Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

Table 1

Posttonsillectomy hemorrhage rates requiring a return to theater: comparison of different surgical techniques [15, 17].

(a) RCS Tonsillectomy Audit, UK - 2005

Surgery		Posttonsillectomy hemorrhage (PTH)						Return to operating theater for PTH
		PTH		No PTH	OR	95% CI		Return		No return	OR	95% CI
		%						%
Cold steel dissection & cold hemostasis	4.285	1.7	73	4.212	1			0.8	34	4.251	1
Cold steel dissection & monopolar diathermy hemostasis	1.772	2.9	52	1.720	1.7444	1.2169–2.5004	0,0025	0.8	14	1.758	0.9957	0.5330–1.8600	0.9892
Cold steel dissection & bipolar diathermy hemostasis	11.956	2.7	323	11.633	1.6021	1.2397–2.0704	0,0003	0.7	84	11.872	0.8846	0.5930–1.3196	0.548
Monopolar diathermy forceps	452	6.6	30	422	4.1018	2.6505–6.3478	<0.0001	1.6	7	445	1.9668	0.8668–4.4626	0.1057
Bipolar diathermy forceps	10.240	4.6	473	9.767	2.7943	2.1781–3.5847	<0.0001	1.0	102	10.138	1.2579	0.8519–1.8576	0.2485
Bipolar diathermy scissors	2.322	5.1	119	2.203	3.1167	2.3184–4.1900	<0.0001	1.3	30	2.292	1.6365	0.9990–2.6809	0.0505
Coblation	1.565	4.6	72	1.493	2.7825	1.9987–3.8737	<0.0001	1.8	28	1.537	2.2777	1.3766–3.7688	0.0014
Other	1.329	4.1	55	1.274	2.4909	1.7456–3.5544	<0.0001	1.4	19	1.310	1.8134	1.0309–3.1900	0.0389
Total	33.921	3.5	1.197	32.724				0.9	318	33.603

(b) National Tonsil Surgery Register, Sweden, 2014

Surgery		Late posttonsillectomy hemorrhage (PTH)						Return to operating theater for late PTH
		PTH		No PTH	OR	95% CI		Return		No return	OR	95% CI
		%						%
Cold steel dissection & cold hemostasis	636	3.3	21	615	1			1.1	7	629	1
Cold steel dissection & hot hemostasis	6.406	8.8	566	5.840	2.8383	1.8217–4.4222	<0.0001	2.7	171	6.235	2.4644	1.1522–5.2709	0.0201
Bipolar diathermy scissors	1.314	13.4	176	1.138	4.5292	2.8506–7.1963	<0.0001	3.2	42	1.272	2.967	1.3254–6.6419	0.0082
Coblation	902	9.9	89	813	3.2059	1.9701–5.2169	<0.0001	2.4	22	880	2.2464	0.9538–5.2910	0.0641
Ultracision	259	16.2	42	217	5.6682	3.2827–9.7873	<0.0001	3.9	10	249	3.6087	1.3585–9.5863	0.01
Total	9.517	9.4	894	8.623				2.6	252	9.265

Breakdown according to surgery among all 33,921 patients who underwent tonsillectomy in the RCS Tonsillectomy Audit, UK, 2005. Breakdown according to surgery among the 9,603 responders to the 30-day questionnaire (out of 15,734 patients who underwent tonsillectomy) in the National Tonsil Surgery Register, Sweden, 2014. RCS: Royal College of Surgeons; OR: odds ratio; CI: confidence interval; statistic; odds ratios were calculated with MedCalc online: https://www.medcalc.org/calc/odds_ratio.php. Given some inconsistencies in the Swedish paper, the following assumptions were made: () the figures for the number of patients who answered the 30-day questionnaire in each of the individual surgery-type groups were correct; () the figures for the “yes outcomes” (“yes PTH” and “yes RTT”) were correct; and () the figures for the “no outcomes” (“no PTH” and “no RTT”) consisted in the difference between the numbers of those who answered the 30-day questionnaire and those for the “yes answers.”