Tonsillectomy Techniques Differ in Complication Rates
By Laurie Barclay, MD
Medscape Medical News
June 1, 2010 — Tonsillectomy techniques differ in complication rates, according to the results of a case-control study and chart review reported in the June 2010 issue of Otolaryngology–Head and Neck Surgery.
"Questions will remain regarding what is the best procedure," said senior author Craig S. Derkay, MD, FAAP, in a news release. "However, an important point is that that no matter which surgical technique was used for removal of the tonsils in the study, our results demonstrate an acceptable level of safety across all procedures."
The goal of the study was to compare major complication rates in a large cohort of children undergoing adenotonsillectomy by 3 different techniques. These were microdebrider intracapsular tonsillectomy, in which a rotary cutting tool is used to shave tissue; coblation, a controlled, non–heat-driven process using radiofrequency energy; or electrocautery, in which tissue is destroyed by heat conduction from an electrically heated metal probe.
Major complications were defined as postoperative hemorrhage necessitating return to the operating room, or cauterization in the emergency department and dehydration necessitating intravenous fluids or readmission.
At a regional children's hospital, the investigators reviewed records of 4776 patients aged 1 to 18 years who underwent adenoidectomy, tonsillectomy, or adenotonsillectomy by microdebrider, coblator, or Bovie during a 36-month period. To help identify risk factors for major postoperative complications, patients with such complications were each compared vs 2 case-matched control subjects.
Complication rate was 1.7% ± 0.4% (80/4776) overall and 2.3% ± 0.5% for adenotonsillectomy or tonsillectomy alone (80/3362). Different techniques of tonsil removal were associated with varying rates of major complications (34/1235 [2.8% ± 0.9%] for coblation, 40/1289 [3.1% ± 0.9%] for electrocautery, and 6/824 [0.7% ± 0.7%] for microdebrider [P < .001]).
Although age was not a factor associated with postsurgical dehydration (5.33 vs 5.49 years), postoperative hemorrhage occurred in older children (8.5 vs 5.5 years; P < .001). Patients at risk for complications during adenotonsillectomy were not reliably identified by the case-control portion of the study. Neither identity of the surgeon nor participation by resident surgeons was a confounding independent variable.
"In this 'real life' teaching hospital surgical setting in which [3] different techniques of tonsillectomy are routinely performed by a variety of resident and attending surgeons, microdebrider intracapsular tonsillectomy is associated with lower rates of post-tonsillectomy hemorrhage and dehydration when compared to coblation and electrocautery complete tonsillectomy technique," the study authors write.
Limitations of this study include retrospective, observational design; reliance on the accuracy of electronic medical record coding; and the possibility that patients with complications did not return to the study institution for management of their complications.
"No matter which surgical technique was used for removal of the tonsils at our institution, our results demonstrate an acceptable level of safety," the study authors conclude.
This study received no external funding. The study authors have disclosed no relevant financial relationships.