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.