Coblation intracapsular tonsillectomy: A cohort study of NHS practice in England using Hospital Episode Statistics

Abstract

Objectives To identify paediatric intracapsular Coblation tonsillectomy procedures from routine administrative data in England, and determine their safety. Design Retrospective observational cohort study of four ENT centres using routine data from Hospital Episode Statistics (HES). Setting Acute NHS trusts in England conducting exclusively intracapsular Coblation tonsillectomy. Participants Children (≤16 years old) undergoing bilateral intracapsular Coblation tonsillectomy. Main outcome measures Number of procedures, readmissions for pain, readmissions for bleeding and requirement for additional surgery for regrowth. Results A total of 5525 procedures were identified. The median patient age was 4 (IQR 2–5). In‐hospital complications occurred in 1%, with 0.1% returning to theatre for arrest of primary tonsil bleeding. Almost half of the procedures were conducted as a day‐case (44%), with only a small proportion staying in hospital more than one night (7%). Within 28 days, 1.2% of patients were readmitted with bleeding, 0.7% with infection and 0.3% with pain; 0.2% of patients required return to theatre for control of secondary haemorrhage. Longitudinal follow‐up has found that revision tonsil surgery is 0.3% at 1 year (n = 4498), 1.1% at 2 years (n = 2938), 1.7% at 3 years (n = 1781), 1.9% at 4 years (n = 905) and 2.2% at 5 years (n = 305). Conclusions Intracapsular coblation tonsillectomy safety outcomes in this study show primary and secondary bleeding rates and emergency return to theatre rates are lower than all tonsillectomy techniques reported in the National Prospective Tonsillectomy Audit and also lower than previously published Hospital Episode Statistics analysis of tonsillectomy procedures.

Diagnostic tonsillectomy for histology in children: An audit of practice at a tertiary paediatric centre over 20 years

“…This may have a lower risk of post‐operative haemorrhage, although haemorrhage rates following tonsil biopsy are not often reported; tonsil biopsy is often an exclusion criterion in publications discussing factors affecting post‐tonsillectomy haemorrhage rates 2 . A tonsil biopsy could be combined with intracapsular tonsillotomy if there are obstructive symptoms, which may have a lower bleeding rate than extracapsular techniques 12 …”

“…2 A tonsil biopsy could be combined with intracapsular tonsillotomy if there are obstructive symptoms, which may have a lower bleeding rate than extracapsular techniques. 12…”

Intracapsular tonsillectomy: setting a new standard

“…Only 1.7% of claims were made after ICT as opposed to ECT, and the seven reported deaths were after ECT, exclusively [14 ▪ ]. In addition, a database review of English hospitals exclusively employing coblation ICT showed a 1.2% readmission rate and 0.2% reoperation rate for posttonsillectomy hemorrhage [15 ▪ ]. Revision tonsil surgery occurred in 0.3% at 1 year and 2.2% at 5 years [15 ▪ ].…”

A retrospective observational cohort study evaluating the postoperative outcomes of intracapsular coblation tonsillectomy in children

“…It could track the revision rate up to 5 years to be 2.2%. However, multiple centers and surgeons were involved, and the characteristic of the patients, including any existing comorbidities, were not analyzed 15 .…”