A significantly greater than normal secondary haemorrhage rate was noted in patients who had undergone tonsillectomy or adenotonsillectomy as waiting list ‘initiative’ cases within an alternative healthcare provider setting, compared with patients undergoing the same surgery within a primary healthcare trust (17.8 vs 3.9 per cent, respectively; p < 0.001).
An audit was therefore set up to examine any variations in practice which may have caused this difference. Duration of analgesic prescription was identified as the only significant variable, and this was subsequently altered from three to seven days, to match the primary trust's protocol. Completion of the audit loop showed that the difference in secondary haemorrhage rates between the two provider sites had ceased to be significant (5.9 vs 3 per cent; p > 0.1). We conclude that adequate analgesia, for the first week post-tonsillectomy, is essential in order to keep the secondary haemorrhage rate within an acceptable range.