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Comment & Response
January 16, 2020

The “Right Rate” of Tonsillectomy

Author Affiliations
  • 1World Development Group Inc, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. 2020;146(3):311. doi:10.1001/jamaoto.2019.4206

To the Editor Tonsillectomy has been performed for thousands of years. In modern times, the operation went from being needed rarely to becoming almost routine.1 In New York, a random sample of 1000 schoolchildren was examined; reported in 1934, 60% were found to have undergone tonsillectomy.2 The remaining children were examined by school physicians; 45% were recommended for tonsillectomy. A second group of physicians examined those who were not; then a third group, the remainder. In each of the 3 successive rounds, 44% to 45% of children examined were recommended for tonsillectomy.2 At the end of the experiment, 94% of the children had either had or were recommended for the operation.2 By the 1980s, tonsillectomy was labeled a dangerous fad.3 In the absence of sound scientific evidence, preferences dominate clinical decision-making. Variation in rates of procedures stems from many factors, chief among them surgeons' attitudes, a well-known factor.4 In her insightful commentary, Dr Chen raises 2 important questions: (1) why is there so much variation despite the proliferation of clinical practice guidelines (CPG); (2) how can unwanted variation in rates be reduced?5

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