Coblation intracapsular tonsillectomy: A cohort study of NHS practice in England using Hospital Episode Statistics.

OBJECTIVES: To identify paediatric intracapsular Coblation tonsillectomy procedures from routine administrative data in England, and determine their safety. DESIGN: Retrospective observational cohort study of four ENT centres using routine data from Hospital Episode Statistics (HES). SETTING: Acute NHS trusts in England conducting exclusively intracapsular Coblation tonsillectomy. PARTICIPANTS: Children (≤16 years old) undergoing bilateral intracapsular Coblation tonsillectomy. MAIN OUTCOME MEASURES: Number of procedures, readmissions for pain, readmissions for bleeding and requirement for additional surgery for regrowth. RESULTS: A total of 5525 procedures were identified. The median patient age was 4 (IQR 2-5). In-hospital complications occurred in 1%, with 0.1% returning to theatre for arrest of primary tonsil bleeding. Almost half of the procedures were conducted as a day-case (44%), with only a small proportion staying in hospital more than one night (7%). Within 28 days, 1.2% of patients were readmitted with bleeding, 0.7% with infection and 0.3% with pain; 0.2% of patients required return to theatre for control of secondary haemorrhage. Longitudinal follow-up has found that revision tonsil surgery is 0.3% at 1 year (n = 4498), 1.1% at 2 years (n = 2938), 1.7% at 3 years (n = 1781), 1.9% at 4 years (n = 905) and 2.2% at 5 years (n = 305). CONCLUSIONS: Intracapsular coblation tonsillectomy safety outcomes in this study show primary and secondary bleeding rates and emergency return to theatre rates are lower than all tonsillectomy techniques reported in the National Prospective Tonsillectomy Audit and also lower than previously published Hospital Episode Statistics analysis of tonsillectomy procedures.

Simultaneous cochlear implantation in children: the Great Ormond Street experience.

OBJECTIVES: To analyse the surgical aspects and safety of bilateral simultaneous cochlear implantation in children. METHODS: A retrospective case series at a tertiary paediatric centre in the United Kingdom. Surgical times, analgesia and antiemetic use, and complications were analysed for the first 25 bilateral simultaneous cochlear implants performed at Great Ormond Street Hospital for Children between September 2007 and December 2009. These were compared with a consecutive group of sequentially implanted children whose second implant was performed during the same period. RESULTS: Total time for simultaneous implantation was significantly less than the cumulative time required for sequential implantation (P < 0.05). In addition, the number of paracetamol, non-steroidal anti-inflammatory, and antiemetic doses was significantly less for simultaneous implantation than for sequential implantation (P < 0.001). Furthermore, the number of doses of analgesia and antiemetic required for simultaneous implantation were no higher than for single-side surgery (P > 0.05). No difference in complication rates was seen between the groups. DISCUSSION: Bilateral simultaneous cochlear implantation in children is safe and results in a reduction in total theatre time when compared with the cumulative time required for sequential implantation. Simultaneous implantation also reduces total analgesia and antiemetic requirements and length of stay to levels comparable with single-side implantation.