Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

Abstract

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

“…"Cold" methods, where no heat is used, include cold steel dissection, guillotine, microdebrider, harmonic scalpel, and plasma blade. "Hot" methods include electrocautery (monopolar or bipolar), coblation (radiofrequency-controlled ablation), or laser [2,8,[31][32][33][34][35]. To date, no single technique has been widely accepted as the most superior method for performing the surgery [2,31,36,37].…”

“…To date, no single technique has been widely accepted as the most superior method for performing the surgery [2,31,36,37]. Indication for surgery also does not determine the method of tonsillectomy [8]. The technique chosen by surgeons varies with a surgeon's experience and comfort level with any specific technique [6].…”

“…The cold steel tonsillectomy is completed with reusable, resterilizable metal surgical instruments. The palatine tonsil is dissected free (total tonsillectomy completed) of the peritonsillar space and bleeding is controlled by ligation or electrocautery [8,35]. Reusable metal instruments are commonly used in surgery; however, in the United Kingdom (UK) in the 1990s, this practice was brought into question with concerns of spreading Creutzfeldt-Jakob disease between patients.…”

“…It is thought to be more time consuming than other methods; however, this has not always been substantiated in the literature [44,45]. It is associated with more intra-operative blood loss than other methods but is thought to cause less tissue damage and be less painful post-operatively [8,44]. It is the least costly method as the instruments can be sterilized and reused, which may account for its use in developing countries [2].…”

“…With the emergence of anaesthesia, surgeons were able to improve the procedure by slowly dissecting tissue in a controlled fashion [5] prompting the development of the dissection tonsillectomy in 1917 [4]. From that time, tonsillectomy as a recognized procedure gained prominence, with tonsillectomy now being one of the most common surgical procedures [6][7][8] in children.…”