Document Detail


Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity.
MedLine Citation:
PMID:  17883557     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether an increase in the use of bipolar diathermy energy to perform a tonsillectomy is associated with an increase in postoperative pain and haemorrhage. STUDY DESIGN: Prospective study. SETTING: District General Hospital. METHODS: In all, 101 patients above the age of 13 years who underwent a tonsillectomy that involved the use of bipolar diathermy during the study period were included. The cumulative amount of diathermy energy used to perform each tonsillectomy was calculated with the help of a digital stop clock timing device connected to the diathermy foot-pedal. MAIN OUTCOME MEASURES: Postoperative pain scores and the incidence of secondary haemorrhage were recorded for each patient at four points in time following surgery, up to the tenth postoperative day. The haemorrhage rates were categorised into three groups (no bleeding, minor bleeding and major bleeding) according to severity. Associations between the diathermy energy used to perform each tonsillectomy and the corresponding postoperative pain scores and secondary bleeding rates were investigated. RESULTS: There was a statistically significant positive relationship between the total amount of bipolar diathermy energy used per tonsillectomy and the pain scores at all the four recorded points in time (r(s) = 0.44-0.72, P < 0.001). When the median energy consumption in the three groups (no bleeding, minor bleeding and major bleeding) were compared using the Kruskal-Wallis test, we found that there was limited evidence of a difference between the groups, but this was not statistically significant at the 5% level [H (2) = 5.374, P = 0.065, 99% CI 0.058-0.071]. CONCLUSIONS: Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.
Authors:
A A J Cardozo; C Hallikeri; H Lawrence; V Sankar; S Hargreaves
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery     Volume:  32     ISSN:  1749-4478     ISO Abbreviation:  -     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-21     Completed Date:  2008-01-03     Revised Date:  2009-03-10    
Medline Journal Info:
Nlm Unique ID:  101247023     Medline TA:  Clin Otolaryngol     Country:  England    
Other Details:
Languages:  eng     Pagination:  366-71     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology, Royal Bolton Hospital, Bolton, Lancashire, UK. aruncardi@yahoo.co.uk
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Electrocoagulation / methods*
Female
Follow-Up Studies
Great Britain / epidemiology
Humans
Male
Middle Aged
Morbidity / trends
Pain, Postoperative / epidemiology*,  etiology
Postoperative Hemorrhage / epidemiology*,  etiology
Prospective Studies
Tonsillectomy / methods*
Tonsillitis / surgery*
Treatment Outcome
Comments/Corrections
Comment In:
Clin Otolaryngol. 2008 Aug;33(4):373-4   [PMID:  18983355 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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