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Effect of disposable instruments on paediatric post-tonsillectomy haemorrhage rates
Mary-Louise Montague1, Michael S W Lee, S S Musheer Hussain
1Department of Otolaryngology, Ward 26, Ninewells Hospital and Medical School, Dundee, Scotland DD1 9SY, UK. mlmontague@btinternet.com
Insights
Switching to disposable instruments for pediatric tonsillectomies did not increase post-tonsillectomy hemorrhage rates. This study found no statistically significant difference in bleeding risks between disposable and reusable surgical tools.
Area of Science:
- Otolaryngology
- Surgical Safety
- Infection Control
Background:
- UK government directive in 2001 mandated disposable instruments for tonsillectomy to prevent variant Creutzfeld-Jacob disease transmission.
- A perceived rise in post-tonsillectomy hemorrhage followed the implementation of disposable instruments.
Purpose of the Study:
- To investigate if the shift to disposable tonsillectomy instruments correlated with a significant change in pediatric post-tonsillectomy hemorrhage rates.
- To compare hemorrhage rates between reusable and disposable instrument use in pediatric tonsillectomy.
Main Methods:
- Prospective audit comparing pediatric tonsillectomies using reusable instruments (n=156, Nov 1999-Nov 2000) with those using disposable instruments (n=115, Aug 2001-Dec 2001).
- Hemorrhage rates (reactionary and secondary) were compared between the two groups.
- Fisher's exact test and confidence intervals were used for statistical analysis.
Main Results:
- No reactionary hemorrhages were observed with either instrument type.
- Secondary hemorrhage rates for cold dissection were similar: 3.2% (reusable) vs. 2.6% (disposable).
- Secondary hemorrhage rates for bipolar diathermy dissection were 6.4% (reusable) vs. 12.8% (disposable).
- Overall secondary hemorrhage rates showed no statistically significant difference between reusable and disposable instruments (P=0.93).
Conclusions:
- The adoption of disposable instruments for pediatric tonsillectomy in this center did not result in a statistically significant increase in post-tonsillectomy hemorrhage.
- Findings suggest disposable instruments are a safe alternative regarding hemorrhage risk in pediatric tonsillectomy.
Background:
A government directive aiming to minimise the theoretical risk of acquiring variant Creutzfeld-Jacob disease from reusable instruments lead 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, difference 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.
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