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Published on: November 6, 2019
Postoperative complications of powered intracapsular tonsillectomy and monopolar electrocautery tonsillectomy in
Douglas R Johnston1, Michael Gaslin, Maurits Boon
1Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Insights
Teens and adults have similar rates of post-tonsillectomy hemorrhage, dehydration, and tonsillitis. However, adults undergoing monopolar electrocautery tonsillectomy (MET) for chronic tonsillitis showed higher hemorrhage risks compared to teens.
Area of Science:
- Otolaryngology
- Surgical Outcomes
- Pediatric Surgery
Background:
- Tonsillectomy is a common surgical procedure.
- Complication rates may differ between adolescent and adult patients.
- Surgical technique may influence outcomes.
Purpose of the Study:
- To compare post-tonsillectomy hemorrhage, dehydration, and recurrent tonsillitis rates in teens versus adults.
- To evaluate outcomes based on surgical technique: powered intracapsular tonsillectomy (PIT) versus monopolar electrocautery tonsillectomy (MET).
- To analyze complication rates by surgical indication within each technique group.
Main Methods:
- Retrospective review of 579 patients (≥12 years old) from 2000-2006.
- Comparison of 200 teens (12-19 years) and 379 adults (>19 years).
- Outcomes analyzed by surgical technique (PIT vs. MET) and indication (chronic tonsillitis, hypertrophy).
Main Results:
- No significant differences in hemorrhage, dehydration, or tonsillitis between teens and adults for PIT or MET.
- Adults undergoing MET showed a trend towards higher hemorrhage rates than teens (p=0.053).
- Adults undergoing MET for chronic tonsillitis had higher hemorrhage rates than teens.
Conclusions:
- Teenage patients undergoing tonsillectomy can be considered unique regarding complication profiles.
- Technique-specific complication rates (PIT vs. MET) showed no significant differences between teens and adults.
- Adults undergoing MET for chronic tonsillitis face a higher risk of postoperative hemorrhage compared to teens.
Objectives:
This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).
Methods:
In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both).
Results:
In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery.
Conclusions:
Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.
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