Incidence Of Secondary Haemorrhage Research Articles

Measurement of the True Incidence of Secondary Haemorrhage Post Tonsillectomy

Measurement of the True Incidence of Secondary Haemorrhage Post Tonsillectomy

Teenage and adult tonsillectomy: dose–response relationship between diathermy energy used and morbidity

To determine whether an increase in the use of bipolar diathermy energy to perform a tonsillectomy is associated with an increase in postoperative pain and haemorrhage. Prospective study. District General Hospital. In all, 101 patients above the age of 13 years who underwent a tonsillectomy that involved the use of bipolar diathermy during the study period were included. The cumulative amount of diathermy energy used to perform each tonsillectomy was calculated with the help of a digital stop clock timing device connected to the diathermy foot-pedal. Postoperative pain scores and the incidence of secondary haemorrhage were recorded for each patient at four points in time following surgery, up to the tenth postoperative day. The haemorrhage rates were categorised into three groups (no bleeding, minor bleeding and major bleeding) according to severity. Associations between the diathermy energy used to perform each tonsillectomy and the corresponding postoperative pain scores and secondary bleeding rates were investigated. There was a statistically significant positive relationship between the total amount of bipolar diathermy energy used per tonsillectomy and the pain scores at all the four recorded points in time (r(s) = 0.44-0.72, P < 0.001). When the median energy consumption in the three groups (no bleeding, minor bleeding and major bleeding) were compared using the Kruskal-Wallis test, we found that there was limited evidence of a difference between the groups, but this was not statistically significant at the 5% level [H (2) = 5.374, P = 0.065, 99% CI 0.058-0.071]. Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.

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

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.

TRAUMATIC HYPHAEMA TREATED WITH THE ANTIFIBRINOLYTIC DRUG TRANEXAMIC ACID

During the year 1975 (Jan. 1st-Dec. 31st) 72 patients, consecutively admitted to the eye department of Arhus Kommunehospital with traumatic hyphaema, were treated with the antifibrinolytic drug tranexamic acid. Secondary haemorrhage occurred in one case. This incidence of secondary haemorrhage (1.4%) seems to be the lowest on record. A group of patients from the period 1965-1968, treated identically with the exception of the tranexamic acid, were selected for comparison. This group of 135 patients included 9 cases (6.7%) with a secondary haemorrhage. The difference between these two groups is statistically significant (P less than 0.05).

Treatment of traumatic hyphaema with corticosteroids and mydriatics.

The incidence of secondary haemorrhage following contusion of the eye in a 9‐year series (356 cases) in which patients who had hyphaema were treated locally with corticosteroids and mydriatics was found to be 2.4%. This figure appears to be the lowest on record.