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The utility of common surgical instruments for pediatric adenotonsillectomy
Prasad John Thottam1, Jennifer R Christenson, David S Cohen
1Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan, U.S.A; Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, U.S.A; Michigan State University, East Lansing, Michigan, U.S.A.
Insights
Monopolar cautery significantly reduces pediatric adenotonsillectomy surgical time and costs compared to PlasmaBlade and radiofrequency ablation, with similar postoperative hemorrhage rates. This makes it a more cost-effective and time-efficient surgical instrumentation choice.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Economics
Background:
- Adenotonsillectomy is a common pediatric surgical procedure.
- Surgical instrumentation choice can impact procedure efficiency and cost.
- Evaluating different instruments is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare monopolar electrocautery, radiofrequency ablation, and PlasmaBlade for pediatric adenotonsillectomy.
- To assess the correlation between surgical instrumentation and intraoperative surgical time.
- To evaluate the impact on postoperative hemorrhage and healthcare costs.
Main Methods:
- Retrospective chart analysis of 1,280 pediatric adenotonsillectomy cases (2011-2013).
- Comparison of surgical time, postoperative hemorrhage rates, and associated costs.
- Statistical analysis using ANOVA and chi-squared tests.
Main Results:
- Monopolar cautery demonstrated significantly faster surgical times compared to PlasmaBlade and radiofrequency ablation.
- No significant difference in postoperative hemorrhage rates was observed between the instruments.
- Average costs were substantially lower for monopolar cautery ($30.04) versus PlasmaBlade ($246.95) and radiofrequency ablation ($244.32).
Conclusions:
- Monopolar electrocautery is a more cost-effective and time-efficient surgical instrumentation for pediatric adenotonsillectomy.
- It offers comparable postoperative hemorrhage rates to newer technologies.
- This study supports the use of monopolar cautery for improved efficiency and reduced healthcare costs.
Objectives/Hypothesis:
To evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage, and associated healthcare cost for pediatric adenotonsillectomy.
Study Design:
Retrospective chart analysis.
Methods:
Chart data were collected from pediatric patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and χ(2) analysis was utilized to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.
Results:
A total of 1,280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the three instrumentation groups. When examining the various instruments' effect on procedure time in minutes, univariate ANOVA demonstrated a significant difference overall among the three groups (F = 8.79; P < .001). Post-hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either PlasmaBlade (P = .03) or radiofrequency ablation (P < .001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ(2) = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated to be $30.04 for monopolar cautery, $246.95 for PlasmaBlade, and $244.32 for radiofrequency ablation.
Conclusions:
The ideal surgical instrumentation should be cost and time efficient with a low complication rate. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates, and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
Level Of Evidence:
4.
