title: Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden.
abstract: OBJECTIVE
  To analyse post-tonsillectomy haemorrhage (PTH) rates related to technique for dissection and haemostasis.
  
  
  METHODS
  Register study from the National Tonsil Surgery Register in Sweden (NTSRS).
  
  
  METHODS
  All patients, subjected to tonsillectomy (TE) without adenoidectomy from 1 March 2009 to 26 April 2013, were included in the study. The surgeon reports data about technique and early PTH, while late PTH is reported by the patient in a questionnaire 30 days after surgery.
  
  
  RESULTS
  15734 patients with complete data concerning technique for dissection and for haemostasis were identified in the NTSRS. Techniques used were cold steel dissection with uni- or bipolar diathermy haemostasis (65.3%), diathermy scissors (15.7%), coblation (9.1%), cold steel dissection with cold haemostasis (7.4%) and ultrascision (2.5%). Early and late PTH were reported in 3.2% and 9.4% of the cases, respectively, and return to theatre (RTT) in 2.7%. The rates for PTH and RTT related to technique were analysed. Compared with cold dissection+ cold haemostasis, late PTH rate was 2.8 times higher after cold dissection + hot haemostasis, 3.2 times higher after coblation, 4.3 times higher after diathermy scissors and 5.6 times higher after ultrascision. The risk for RTT was higher for all hot techniques except for coblation, while ultrascision resulted in a lower risk for early PTH.
  
  
  CONCLUSIONS
  All hot techniques resulted in a higher risk for late PTH compared with cold steel dissection +cold haemostasis. The risk for RTT was higher for all hot techniques except for coblation, while ultrascision resulted in a lower risk for early PTH. An early PTH was associated with an increased risk for late PTH.
authors.affiliation: Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden.|Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A-C Hessén
authors.initials: AC
authors.lastname: Söderman
authors.affiliation: Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.|Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Odhagen
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Ericsson
authors.affiliation: Sollentuna Specialist Clinic, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Hemlin
authors.affiliation: Department of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Hultcrantz
authors.affiliation: Department of Otorhinolaryngology, Ryhov County Hospital and Futurum, the Academy for Health and Care, County Council, Jönköping, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Sunnergren
authors.affiliation: Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.|Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Stalfors
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D014068:Tonsillectomy / Q000009:adverse effects*; D055815:Young Adult