Effect of disposable instruments on paediatric post-tonsillectomy haemorrhage rates

Abstract

Background: A government directive aiming to minimise the theoretical risk of acquiring variant Creutzfeld–Jacob Disease (vCJD) from reusable instruments leads to tonsillectomy with disposable instruments becoming standard practice in the UK during 2001. A perceived increase in post-tonsillectomy haemorrhage followed soon after implementation of the directive. Objective: To determine if the introduction of disposable instruments is associated with a statistically significant change in post-tonsillectomy haemorrhage rates in children. Methods: A prospective audit of paediatric tonsillectomy with reusable instruments (n=156) had been undertaken (November 1999–November 2000). All children undergoing tonsillectomy with disposable instruments (n=115) were also studied prospectively (August 2001–December 2001) allowing the reactionary and secondary post-tonsillectomy haemorrhage rates for the two study periods to be compared. We hypothesised no difference in haemorrhage rates between reusable and disposable instruments. Statistical significance was calculated using Fisher's exact test and confidence intervals were established for the differences between study groups. Results: Cold dissection was undertaken in 62 children with reusable instruments and in 76 children with disposable instruments with secondary haemorrhage rates of 3.2% (n=2) and 2.6% (n=2), respectively. Bipolar diathermy dissection was undertaken in 94 children with reusable instruments and in 39 children with disposable instruments with respective secondary haemorrhage rates of 6.4% (n=6) and 12.8% (n=5). No reactionary haemorrhages occurred with reusable or disposable instruments. No difference was found in the overall secondary haemorrhage rate between reusable and disposable instruments (p=0.93, Diff 1.0% (95% CI; −7.4 to +4.6)). Conclusions: The introduction of disposable instruments has not produced a statistically significant increase in paediatric post-tonsillectomy haemorrhage rates in our centre.