Adopting pediatric radiofrequency ablation intracapsular tonsillectomy to reduce post-tonsillectomy hemorrhage through a quality improvement framework.

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.