Discussion
Our change in practice for checking for adequate intra-operative
haemostasis has successfully reduced the incidence of post-operative
haemorrhage in our tonsillectomy patients. The most important impact is
the significant absence of any primary post-tonsillectomy bleeding in
the second cycle. Moreover, the data suggests a second benefit of
reducing the number of post-operative bleeds requiring further surgical
exploration and intervention and therefore reducing patients’ morbidity
and mortality. These successes not only have the potential to improve
the post-operative recovery of our paediatric patients, but also reduce
the incidence of re-admissions, length of hospital stay and resource
allocation.
One potential limitation that we have identified in this study is the
use of a single surgeon’s patient workload, preventing us from comparing
operative surgical techniques for the tonsillectomy itself. However, as
the purpose of this study was to compare post-operative complications
following a change in our approach to checking haemostasis, we consider
that using the outcomes of one surgeon should rule out other factors
that could influence the outcomes due to operative technique
variability. To further add support to our results, we would propose
additional audits with a larger patient cohort, from multiple regions
and consultant workloads, so we may determine a consensus for adequate
haemostasis checks, regardless of methods of dissection.