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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Comparison of postoperative bleeding in pediatric tonsillectomy versus tonsillotomy
Zofnat Asulin1, Ohad Cohen1, Boaz Forer1
1Department of Otolaryngology and Head and Neck Surgery, Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Insights
Pediatric tonsillotomy is safer than tonsillectomy for obstructive sleep apnea, showing lower bleeding rates and fewer readmissions. This study highlights tonsillotomy as a preferred, less invasive option for children.
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.
Objective:
Tonsillar surgery is a common intervention for pediatric obstructive sleep apnea and recurrent tonsillitis. This study compared postoperative bleeding incidence and severity following tonsillotomy and tonsillectomy at a single medical center.
Study Design:
A retrospective cohort study on 1984 pediatric patients (1-18 years old) who underwent surgery during 2004-2011 and 2019-2022. Tonsillectomy was performed during 2004-2011, while tonsillotomy was preferred for obstructive sleep apnea during 2019-2022. Tonsillectomy was performed using cold steel technique with complete removal of tonsillar tissue, while tonsillotomy was conducted using mono- or bipolar diathermy, preserving minimal tissue on the tonsillar capsule.
Setting:
Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University.
Methods:
Outcome measures included postoperative bleeding incidence and severity, surgery duration, hospitalization length, and readmission.
Results:
Tonsillotomy was conducted on 958 (48.3 %) patients, and tonsillectomy was performed on 1026 (51.7 %) patients. Obstructive sleep apnea was the only indication in 1553 (78.3 %) patients. Overall bleeding rate was lower following tonsillotomy (3.9 %) than tonsillectomy (9.5 %) (p < 0.001). Significantly more patients required surgical bleeding control post-tonsillectomy than post-tonsillotomy: 39 (3.7 %) vs. 5 (0.5 %), respectively (p < 0.001). Tonsillectomy resulted in higher readmission rates (11.8 % vs 6.1 %, p < 0.001), more blood transfusions (3 vs. 0), and higher postoperative hemoglobin diminution (1.57 ± 2 vs. 0.94 ± 1 g/dL, p = 0.035). The duration of the surgery was shorter for tonsillotomy (24.7 vs 26.5 min, p = 0.012). Tonsillectomy sustained higher bleeding rates for obstructive sleep apnea patients (7.0 % vs 3.9 %, p = 0.006). For recurrent tonsillitis patients, bleeding rates did not vary between year groups. Older age and tonsillectomy were the most significant risk factors for postoperative bleeding.
Conclusion:
Among children undergoing tonsillar surgery for obstructive sleep apnea, tonsillotomy was associated with a safer postoperative bleeding profile, reduced bleeding severity, and fewer readmissions compared to tonsillectomy.
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