Are haematological tests warranted prior to tonsillectomy?

Area of Science:

• Otolaryngology
• Hematology
• Health Economics

Background:

• Tonsillectomy and adenoidectomy are common surgical procedures.
• Pre-operative investigations like full blood count (FBC) and group and serum storage (G&S) are frequently performed.
• The necessity of these routine tests in otherwise healthy patients is debated.

Purpose of the Study:

• To assess the current practice of pre-operative phlebotomy for FBC and G&S before tonsillectomy with or without adenoidectomy.
• To compare regional practice with national trends.
• To evaluate the clinical and financial implications of routine pre-operative blood tests.

Main Methods:

• A postal questionnaire was distributed to consultant otolaryngologists in the South West Thames region.
• National practice was assessed through questions posed to attendees of an otolaryngology course.
• Response rates and the frequency of requests for FBC and G&S were analyzed.

Main Results:

• An 86% postal response rate was achieved.
• 67% of regional practitioners requested FBC before tonsillectomy, and 50% before adenoidectomy alone.
• These rates were significantly higher than the 'countrywide' practice (24% and 6% respectively).
• Pre-operative G&S requests were 17% regionally versus 6% countrywide.

Conclusions:

• There is a significant variation in pre-operative blood test practices for tonsillectomy/adenoidectomy.
• Routine FBC and G&S may be non-contributory in clinically healthy patients without specific indications.
• Reducing unnecessary pre-operative investigations has significant financial benefits and safer alternatives like post-operative IV access exist.