Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle

Abstract

The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage. Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Kunststoff-Einmalinstrumente aus Hochleistungspolymer bei Tonsillektomien und Adenotomien

“…Die Indikation zur Tonsillektomie wurde bei 47 Patienten, davon 13 Kinder (3,5-9,6 Jahre), 12 Jugendliche (11,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)9 Jahre), 21 Erwachsene (21,3-52,3 Jahre), ein Senior (71,2 Jahre), aufgrund der Diagnose "chronisch rezidivierende Tonsillitis" und bei 3 Patienten,davon 2 Erwachsene (24,4/39,0 Jahre), ein Jugendlicher (15,5 Jahre), bei "Peritonsillarabszess" gestellt. …”

“…Hier wurden Bedenken zur funktionalen Qualität der Instrumente geäußert, nachdem es zu vermehrten intra-und postoperativen Komplikationen kam [7]. So kam es zu einer Zunahme der stationären Wiederaufnahme in einem englischen Zentrum um 6,5%.…”

Ligation Versus Bipolar Diathermy for Hemostasis in Tonsillectomy: A Comparative Study

“…This was confirmed by retrospective audit done throughout the UK, which reported an increase of secondary haemorrhage as high as 16.85% with diathermy. However, cochrane review of dissection versus diathermy for tonsillectomy demonstrated reduced intraoperative bleeding but increased pain in the diathermy group, with no significant difference in secondary haemorrhage [16].…”

Fair and Ethical Trade in Health: Lessons from Surgical Instruments

“…These were largely made in Pakistan and were eventually rejected due to quality issues, particularly clinicians' concerns that they may be increasing patient morbidity. [2][3][4] However, the surgical instrument industry in Pakistan manufactures some instruments to the highest international standards as well as the cheaper, disposable and lower-quality products. I can assure you there's a fair chance you have at some point operated with a Pakistani-manufactured instrument without knowing the difference; millions of these are bought by the NHS every year.…”