Use of bipolar diathermy in tonsillectomy is a powerful risk factor for hemorrhage

Abstract

Problem: Tonsillectomy remains among the most frequently performed surgical procedures. Bipolar diathermy for tonsillar dissection and/or hemostasis is the most popular technique in the UK. Although it allows good control of intraoperative bleeding, little evidence exists to support diathermy as superior to traditional “cold steel” dissection with only packs and ties for hemostasis. Excessive use of diathermy may further influence the occurrence of secondary haemorrhage. Methods: The National Prospective Tonsillectomy Audit (NPTA) is collecting data on the occurrence of complications following tonsillectomies performed since July 2003 in England and Northern Ireland. Postoperative hemorrhages and other complications within 28 days of surgery leading to delayed discharge, readmission, or return to theatre are recorded. On 23 February 2004, the Audit included data on 13,554 patients, of whom 11,796 (87%) from 252 different hospitals consented to electronic submission of their tonsillectomy data to the central database. Results: We demonstrated an overall hemorrhage rate following tonsillectomy of 3.3%. 2% of patients had a hemorrhage of sufficient severity to require return to the operating theatre. The relative risk of hemorrhage in the bipolar diathermy dissection and hemostasis group (relative to cold steel group) was 3.1 (95% CI 1.9 5.0; P < 0.0001). Use of cold steel for dissection but bipolar diathermy for hemostasis carried an intermediate risk of hemorrhage, (relative risk 2.2; 95% CI 1.3 3.7; P = 0.002). High diathermy power settings were found to be a risk factor for secondary hemorrhage and return to theatre. Adjustment for risk factors including case-mix did not change our findings appreciably. Conclusion: We recommend that bipolar diathermy is used with caution and at low settings for tonsillectomy. Significance: Hemorrhage rates and rates of return to the operating theatre will be presented on the basis of tonsillectomy technique used (cold steel, cold steel and diathermy haemostasis, and bipolar diathermy dissection and hemostasis). Support: None reported.