Coblation(r) Has Similar Bleed Rates, Less Dehydration, Neck Pain than Electrocautery

Newswise — Coblation® caused significantly less dehydration for children after tonsillectomy and less neck pain after adenoidectomy, according to a new study. The research will also show that Coblation and electrocautery had similar post-operative hemorrhage, or re-bleeding, rates following tonsillectomy.

Results of the study entitled "Coblation Adenotonsillectomy: An Improvement over Electrocautery Technique?" will be presented at the 109th Annual Meeting and OTO Expo of American Academy of Otolaryngology—Head and Neck Surgery Foundation, September 25 " 28 at the Los Angeles Convention Center. This study was conducted at the Children's National Medical Center in Washington, DC by Sukgi S. Choi, M.D. with coauthors Robert S. Glade MD, Susan E. Pearson MD, and George H. Zalzal MD,

Tonsillectomy is the second most common childhood surgery performed in the United States. Techniques for removing the tonsils and adenoids include "cold" instruments such as scissors, curette, snare or scalpel; electrocautery and more recently, the harmonic scalpel, microdebrider and Coblation. Numerous studies have been conducted comparing the results and post-operative complications of each method. None of the studies to date have been as large as the current study.

Methodology: A retrospective chart review of 1997 patients, ages one to 18, who underwent adenotonsillectomy at Children's National Medical Center in Washington, DC from January 2000 to June 2004 for removal of tonsils and adenoids that were either enlarged and/or chronically infected.

Charts were evaluated for age, gender, indications for surgery, underlying medical conditions, surgical technique used and any postoperative complications. Comparisons for rate of primary hemorrhage (occurring during the first 24 postoperative hours), secondary hemorrhage (occurring after 24 hours), and emergency room (ER) visits for dehydration or poor oral intake, were made for coblation and electrocautery tonsillectomy using Chi-square analysis using Yates correction. Rates of hemorrhage and ER visits for neck pain or stiffness for Coblation® (ArthroCare, Austin, TX), electrocautery, and adenoid curette/cautery adenoidectomy were also compared using Chi-square analysis with Yates correction.

Results: The retrospective review found the following key findings: Of all coblation tonsillectomy patients, three had episodes of primary hemorrhage (0.4 percent), 35 episodes of secondary hemorrhage (4.7 percent) and 23 emergency room visits for dehydration (3.1 percent). For electrocautery tonsillectomy, nine episodes of primary hemorrhage were seen (0.7 percent), 41 episodes of secondary hemorrhage (3.3 percent) and 64 ER visits for dehydration (5.1 percent). Chi-square analysis showed no statistical difference in the rate of primary and secondary hemorrhage for the two techniques. Of the 88 patients with postoperative hemorrhage, 30 required operative management (12 coblation and 18 electrocautery). Chi-square analysis showed higher rate of ER visits for dehydration f in the electrocautery group.

Analysis of the complication rates seen in patients undergoing tonsillectomy by surgical techniques and age (younger and older than age three years) was performed. In patients undergoing coblation tonsillectomy who are under three years of age, there were no episodes of primary hemorrhage, seven secondary hemorrhage (6.7 percent) and six ER visits for dehydration (5.77 percent). Electrocautery tonsillectomy revealed no episodes primary hemorrhage, one episode of secondary hemorrhage (0.5 percent), and 10 episodes of dehydration (5.4 percent). Chi-square analysis in this age group showed the rate of secondary hemorrhage to be higher with coblation tonsillectomy but showed no difference in the rates of primary hemorrhage and dehydration for the two techniques.

In patients undergoing coblation tonsillectomy who are three years or older, three episodes primary hemorrhage (0.5 percent), 28 secondary hemorrhage (4.4 percent), and 17 ER visits for dehydration (2.7 percent) were seen. With electrocautery tonsillectomy, nine episodes of primary hemorrhage were seen (0.8 percent). 40 secondary hemorrhage (3.8 percent), and 54 ER visits for dehydration (5.1 percent). Chi-square analysis for this age group showed the frequency of ER visits for dehydration to be significantly higher in the electrocautery tonsillectomy, but showed no difference in rates of primary or secondary hemorrhage.

Review of adenoidectomy patients revealed no ER visits for neck pain/stiffness made in patients who received adenoidectomy by coblation, 17 in combined adenoid curette and electrocautery group, and three in electrocautery alone group. Chi-square analysis showed no significant difference in the occurrence of neck pain/stiffness necessitating ER visit for coblation and electrocautery adenoidectomy groups, but a higher incidence in the curette/cautery adenoidectomy group compared to both coblation and electrocautery groups. There were no post adenoidectomy bleeds.

Conclusions: Coblation tonsillectomy had similar rates of primary and secondary hemorrhage when compared to electrocautery tonsillectomy, but a lower incidence of postoperative pain and dehydration. Coblation adenoidectomy caused less postoperative neck pain than curette/cautery adenoidectomy.