Key Messages From the National Prospective Tonsillectomy Audit

Abstract

The results confirm that "hot" tonsillectomy techniques carry a substantially elevated risk of postoperative hemorrhage when diathermy is used as a dissection tool in tonsillectomy.

Audit in clinical practice

“…The audit showed elevated hemorrhage rates in tonsillectomies performed using diathermy for dissection and hemostasis when compared to cold steel dissection and ties to achieve hemostasis [1].…”

Guillotine versus dissection tonsillectomy: randomised, controlled trial

“…Although the difference was non-significant ( p > 0.1, McNemar two-sided test), we found a lower proportion of secondary haemorrhage for guillotine tonsillectomy (0 per cent) than dissection tonsillectomy (3 per cent), reflecting the earlier results of Roberts et al 13 The National Prospective Tonsillectomy Audit found that bipolar diathermy haemostasis carried a slightly increased relative risk of secondary haemorrhage compared with the use of ties alone. 2 The difference in secondary haemorrhage rates may reflect a greater requirement for bipolar diathermy haemostasis in the dissection group. However, it must be reiterated that the difference between techniques in this respect did not achieve statistical significance.…”

“…In the above-mentioned national audit, tonsillectomy using coblation or diathermy instruments for dissection was shown to result in higher rates of post-operative haemorrhage than cold steel techniques. 2 There have been no well controlled trials justifying concerns about guillotine-related haemorrhage, incomplete tonsillar excision or inadvertent trauma to local structures. However, a recent retrospective analysis of 168 guillotine tonsillectomies suggested that intraoperative bleeding was minimal and that complication rates were equivalent to those of dissection tonsillectomy.…”

“…It is currently the most commonly performed technique, being used in 53 per cent of tonsillectomy cases in a recent National Prospective Tonsillectomy Audit. 2 Other technological advances include the use of monopolar or bipolar diathermy, carbon dioxide and potassium titanyl phosphate lasers, coblation, and the harmonic scalpel; however, all have their drawbacks. In the above-mentioned national audit, tonsillectomy using coblation or diathermy instruments for dissection was shown to result in higher rates of post-operative haemorrhage than cold steel techniques.…”

“…1 Over 50 000 tonsillectomies were performed in National Health Service trusts in England between July 2003 and September 2004. 2 Various tonsillectomy instruments and techniques have evolved over time, with the first tonsillar guillotine being developed in the eighteenth century. 1,3 Perhaps the most recognised is Popper's haemostatic guillotine, developed and introduced in 1929 by Otto Oswald Popper.…”