Intracapsular Tonsillectomy With Monopolar Cautery-A Cost-Effective Surgical Technique

To illustrate improved posttonsillectomy hemorrhage rates with a novel cost-effective monopolar intracapsular tonsillectomy (ICT) technique.

Retrospective cohort.

Single physician's experience at a Midwest private practice.

A single surgeon's chart review of 576 pediatric patients who underwent a tonsillectomy in the last 20 years was completed. In total, 331 cases were treated with ICT performed with a novel monopolar bovie electrocautery technique, as opposed to the more widely used microdebrider or coblator techniques. In total, 246 were treated with the traditional extracapsular tonsillectomy (ECT) technique using monopolar electrocautery.

Of the 331 ICTs performed, one postoperative hemorrhage requiring intervention was identified, resulting in an ICT postoperative bleed rate of 0.3%. Of the 246 ECTs performed, 9 postoperative bleeds requiring intervention were identified, resulting in an ECT postoperative bleed rate of 3.7%. In this cohort, the relative risk of developing a bleed with ECT was 12 times higher than the bleed risk with ICT (P = .018). Every 30 cases of ICT prevented one tonsil bleed (number needed to treat [NNT] = 29.8). Potential savings of ICT with monopolar cautery is $1.5 to $1.6 million for every 10,000 cases that transition to ICT with electrocautery from a microdebrider or coblator technique.

ICT with monopolar electrocautery resulted in a significantly decreased bleed rate compared to the ECT technique in this single surgeon experience and at a much lower cost compared to the more widely used microdebrider or coblator techniques.