The evidence of comparative effectiveness for tonsillectomy between Metzenbaum with bipolar electrocautery technique and monopolar with bipolar electrocautery technique
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Abstract
Abstract Tonsillectomy is a commonly performed surgery in children and adults in otolaryngology practice. Recently, there have been various surgical techniques for tonsillectomy. Every surgical technique has a unique set of outcomes and risks. The most critical complication is post-tonsillectomy hemorrhage, which increases medical expenses, and if treatment is not timely, it may cause the patient's death.
Objectives This study aims at comparing the effectiveness and complications after tonsillectomy between Metzenbaum with bipolar electrocautery technique (group A) and monopolar with bipolar electrocautery technique (group B) in children and adult patients. Additionally, investigations regarding the incidence and risk factors of post-tonsillectomy hemorrhage are also entertained.
Material and methods The study comprised adult and pediatric patients who satisfied the eligibility requirements and performed tonsillectomy between January 1, 2017, and March 31, 2024. Patient history and surgical information were entered in the case record form and the Excel program for data analysis using STATA version 15.1.
Results Surgical technique affects the time required for surgery and the hospital length of stay. Group A had a significantly shorter operation time and hospital length of stay compared to group B (18.97 vs. 26.30 min, P-value < 0.001, 2.90 vs. 3.07 days, P-value = 0.0459). In the context of post-tonsillectomy hemorrhage (PTH), of the 547 patients, 115 (21.02%) had a PTH, and 113 had secondary hemorrhage (98.26%). The results of the bivariate analysis found that patients who were older than or equal to 15 years or had a body mass index more than or equal to 25 had an effect on the incidence of PTH and secondary hemorrhage (P-value = 0.007, 0.009, and 0.015, 0.025). According to the multivariate analysis conducted using the log-binomial regression model, the surgical technique was found to have a non-significant effect (P-value = 0.159, 0.982, and 0.151) on the incidence of PTH, primary hemorrhage, and secondary hemorrhage. The main factors affecting the incidence of PTH, primary hemorrhage, and secondary hemorrhage are age >= 15 years old (P-value = 0.026, <0.0001 and 0.027) with RR values of 2.31, 805644.9 and 2.30, respectively and BMI >= 25 (P-value = = 0.027, <0.0001 และ 0.042) with RR values of 1.44, 8732261 and 1.40, respectively.
Conclusion Metzenbaum with bipolar electrocautery technique provides a number of benefits over monopolar with bipolar electrocautery technique, such as less operation time and a shorter hospital length of stay. The incidence of PTH and postoperative bleeding day between the two surgical techniques is no different. 98.26% of PTH is secondary hemorrhage, which is caused by risk factors such as age >= 15 years old or having a BMI >= 25.
Key words: Tonsillectomy, Metzenbaum, Electrocautery, Hemorrhage
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ต้นฉบับที่ส่งมาพิจารณายังวารสารหู คอ จมูก และใบหน้า จะต้องไม่อยู่ในการพิจารณาของวารสารอื่น ในขณะเดียวกันต้นฉบับที่จะส่งมาจะผ่านการอ่านโดยผู้ทรงคุณวุฒิ หากมีการวิจารณ์หรือแก้ไขจะส่งกลับไปให้ผู้เขียนตรวจสอบแก้ไขอีกครั้ง ต้นฉบับที่ผ่านการพิจารณาให้ลงตีพิมพ์ถือเป็นสมบัติของวารสารหู คอ จมูกและใบหน้า ไม่อาจนำไปลงตีพิมพ์ที่อื่นโดยไม่ได้รับอนุญาต
ตารางแผนภูมิ รูปภาพ หรือข้อความเกิน 100 คำที่คัดลอกมาจากบทความของผู้อื่น จะต้องมีใบยินยอมจากผู้เขียนหรือผู้ทรงลิขสิทธิ์นั้นๆ และใหร้ะบุกำกับไว้ในเนื้อเรื่องด้วย
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