title: Instrumentation and patient characteristics that influence postoperative haemorrhage rates following tonsil and adenoid surgery.
abstract: OBJECTIVE
  To investigate the effect of the type instrumentation used and the age and gender characteristics of patients on postoperative haemorrhage rates following tonsil and adenoid surgery.
  
  
  METHODS
  A retrospective analysis of 13 593 procedures was performed from The Patient Episode Database for Wales between 1 January 1999 and 31 March 2004.
  
  
  METHODS
  National health policy changes created four periods of different instrument usage (reusable, single-use with diathermy, single-use alone, specified single-use with diathermy). These and the age and gender distribution of the patients were examined against four categories of postoperative haemorrhage.
  
  
  METHODS
  Postoperative haemorrhage rates were expressed as the number of complications per operations performed. Primary postoperative haemorrhage that occurred during the initial admission either required a return to theatre [R1] or was managed conservatively [N1]; secondary postoperative haemorrhage that required a return to hospital either returned to theatre [R2] or was managed conservatively [N2], were compared.
  
  
  RESULTS
  Primary haemorrhage with return to theatre doubled, from the baseline rate with reusable instruments, from 0.6% (CI 0.5-0.8) to 1.2% (CI 0.7-1.9) when single-use instruments were introduced and remained high at 1.4% (CI 0.9-2.1) after the withdrawal of single-use diathermy. This haemorrhage rate returned to the baseline rate (0.6% CI 0.3-1.0) when specified single-use instruments were introduced. None of the other haemorrhage rates changed significantly throughout the four observation periods. Adenotonsillectomy and tonsillectomy patients have different age and gender patterns. In a univariate analysis, males over the age of 12 years were twice as likely to have haemorrhage with return to theatre than girls of the same age, 3.8% (CI 3.0-4.7) versus 1.7% (CI 1.4-2.1).
  
  
  CONCLUSIONS
  A significant rise in serious postoperative primary haemorrhage but not secondary haemorrhage was seen following the initial introduction of single-use instruments that reverted to baseline with the introduction of specified single-use instruments. Diathermy does not appear to have affected the haemorrhage rates. There is a distinct age and gender pattern for tonsil and adenoid surgery and risk of postoperative haemorrhage. The use of arbitrary divisions of age may be misleading in studies that examine post-tonsillectomy haemorrhage.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Wales, Cardiff, UK. alun.tomkinson@cardiffandvale.wales.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Tomkinson
authors.forename: S
authors.initials: S
authors.lastname: De Martin
authors.forename: C R
authors.initials: CR
authors.lastname: Gilchrist
authors.forename: M
authors.initials: M
authors.lastname: Temple
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000295:instrumentation; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004209:Disposable Equipment / Q000706:statistics & numerical data*; D017743:Equipment Reuse / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects* / Q000295:instrumentation; D006113:United Kingdom / Q000453:epidemiology