Morbidity after pediatric tonsillotomy versus tonsillectomy: A population‐based cohort study

Abstract

Objectives/Hypothesis: To compare and evaluate morbidity following pediatric tonsillectomy (TE) and tonsillotomy (TT) performed due to tonsil-related upper airway obstruction.Study Design: Retrospective population-based cohort study based on data from the Swedish National Patient Register (NPR).Methods: All patients aged 1 to 12 years who were registered in the NPR between January 1, 2007 and December 31, 2015, and who underwent an isolated tonsil surgery (AE adenoidectomy) for the sole indication of upper airway obstruction were included. Postoperative morbidity within 30 days of surgery, including readmission due to hemorrhage and return to theater (RTT), was evaluated and compared between the two groups. A forward stepwise multivariable logistic regression analysis was used to identify independent predictors of postoperative morbidity.Results: In total, 35,060 patients were included in the study, 23,447 of whom underwent TT and 11,613 of whom underwent TE. Readmission due to postoperative hemorrhage, RTT, readmission due to any reason, and contact with healthcare were all less common after TT than after TE. Readmission due to postoperative hemorrhage was significantly more common after TE (2.5%) than after TT (0.6%) (odds ratio: 3.91, 95% confidence interval: 3.20-4.77).Conclusions: This study showed that TT is associated with a statistically significantly lower risk of postoperative complications than TE when performed in children to correct tonsil-related upper airway obstruction. Statistically significant differences were found for all outcome variables, namely, readmission to hospital due to bleeding, RTT, readmission due to any reason, and postoperative contact with healthcare for any reason.

Seinblødning etter tonsilleoperasjon

“…Tonsillotomi (reduksjon av mandlenes størrelse) er de senere årene blitt mer vanlig ved søvnapné hos barn, og det er god evidens for at dette er et bedre inngrep enn tonsillektomi hva angår postoperative smerter og risiko for seinblødning (27,28). Foreløpig er bare et fåtall av våre pasienter behandlet med tonsillotomi, men trolig bør flere barn med tonsillehypertrofi vurderes for dette inngrepet, slik tendensen er i for eksempel Sverige (28). Et viktig motargument mot tonsillotomi er at det er en større tendens til gjenvekst av tonsiller (27) og dermed risiko for ny tonsilleoperasjon grunnet tonsillehypertrofi (29).…”

A single‐centre change of practice audit of pain after coblation intracapsular tonsillectomy compared to standard dissection tonsillectomy in a discrete pediatric population

“…Tonsillectomy techniques using low temperatures and avoiding dissection deep to the tonsillar capsule (intracapsular as against extracapsular) 1…”

“…Tonsillectomy techniques using low temperatures and avoiding dissection deep to the tonsillar capsule (intracapsular as against extracapsular) 1 are associated with reduced postoperative hemorrhage, but severity of postoperative pain is unclear. Use of radiofrequency energy at low temperature to ablate tonsillar lymphoid tissue leaving the posterior capsule intact is called coblation intracapsular tonsillectomy (CIT).…”

Efficacy of bupivacaine infiltration for controlling post‑tonsillectomy pain, duration of surgery and post‑operative morbidities: A systematic review and meta‑analysis

“…A high level of edema within 24 h of the operation in the uvula and the palatopharyngeal and palatoglossal areas may interfere with optimal healing and is associated with increased post-operative morbidities (13). In addition, tonsillectomy causes collateral damage to the pharyngeal muscles and exposes nerve endings (tonsillar glossopharyngeal, maxillary trigeminal and lesser palatine nerve branches) (14), leading to post-operative complications such as severe pain, difficulty swallowing or breathing, as well as vomiting and otalgia (13,15,16).…”