Adenoidectomy Technique in the United Kingdom and Postoperative Hemorrhage

Abstract

Objective. To investigate the incidence of postoperative hemorrhage and its risk factors after adenotonsillectomy. Study Design. A prospective cohort study as part of the National Prospective Tonsillectomy Audit. Setting. National Health Service and private hospitals in England and Northern Ireland. Subjects and Methods. National Prospective Tonsillectomy Audit methodology was followed with a nonrandomized prospective observational cohort methodology and data collection. Results. A total of 33,921 patients underwent tonsillectomy; of these, 9900 underwent adjunctive adenoidectomy. Traditional curette adenoidectomy (without any diathermy use at all) was performed in 6871 patients. Suction diathermy technique was used in 1489 patients. Hemorrhage rates were calculated for these main adenoidectomy technique groups and compared by calculation of risk ratios. Both early and late hemorrhage rates for suction diathermy were found to be 0.07% (n = 1 in each case). In the traditional curette group, these rates were 0.3% (n = 19) and 0.2% (n = 14), respectively. The risk ratio for hemorrhage overall was 3.6 for curette adenoidectomy compared with suction diathermy (95% confidence interval, 0.86-14.9; P = .06). The data suggest comparable hemorrhage rates in both adenoidectomy technique groups and fail to demonstrate diathermy usage as a risk factor for hemorrhage following adenoidectomy despite a clear interaction between diathermy usage and subsequent hemorrhage in tonsillectomy. Conclusion. Use of suction diathermy in adenoidectomy appears to have a similar safety profile to conventional techniques and may offer additional benefits over traditional adenoid curettage. Further clinical and laboratory-based research into the complex interaction between diathermy usage and both adenoid and tonsillar tissue is warranted.