Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit.
BACKGROUND
The National Institute for Health and Clinical Excellence (NICE) issued guidance on surgical techniques for tonsillectomy during a national audit of surgical practice and postoperative complications.


OBJECTIVE
To assess the impact of the guidance on tonsillectomy practice and outcomes.


METHODS
An interrupted time-series analysis of routinely collected Hospital Episodes Statistics data, and an analysis of longitudinal trends in surgical technique using data from the National Prospective Tonsillectomy Audit.


METHODS
Patients undergoing tonsillectomy in English NHS hospitals between January 2002 and December 2004.


METHODS
Postoperative haemorrhage within 28 days.


RESULTS
The rate of haemorrhage increased by 0.5% per year from 2002, reaching 6.4% when the guidance was published. After publication, the rate of haemorrhage fell immediately to 5.7% (difference 0.7%: 95% CI -1.3% to 0.0%) and the rate of increase appeared to have stopped. Data from the National Prospective Tonsillectomy Audit showed that the fall coincided with a shift in surgical techniques, which was consistent with the guidance.


CONCLUSIONS
NICE guidance influenced surgical tonsillectomy technique and in turn produced an immediate fall in postoperative haemorrhage. The ongoing national audit and strong support from the surgical specialist association may have aided its implementation.
Audit
National Prospective Tonsillectomy
NP
London School of Hygiene and Tropical Medicine, Public Health and Policy, Keppel St, London WC1E 7HT, UK. david.cromwell@lshtm.ac.uk
D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D010043:Outcome and Process Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data; D013222:State Medicine; D014068:Tonsillectomy / Q000592:standards* / Q000706:statistics & numerical data; D006113:United Kingdom