Comparison of postoperative bleeding in pediatric tonsillectomy versus tonsillotomy

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Sleep Medicine

Background:

• Tonsillar surgery is common for pediatric obstructive sleep apnea (OSA) and recurrent tonsillitis.
• Tonsillotomy and tonsillectomy are surgical options with varying outcomes.

Purpose of the Study:

• To compare postoperative bleeding incidence and severity between tonsillotomy and tonsillectomy in pediatric patients.
• To evaluate other outcomes such as hospitalization length and readmission rates.

Main Methods:

• Retrospective cohort study of 1984 pediatric patients (ages 1-18) from 2004-2011 (tonsillectomy) and 2019-2022 (tonsillotomy).
• Tonsillectomy used cold steel; tonsillotomy used diathermy, preserving tonsillar capsule.
• Outcomes measured: bleeding incidence/severity, surgery duration, hospitalization, readmission.

Main Results:

• Tonsillotomy (48.3%) had lower bleeding rates (3.9%) than tonsillectomy (9.5%) (p < 0.001).
• Tonsillectomy led to higher surgical bleeding control needs (3.7% vs 0.5%), readmissions (11.8% vs 6.1%), and hemoglobin drop.
• Older age and tonsillectomy were significant risk factors for postoperative bleeding.

Conclusions:

• Tonsillotomy is associated with a safer postoperative bleeding profile in children with OSA compared to tonsillectomy.
• Tonsillotomy demonstrated reduced bleeding severity and fewer readmissions.
• The findings support tonsillotomy as a preferred surgical approach for pediatric OSA.