Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-24T02:34:15.793Z Has data issue: false hasContentIssue false
  • English
  • Français

Experience is more important than technology in paediatric post-tonsillectomy bleeding

Published online by Cambridge University Press:  10 April 2017

A D Hinton-Bayre ,
K Noonan ,
S Ling  and
S Vijayasekaran
A D Hinton-Bayre*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Australia Ear Science Centre, School of Surgery, University of Western Australia, Perth, Australia
K Noonan
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Australia
S Ling
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Australia
S Vijayasekaran
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Australia Otolaryngology Unit, School of Surgery, University of Western Australia, Perth, Australia
*
Address for correspondence: Dr Anton Hinton-Bayre, Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Paediatric tonsillectomy is a common procedure and one of the first skills acquired by surgical trainees. Post-tonsillectomy bleeding is one of the most significant complications. This study examined post-tonsillectomy bleed rates associated with technology and level of surgical experience.

Methods:

Data were collected on all tonsillectomies performed by surgical consultants (n = 6) and trainees (n = 10) at affiliated hospitals over a nine-month period. Hospital records were audited for post-tonsillectomy bleeding re-admissions and returns to the operating theatre.

Results:

A total of 1396 tonsillectomies were performed (279 by trainees, 1117 by consultant surgeons). Primary post-tonsillectomy bleed rates were equivalent between trainees and consultants. Secondary bleed rates were significantly greater for trainees (10.0 per cent) compared to consultants (3.3 per cent), as were return to operating theatre rates (2.5 per cent vs 0.7 per cent). Amongst consultants, technology used was not associated with differences in secondary post-tonsillectomy bleeding and returns to the operating theatre.

Conclusion:

Our data suggest that experience of the surgeon may have greater bearing on post-tonsillectomy bleed rates than the technology used.

Keywords

TonsillectomyBleedingHemorrhageLearning Curve
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Supplement S2: ASOHNS Supplement , July 2017 , pp. S35 - S40
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the Royal Australasian College of Surgeons Regional Joint Annual Scientific Meeting (for Western Australia, Northern Territory and South Australia), 8–10 August 2014, Bunker Bay, Western Australia, Australia.

References

1 Australian Commission on Safety and Quality in Health Care. Australian Atlas of Health Care Variation: Tonsillectomy hospital admissions 17 years and under. In: https://www.safetyandquality.gov.au/wp-content/uploads/2015/11/SAQ201_04_Chapter3_v6_FILM_tagged_merged_3-6.pdf [15 March 2017]Google Scholar
2 Royal College of Surgeons of England. National Prospective Tonsillectomy Audit: Final Report. London: Royal College of Surgeons of England, 2005 Google Scholar
3 Burton, MJ, Doree, C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2007;(3):CD004619CrossRefGoogle Scholar
4 Pinder, DK, Wilson, H, Hilton, MP. Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 2011;(3):CD002211Google Scholar
5 Rogers, MA, Fraunfelder, C, Woods, C, Wee, C, Carney, AS. Bleeding following coblation tonsillectomy: a 10-year, single-surgeon audit and modified grading system. J Laryngol Otol 2015;129:S32–7 CrossRefGoogle ScholarPubMed
6 Hessén Söderman, AC, Ericsson, E, Hemlin, C, Hultcrantz, E, Månsson, I, Roos, K et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 2011;121:2322–6CrossRefGoogle Scholar
7 Windfuhr, JP, Schloendorff, G, Baburi, D, Kremer, B. Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Pediatr Otorhinolaryngol 2008;72:1029–40CrossRefGoogle ScholarPubMed
8 Blakley, BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg 2009;140:288–90CrossRefGoogle ScholarPubMed
9 Walker, P, Gillies, D. Post-tonsillectomy hemorrhage rates: are they technique-dependent? Otolaryngol Head Neck Surg 2007;136:S27–31 CrossRefGoogle ScholarPubMed
10 Cardwell, ME, Siviter, G, Smith, AF. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy (review). Evid-Based Child Health 2011;7:244–87CrossRefGoogle Scholar
11 Isaacson, G. Tonsillectomy care for the pediatrician. Pediatrics 2012;130:324–34CrossRefGoogle ScholarPubMed
12 van der Meulen, J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;364:697–702 CrossRefGoogle Scholar
13 Söderman, AC, Odhagen, E, Ericsson, E, Hemlin, C, Hultcrantz, E, Sunnergren, O et al. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol 2015;40:248–54CrossRefGoogle ScholarPubMed
14 Amir, I, Belloso, A, Broomfield, SJ, Morar, P. Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques. Eur Arch Otorhinolaryngol 2012;269:667–71CrossRefGoogle ScholarPubMed
15 Temple, RH, Timms, MS. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195–8CrossRefGoogle ScholarPubMed
16 Belloso, A, Chidambaram, A, Morar, P, Timms, MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:2010–13CrossRefGoogle ScholarPubMed
17 Walner, DL, Miller, SP, Villines, D, Bussell, GS. Coblation tonsillectomy in children: incidence of bleeding. Laryngoscope 2012;122:2330–6CrossRefGoogle ScholarPubMed
18 Gallagher, TQ, Wilcox, L, McGuire, E, Derkay, CS. Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck Surg 2010;142:886–92CrossRefGoogle ScholarPubMed
19 Carney, AS, Harris, PK, MacFarlane, PL, Nasser, PL, Esterman, A. The coblation tonsillectomy learning curve. Otolaryngol Head Neck Surg 2008;138:149–52CrossRefGoogle ScholarPubMed
20 Sarny, S, Ossimitz, G, Habermann, W, Stammberger, H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011;121:2553–60CrossRefGoogle ScholarPubMed
21 MacFarlane, PL, Nasser, S, Coman, W, Kiss, G, Harris, PK, Carney, AS. Tonsillectomy in Australia: an audit of surgical technique and postoperative care. Otolaryngol Head Neck Surg 2008;139:109–14CrossRefGoogle ScholarPubMed
22 Tomkinson, A, Harrison, W, Owens, D, Harris, S, McClure, V, Temple, M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 2011;121:279–88CrossRefGoogle ScholarPubMed
23 Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–3CrossRefGoogle ScholarPubMed
24 Al-Qahtani, AS. Post-tonsillectomy hemorrhage. Monopolar microdissection needle versus cold dissection. Saudi Med J 2012;33:50–4Google ScholarPubMed
25 Awad, Z, Unadkat, S, Ziprin, P, Tolley, NS, Taghi, AS, Darzi, A. Using cumulative summation to draw otolaryngology trainees' learning curves in tonsillectomy. Otolaryngol Head Neck Surg 2013;149:54 CrossRefGoogle Scholar