Exploring spillover effects following surgical de-implementation: An observational evaluation of primary care, referrals, and time to surgical intervention following reductions in the use of tonsillectomy and Dupuytren’s contracture

Glynn, Joel, Jones, Timothy, Creavin, Sam, Conefrey, Carmel, Falco, Jenny, Farrar, Nicola, Bell, Mike, Blazeby, Jane, Burton, Christopher, Donovan, Jenny L., Gibson, Andy, McNair, Angus, Morley, Josie, Owen-Smith, Amanda, Rule, Ellen, Thornton, Gail, Tucker, Victoria, Williams, Iestyn, Hollingworth, William and Rooshenas, Leila (2026) Exploring spillover effects following surgical de-implementation: An observational evaluation of primary care, referrals, and time to surgical intervention following reductions in the use of tonsillectomy and Dupuytren’s contracture. Implementation Science Communications. ISSN 2662-2211

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Abstract

Background: Reducing the use of low-value surgery is important to maintain effective, safe and financially sustainable health systems. However, following de-implementation there are inevitably wider impacts for health systems beyond the targeted reduction in surgery, which have hitherto not been explored. Here we describe the spillover effects following the reduction in the use of two surgical procedures; tonsillectomy and Dupuytren’s contracture release (DCR) identified in 2019 by the Evidence Based Interventions (EBI) programme a de-implementation initiative in England. Methods: This longitudinal observational study used linked primary (Clinical Practice Research Datalink) and secondary (hospital episode statistics) care electronic health records from 1st April 2016 to 29th February 2020 to identify care for patients presenting with symptoms of tonsillitis or Dupuytren’s contracture (DC). Outcome measures include GP visits; related prescriptions; outpatient appointments, referral to secondary care and surgery. Differences were explored between cohorts of patients seeking care for tonsillitis or DC before and after EBI guidelines. Using a two-part Generalised Linear Model (GLM), we explored changes in likelihood of surgery and the time-to-surgery (if it occurred) before and after EBI guidelines. Results: Repeat GP visits for tonsillitis increased by 540 per 10,000 patients-per-year post-EBI, but remained stable for DC. Antibiotic prescriptions for tonsillitis fell, and outpatient appointments remained stable for both conditions. The likelihood of surgery reduced for both conditions post-EBI with an odds ratio of 0.75 {95%CI 0.71, 0.79} and 0.88 {95%CI 0.81, 0.95}), with a shorter time-to-tonsillectomy of -5.2 days (95%CI {-9.5 days to -1 day}). Reduction in time-to-DCR was less evident (-2.2 days CI {95%-7.1 to + 3}) but should be considered in the context of nationally increasing elective waiting time trends. Conclusions: Reductions in both surgical procedures were associated with small, but potentially important, changes to primary care utilisation and specialist treatment. Policy makers should identify potential spillovers from de-implementation, design policies to mitigate negative effects, and monitor these wider impacts alongside the direct influence on the targeted procedure rates.

Item Type:	Article
Additional Information:	Data availability: The primary and secondary care data for this project was provided by Clinical Practice Research Datalink (CPRD) [39]. Data was extracted for both CPRD Aurum and Hospital episode statistics (APC and Outpatient) through a single study data sharing agreement between The Sectary of State for Health and Social Care and the University of Bristol. Protocol 22_001729. The data is not owned or held by the authors or their organisation, as such data cannot be made publicly available. An identical extract of the data can be requested from CPRD using the code lists provided in the supplementary materials.
Uncontrolled Keywords:	de-adoption,de-implementation,tonsilitis,dupuytren contracture,surgery,primary care
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Public Health
Related URLs:	https://link.springer.com/10.1186/s43058...
Depositing User:	LivePure Connector
Date Deposited:	02 Mar 2026 11:30
Last Modified:	02 Mar 2026 11:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102122
DOI:	10.1186/s43058-026-00857-7

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