International journal of pediatric otorhinolaryngology · 2026
Adopting pediatric radiofrequency ablation intracapsular tonsillectomy to reduce post-tonsillectomy hemorrhage through a quality improvement framework.
СтатьяНазвание и аннотация: Перевод в очереди
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Rhee Jess, Gandhi Karan, Dzioba Agnieszka, Eager Kathryn, Hu Kerry, Sattar Othman Maryam, Qadree Abdul, Paradis Josee, Husein Murad, Graham M Elise, Strychowsky Julie E, You Peng
Аннотация
BACKGROUND: Intracapsular tonsillectomy reduces secondary post-tonsillectomy hemorrhage (PTH) but extracapsular approach remains the most predominant approach in tonsillectomy. Transitioning the surgical technique for common procedures like tonsillectomy can be challenging and require careful planning.
OBJECTIVE: To reduce secondary PTH by adopting radiofrequency ablation intracapsular tonsillectomy, widely reported as Coblation intracapsular tonsillectomy (CIT), at an academic paediatric centre.
METHODS: This quality improvement (QI) initiative applied the Institute for Healthcare Improvement Model for Improvement through four plan-do-study-act (PDSA) cycles, reported per SQUIRE 2.0. Tonsillectomies from January 2024 to June 2025 were evaluated in a pre- and post-intervention design. Monthly secondary PTH rate was assessed with statistical process control (SPC) charts, and secondary, process, and balancing measures were compared with extracapsular monopolar tonsillectomy (EMT).
RESULTS: Of 474 tonsillectomies, 262 were CIT and 212 EMT. SPC showed special-cause variation coinciding with CIT adoption: emergency department visits for hemorrhage fell from 6.2% to 1.0% and returns to the operating room from 3.0% to 0.1%. No CIT patient required reoperation for secondary PTH versus 1.9% of EMT patients (p = .026). CIT had longer operative times (35.7 vs 28.6 min, p < .001). Residents participated in 92.0% of CIT cases. One CIT patient sustained intraoperative arterial hemorrhage requiring embolization and recovered fully.
CONCLUSION: Adopting CIT within a QI framework was associated with sustained reductions in secondary PTH and healthcare utilization despite longer operative times and a learning curve. The implementation pathway, including its safety lessons, described may aid others interested in transitioning toward CIT.
OBJECTIVE: To reduce secondary PTH by adopting radiofrequency ablation intracapsular tonsillectomy, widely reported as Coblation intracapsular tonsillectomy (CIT), at an academic paediatric centre.
METHODS: This quality improvement (QI) initiative applied the Institute for Healthcare Improvement Model for Improvement through four plan-do-study-act (PDSA) cycles, reported per SQUIRE 2.0. Tonsillectomies from January 2024 to June 2025 were evaluated in a pre- and post-intervention design. Monthly secondary PTH rate was assessed with statistical process control (SPC) charts, and secondary, process, and balancing measures were compared with extracapsular monopolar tonsillectomy (EMT).
RESULTS: Of 474 tonsillectomies, 262 were CIT and 212 EMT. SPC showed special-cause variation coinciding with CIT adoption: emergency department visits for hemorrhage fell from 6.2% to 1.0% and returns to the operating room from 3.0% to 0.1%. No CIT patient required reoperation for secondary PTH versus 1.9% of EMT patients (p = .026). CIT had longer operative times (35.7 vs 28.6 min, p < .001). Residents participated in 92.0% of CIT cases. One CIT patient sustained intraoperative arterial hemorrhage requiring embolization and recovered fully.
CONCLUSION: Adopting CIT within a QI framework was associated with sustained reductions in secondary PTH and healthcare utilization despite longer operative times and a learning curve. The implementation pathway, including its safety lessons, described may aid others interested in transitioning toward CIT.