Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage

The literature suggests that tonsillectomy techniques are not standardized throughout the world although certain techniques were identified as risk factors for post-tonsillectomy hemorrhage (PTH). This survey was undertaken to evaluate whether surgical techniques are uniformly performed in a nation of 82 million people and if they are related to the incidence of PTH or lethal outcome. A questionnaire was sent personally to the chairmen of 156 departments of otorhinolaryngolog, yincluding 37 University Hospitals to assess the surgical training techniques of tonsil dissection and hemostasis, incidence of primary (< 24 h) and secondary (> 24 h) PTH, number of tonsillectomies performed in 2006 and the number of cases with lethal outcome. The responses were made anonymous for further analysis. The response rate was 88.5% (138/156). A total of 54,572 procedures were performed (mean 395.4, median 361.5, SD 199.5, range 100-975 annually per clinic). Cold dissection was the teaching method of choice (117). Hemostasis was either achieved by suture ligation or bipolar cautery in 91 departments. Secondary bleeding clearly prevailed in the responses (97). One patient experienced a fatal bleeding after tonsillectomy indicated for tumour removal. Two other cases with lethal outcome had undergone surgery elsewhere including one patient who had undergone tonsillotomy. Lethal outcome occurred with an estimated incidence of 1/75,000. The term "conventional tonsillectomy" is loosely defined and includes various surgical techniques for tonsil dissection and methods to achieve hemostasis. The incidence of secondary PTH is related to electrosurgery with statistical significance. Lethal outcome may occur, if ever, rarely but even after intracapsular tonsillectomy.