Nakhla V, Kale S, Trotter M, Pearman K, Wake M.
Single use instruments and the risk of Post Tonsillectomy hemorrhage.
Pak J Otolaryngol Jan ;20(3):53-6.

Single use instruments for tonsillectomy were introduced in the U.K in Spring 2001 due to the theoretical risk of contracting variant Creutzfeldt-Jacob disease (vCJD) from contaminated surgical instruments. This study aims to compare the post-tonsillectomy hemorrhage rates in patients who underwent tonsillectomy with re-usable instruments with those that underwent the same operation with disposable instruments. Data was collected retrospectively from case notes of 342 patients who underwent tonsillectomy within our department, with single use instruments over a 6-month period in 2001. This data was compared with data from case notes of 815 patients who underwent the same operation with re-usable instruments performed the previous year. The data was collected by filling in computer scannable proformas from review of notes of patients who underwent tonsillectomy during the period of the study. The data was analysed statistically. We hypothesised that there was no difference in the posttonsillectomy haemorrhage rates between operations performed with re-usable instruments and single use instruments. The number and rate of patients re-admitted with secondary hemorrhage in the two groups, (re-usable and single use instruments) was collected and compared. We also compared the rates of patients with post-tonsillectomy hemorrhage requiring surgical intervention. The rate of secondary post-tonsillectomy haemorrhage was found to increase from 8.2% with re-usable instruments to 9.9% with single use instruments. However, this increase was not statistically significant: Chi squared=0.69, p=0.405. The percentage of patients with a secondary haemorrhage serious enough to require surgical intervention under general anaesthesia doubled from 10.4% with re-usable instruments to 20.6% with single use instruments. The difference was not statistically significant (p=0.233, Fisher exact test). Although the hospital re-admission rate for secondary post-tonsillectomy haemorrhage increased, and the return to theatre rates doubled with single use instruments, both these rates were not statistically significant. We therefore conclude that disposable instruments for tonsillectomy did not significantly increase risk of secondary post-tonsillectomy haemorrhage.

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