and remains an issue of debate. The surgical rates vary considerably in different periods and across countries. The incidence of tonsillar surgery in the United Kingdom peaked at 390 per 10,000 children in the 1930s [1], but has declined since then to 65 per 10,000 children in 1998 [2]. In 1998, the incidence of T/A ranged from 19 per 10,000 children in Canada to 118 per 10,000 children in Northern Ireland [2]. The difference in surgical rates may be due to the patient preference between surgical intervention and proper bacterial culture oriented antibiotic treatment for upper respiratory tract infections among countries [3]. For example, in the Netherlands, patients with adenotonsillar diseases prefer to undergo T/A rather than antibiotic therapies [4]. In addition, discrepancies exit between physicians and parents regarding the type of surgical intervention for URIs. Physicians usually provide recommendations based on the guidelines or selection criteria stated in published research, whereas parents often choose surgery because of anecdotal enthusiasm based on their education or social experiences [5]. Physicians with different subspecialties may also have different viewpoints on the indications for surgical intervention. Currently, there is little general agreement on indications for surgery between pedia- tricians and otolaryngologists [6]. International Journal of Pediatric Otorhinolaryngology 77 (2013) 677–681 ARTICLE INFO Article history: Received 12 October 2012 Received in revised form 7 January 2013 Accepted 12 January 2013 Available online 8 February 2013 Keywords: Adeno-tonsillectomy Middle ear ventilation Pediatrics Retrospective cohort study Upper respiratory infection ABSTRACT Objective: To investigate whether adenotonsillectomy reduces upper respiratory tract infections (URIs) in the pediatric population. Methods and subjects: We identified 415 children, aged 18 years who had undergone adenoidectomy and/or tonsillectomy during the period from 1999 to 2006, from the Taiwan National Health Insurance Research Database. The comparison group consisted of 1630 children without the surgery randomly selected from the same database frequency matched with sex, age and the surgery date (index date). Changes in physician visits for URIs 2-year period before and 2-year period after the index date were compared between the two groups of children. Results: The number of outpatient visits for URIs decreased with time, children with tonsillectomy and/ or adenoidectomy had a greater reduction than comparison children (mean changes, 14 times and 6 times, respectively) in the 2-year period after the index date. Multivariate analyses using generalized estimated equation revealed a significant effect in reducing URIs visits from the surgery (relative ratio = 0.85, p < 0.0001), strongest for children undergoing both tonsillectomy and adenoidectomy (relative ratio = 0.76, p < 0.0001). The association between surgery and the decrease in URIs was more pronounced for children aged 12 years and less. Conclusion: This population-based study suggests that tonsillectomy and/or adenoidectomy is associated with fewer physician visits for URIs. The association is weakened in old children. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan. Tel.: +886 4 2206 2295; fax: +886 4 2201 9901. E-mail addresses: fcsung1008@yahoo.com, tw.mohd@gmail.com (F.-C. Sung). 1 These authors contributed equally to this work. Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2013.01.011