A sore throat will persist approximately two weeks following surgery while pain following the procedure is significant and may necessitate a hospital stay. Recovery can take from 7 to 10 days and proper hydration is very important during this time, since dehydration can increase throat pain, leading to a circle of poor fluid intake. Tonsillectomy appears to be more painful in adults than children. Controlling the pain following tonsillectomy is important to ensure that people can start eating again normally following the procedure. At some point, most commonly 7 to 11 days after the surgery (but occasionally as long as two weeks after), bleeding can occur when scabs begin sloughing off from the surgical sites. The overall risk of bleeding is approximately 1–2%. It is higher in adults, especially males over age 70 and three-quarters of bleeding incidents occur on the same day as the surgery. Approximately 3% of adults develop bleeding at this time which may sometimes require surgical intervention. Recommendations for pain management include ibuprofen and paracetamol (acetaminophen). The opioid codeine is not recommended for those less than 12 years old. There is a theoretical concern that NonSteroidal Anti-Inflammatory Drugs (NSAIDs) may increase the risk of bleeding but evidence does not support such a risk. Further research is required to determine if mouth rinses, mouthwashes and sprays help improve recovery following surgery. Rates There are variations in tonsillectomy rates, both between and within countries. In 2015, tonsillectomy rates in the Netherlands, Belgium, Finland and Norway were at least twice those in the UK but rates in Spain, Italy and Poland were at least a quarter lower. Tonsillectomy rates even vary considerably between neighbouring countries. For example, rates in Croatia are three times those in Slovenia. Variations between countries may be explained by a lack of or differences between guidelines. However differences in guidelines cannot explain the seven-fold variation between local authority areas within England. In Germany tonsillectomy rates between regions differ by up to a factor of 8. A 2010 study in England found the annual tonsillectomy rate per 100,000 between 2000 and 2005 was 754 in the highest region, the national average was 304 and the lowest region was 102. This means there is a seven-fold difference between the region with the highest tonsillectomy rate and the region with the lowest one. In 2006, English Chief Medical Officer Liam Donaldson revealed that unnecessary tonsillectomies and unnecessary hysterectomies