'Hot' surgical techniques could increase postoperative haemorrhage after tonsillectomy

August 19, 2004

The postoperative haemorrhage rate in tonsillectomies which use 'hot techniques' such as diathermy and coblation to stop bleeding could be over three times greater than operations which use cold steel techniques, conclude authors of a study in this week's issue of THE LANCET.

Tonsillectomy is one of the most common surgical procedures. "Hot" techniques such as diathermy (the use of an electric current at 400-600°C to remove tonsils and to control bleeding) and coblation (a variation on electrosurgery, which operates at 60-70°C, reducing the chance of thermal damage) have become well established alongside the traditional "cold" dissection techniques, which only use packs or ties to minimise intraoperative bleeding. Until now, there is little evidence to say one technique is better than the other.

The National Postoperative Tonsillectomy Audit (NPTA), launched in July 2003 and funded and supported by the UK Department of Health, is investigating haemorrhage and other postoperative complications from all tonsillectomies done in 334 hospitals in England and Northern Ireland. The audit is running in both the NHS and private-sector hospitals. Data from around 12,000 patients were obtained from operations using a combination of hot and cold techniques and from operations that only used cold techniques.

Haemorrhage occurred in 3•3% of patients within 28 days of surgery. Analysis showed that any use of diathermy increased the rate of haemorrhage, in some cases by as much as 6% compared with the 'cold steel only' technique. Adults had higher haemorrhage rates than children, and haemorrhage was more likely from procedures done by junior surgeons.

The investigators suggest that diathermy should be used with caution and that when junior surgeons are trained it should be emphasised that control of intraoperative bleeding with excessive use of diathermy could lead to increased haemorrhage rates. One of the authors, Jan van der Meulen (London School of Hygiene and Tropical Medicine / Royal College of Surgeons of England), comments: "Although our findings favour cold steel without diathermy, we do not think that hot techniques should be stopped on the basis of current evidence [...] Further clinical research is needed to support the results of our study."

An accompanying commentary (p 642) by Malcolm Hilton (Royal Devon and Exeter Hospital, UK) states that van der Meulen's and colleagues' study paves the way for more research (such as a randomised trial) to provide more insight into the pros and cons of different surgical techniques for tonsillectomy.
-end-
Contact: Dr Jan van der Meulen, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London School of Hygiene and Tropical Medicine, 35-43 Lincoln's Inn Field, London WC2A 3PE; T) 44-207-869-6601 / 7869-6600; Jan.vanderMeulen@LSHTM.ac.uk

Dr Malcolm Hilton, Royal Devon & Exeter Hospital, Exeter EX2 5DW, UK; Malcolm.Hilton@rdehc-tr.swest.nhs.uk

Lancet

Related Tonsillectomy Articles from Brightsurf:

'Less pain' to remove tonsils
A 10-year study from Flinders University has found ''shrinking'' tonsils results in far less pain and bleeding than a full tonsillectomy.

World-first saliva test detects hidden throat cancer
A series of saliva HPV tests detected an asymptomatic throat cancer during a trial of a new saliva diagnostic.

One-third of children having tonsillectomies benefitted from opioid-free surgery and recovery
Nearly one-third of children who had surgery to remove their tonsils did not need opioids to get adequate pain relief during and after surgery, according to a study presented at the ANESTHESIOLOGY® 2019 annual meeting.

UTA, University of Maryland team up to better understand sleep apnea treatment in children
Gautam Das, a professor in UTA's Computer Science and Engineering Department, worked with University of Maryland School of Medicine physicians to understand whether sleep studies predicted the improved outcomes following surgery for sleep apnea in children.

Six in 10 children receive opioids after tonsillectomy
Sixty percent of privately insured children undergoing tonsil removal received opioids -- with average prescriptions lasting about six to 10 days -- a new study finds.

Opioid prescribing patterns in children after tonsillectomy
National private insurance claims data were used to examine opioid prescribing patterns in children after tonsillectomy and return visits for complications.

Adenoid and tonsil trouble for teens
With a new, exacting longitudinal study, Tokyo Medical and Dental University (TMDU)-led researchers challenge the established medical consensus that adenoids and tonsils shrink significantly during the teenage years.

Tonsillectomy in children: Update to guidelines for treating and managing care
The American Academy of Otolaryngology-Head and Neck Surgery Foundation published the Clinical Practice Guideline: Tonsillectomy in Children (Update) today in Otolaryngology-Head and Neck Surgery.

Tonsil and adenoid removal associated with respiratory, allergic and infectious disease
Removing tonsils and adenoids in childhood increases the long-term risk of respiratory, allergic and infectious diseases, according to researchers who have examined -- for the first time -- the long-term effects of the operations.

Black box warning slows, but doesn't stop, codeine for kids after tonsil removal
Despite an FDA black box warning against prescribing children codeine following tonsil and adenoid removal, 1 in 20 children undergoing these surgeries continued to receive the opioid, a new study suggests.

Read More: Tonsillectomy News and Tonsillectomy Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.