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

Area of Science:

• Otolaryngology
• Surgical Innovation
• Patient Safety

Background:

• Elective tonsillectomy is a common procedure.
• Introduction of new surgical instruments requires careful evaluation.
• Single-use instruments were introduced to potentially improve safety and efficiency.

Purpose of the Study:

• To audit the impact of single-use instruments on postoperative morbidity after tonsillectomy.
• To identify complications associated with the initial design of single-use bipolar diathermy forceps.
• To evaluate the effectiveness of a redesigned single-use diathermy forceps.

Main Methods:

• A retrospective audit of 145 patient case notes undergoing tonsillectomy over a 6-week period post-introduction of single-use instruments.
• Analysis of secondary hemorrhage incidence, re-admission rates, and need for emergency surgery.
• Animal tissue experiments and design analysis of initial single-use bipolar diathermy.
• A second audit following the replacement of the initial instrument with a redesigned version.

Main Results:

• The initial audit showed 9.5% re-admission for secondary hemorrhage, with 4% requiring emergency surgery.
• Hemostasis with ties resulted in no re-admissions.
• Hemostasis with initial single-use bipolar forceps led to 16.8% re-admission and 7% emergency surgery.
• The second audit after instrument redesign demonstrated a significant reduction in postoperative morbidity.

Conclusions:

• The introduction of single-use instruments for tonsillectomy initially correlated with increased postoperative morbidity, specifically secondary hemorrhage.
• Deficiencies in the initial single-use bipolar diathermy design were identified and addressed through redesign.
• Repeated audit cycles are crucial for identifying and mitigating complications associated with new surgical instrument implementation.