High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

Abstract

To examine the incidence of haemorrhage following tonsillectomy, to explore the usefulness of antibiotic in preventing postoperative haemorrhage and to examine if the haemorrhage depended on the level of expertise of the surgeon. A retrospective review analysing tonsillectomy method, the rate secondary haemorrhage, the grade of operating surgeon. A v 2 analysis was used to determine the statistical difference between the haemorrhage rates of different tonsillectomy methods. One thousand three hundred and thirty-six tonsillectomies were performed during this period by four different methods: 615 by cold steel dissection, 582 by Coblation, 32 by bipolar dissection and 107 by Helica thermal coagulation. 621 tonsillectomies were performed by Consultant grade and middle grades performed 693 operations. 124 patients (9.3 %) were readmitted with haemorrhage. The secondary haemorrhage requiring surgery for controlling bleeding for cold steel dissection method was 1.5 % compared to 6.7 % for coblation method (P \ 0.01 %), 6.3 % for bipolar dissection and 1.9 % for Helica thermal coagulation method. Overall consultants had a post tonsillectomy haemorrhage rate of 5.5 % and middle grades had a rate of 3.7 %. 86.5 % of the patients were already on routine prophylactic oral antibiotics at the time of presentation with haemorrhage needing surgical arrest and 13.5 % were not on antibiotics (P \ 0.05 %). There was statistically significant difference in secondary haemorrhage rate between coblation and cold steel dissection methods. Coblation tonsillectomies had an increased need for operative intervention to control secondary haemorrhage. Routine use of antibiotic and expertise of operating surgeon had no bearing on secondary haemorrhage rate.

Comparison of Cold Technique Tonsillectomy and Thermal Welding Tonsillectomy at Different Age Groups

“…No significant difference was found between the three groups regarding postoperative early or late bleeding (Ozkiris et al, 2013). In the retrospective study by Praveen et al (2013) on 1,336 tonsillectomy patients, postoperative hemorrhage incidence was found to increase in coblation patients following tonsillectomy with coblation, cold technique, helica thermal and bipolar cautery. In a study by Chimona et al (2008) on pediatric age group, perioperative bleeding was higher in the group treated with cold dissection when compared to cold technique radiofrequency and thermal welding tonsillectomy.…”

Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

“…Controversy still persists in the world literature regarding the occurrence of significantly increased bleeding rates after hot tonsillectomy methods. Some studies have compared post-operative haemorrhage among electrocautery or coblation tonsillectomy patients versus cold dissection patients, and found significant increase in the first [18,[21][22][23]. However, other studies reported no significant differences [14], and concern was expressed that the number of well designed, large, randomised, controlled trials was insufficient to detect small differences in secondary haemorrhage rates [13].…”

Post-Tonsillectomy Hemorrhage and Other Complications

“…Praveen et al reported 6.3% return to theatre for Coblation method and overall secondary hemorrhage for Coblation was 12.9% 10 . In our study, only 1.09% of patients return to theatre was recorded.…”

“…In our study, post-tonsillectomy bleeding incidence was 3.8%. Praveen et al reported 9.3% readmission with secondary hemorrhage 10 . Clark et al reported a rate of 1.5% after Coblation method, all patients were managed conservatively 11 .…”