A telephone audit in parallel with the UK national tonsillectomy audit to investigate re-admission as a measure of secondary haemorrhage rate

Nationwide readmissions after tonsillectomy among pediatric patients - United States

OBJECTIVES

1) Investigate incidence and predictors of readmissions after tonsillectomy with or without adenoidectomy (T&A) in children. 2) Identify factors that may predict readmission.

SETTINGS

Nationwide cross-sectional survey of US hospital admissions.

SUBJECTS

and Methods: The 2013 Nationwide Readmission Database (NRD) was used to examine all-cause readmissions within 30 days of T&A in children (age <18 years). Logistic regression was used to analyze the associations of demographics, diagnosis, insurance status, length of index stay, and median household income with readmission.

RESULTS

9079 children undergoing T&A resulted in 327 (3.6%) patients requiring readmission. The average age of children readmitted were 5.0 years and they were 51% female. The most common readmission diagnoses were dehydration (47%), hemorrhage (26%), and pain (16%). The average time to readmission was 7.3 days. The average times to readmission for hemorrhage, pain and dehydration were 6.3, 4.5 and 4.1 days, respectively. Children who needed respiratory intubation (OR = 4.0), had a medical or surgical complication (OR = 3.3), or prolonged hospital stay (OR = 1.03) during the index admission were more likely to be readmitted. Age, gender, payer and socioeconomic status and diagnosis of obstructive sleep apnea (OSA) did not increase the odds of readmission.

CONCLUSIONS

Readmissions in children after T&A were primarily due to dehydration, hemorrhage, and pain. Adequate symptom control in children has the greatest potential to reduce readmission rates following T&A.

Bleeding following coblation tonsillectomy: a 10-year, single-surgeon audit and modified grading system

Objective:

Coblation tonsillectomy can be controversial. This study assessed post-tonsillectomy haemorrhage outcomes for patients operated on by a single experienced coblation-trained ENT surgeon.

Study design:

A retrospective audit of coblation tonsillectomies was performed using the Flinders modification of Stammberger criteria for post-tonsillectomy haemorrhage.

Method:

Case note review, interview and database interrogation were utilised to obtain the dataset. Haemorrhage results were compared to reports in the current literature.

Results:

Of those who underwent coblation tonsillectomy, 3.4 per cent were readmitted to hospital with haemorrhage and 1.3 per cent returned to the operating theatre (0.4 per cent primary haemorrhage and 0.9 per cent secondary haemorrhage). Younger children had a lower risk of returning to the operating theatre than older children or adults (0.3 per cent under the age of 12 years vs 2.0 per cent aged 12 years or older).

Conclusion:

Coblation can be a safe method for tonsillectomy with low complication rates when performed by an experienced ENT surgeon. The Flinders modification of the Stammberger criteria for post-tonsillectomy haemorrhage provides a simple system for data comparison.

Life-threatening posttonsillectomy hemorrhage

OBJECTIVES/HYPOTHESIS

In rare cases, the intensity of posttonsillectomy hemorrhage (PTH) may become life-threatening requiring major surgical means and intensive care. This study was conducted to assess the outcome of life-threatening PTH and its clinical features in a larger patient population.

STUDY DESIGN AND METHODS

Cases occurring during the clinical career of the authors were collected and added by own expert reports to lawsuits and professional boards in cases who had undergone tonsillectomy elsewhere. PTH resulting in hemorrhagic shock requiring resuscitation, ligature of greater arteries in the neck, tracheotomy, packing of the pharynx, embolization, and/or blood transfusions were labeled as life threatening.

RESULTS

Seventy-nine patients had experienced life-threatening PTH between 1980 and 2006, comprising 36 children and 39 adults (age not stated for 4 patients). There were 42 female and 34 male patients (gender not stated for 3 patients). Only nine patients experienced primary bleeding, secondary PTH clearly prevailed (n = 70; 89.6%) in this patient population. Single episodes of life-threatening PTH were reported for 11 cases including two patients with and nine without remaining neurological sequelae. Three of the 11 patients were children (age not stated for 2 patients). Repeated episodes of life-threatening PTH occurred in 68 patients (32 children) including eight with remaining sequelae.

CONCLUSIONS

Life-threatening PTH is an apparently rare, most commonly unpredictable state of emergency requiring a clear management protocol. However, repeated episodes of bleeding classified most clinical courses and should alert the medical staff. Although the bleeding rate after tonsillectomy in children is generally acknowledged to be very low, the rate of life-threatening PTH is apparently higher than in adults. Gender seems not to be a risk factor. Secondary PTH can no longer be assessed to be less dangerous than primary PTH.