'Hot' Tonsillectomy Boosts Risk of Postoperative Bleeding

Yet U.S. doctors don't see this as a significant problem

Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional.

En Español

By
HealthDay Reporter

FRIDAY, Aug. 20, 2004 (HealthDayNews) -- Having your tonsils removed is a relatively simple operation but complications can occur, and a new British study suggests that newer so-called "hot" surgical techniques triple the risk of postoperative bleeding.

Such techniques have only become more common in the past decade or two, the researchers noted, supplanting what is known as a "cold steel" surgery, which was standard practice for almost 100 years.

The ability to control bleeding during surgery, particularly with young children, has made "hot" surgery an attractive option for doctors in the United States, experts said.

However, this latest finding warns that the newer technique may lead to bleeding problems after the patient leaves the operating room.

"The complication rates after tonsillectomies with diathermy [a 'hot' technique] are higher than bleeding rates with 'cold steel' techniques," said lead researcher Dr. Jan van der Meulen, a senior lecturer in health services research from the Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine.

The report appears in the Aug. 21 issue of The Lancet.

"Hot" techniques include diathermy, which uses an electric current to remove tonsils and to control bleeding, and coblation, a variation of electrosurgery, which reduces the chance of heat damage. The "cold" technique, where the tonsils are cut out, uses ice packs or ties to minimize bleeding during the operation, van der Meulen explained.

To find out which method carried a greater risk of postoperative bleeding, van der Meulen's team collected data on postoperative complications from all tonsillectomies done in 334 hospitals in England and Northern Ireland.

The data looked at 12,000 patients who had hot or cold tonsillectomies and included all age groups.

The researchers found bleeding occurred in 3.3 percent of patients within 28 days after surgery, and diathermy increased the rate of bleeding by as much as 6 percent, compared with the "cold" technique.

In addition, they found that adults had higher bleeding rates than children, and bleeding was more likely when junior surgeons did the operation.

The researchers blame the problem on using too much power during diathermy.

"Diathermy should be used more carefully," van der Meulen said. If diathermy is used with the current setting too high, too much surrounding tissue is damaged, which can result in problems days after the surgery.

"During surgery, if you use diathermy at high settings, you stop bleeding very, very well," van der Meulen said. "But you are not aware that you can cause problems later."

Diathermy is used in many surgical procedures, van der Meulen said. "What we find in tonsillectomy might be the case in other procedures as well," he noted.

"This is an example of innovation in surgery where you try to help patients better, but in practice you might do more harm than good," van der Meulen said. "The old-fashioned technique might be better in the end."

However, most doctors in the United States have already made the switch to "hot" surgeries, said Dr. Michael A. Rothschild, chief of pediatric ear, nose and throat surgery at Mount Sinai Hospital in New York City.

"These techniques are associated with less bleeding during the operation, but slightly more bleeding after the surgery," he said, adding that he doesn't see this as a significant problem.

And Dr. Glenn C. Isaacson, a professor and chairman of the department of otolaryngology-head and neck surgery at Temple University School of Medicine in Philadelphia, noted the study sheds little new light on the debate over the two surgical approaches.

"Otolaryngologists who care for small children tend to prefer hot techniques as speed and minimal blood loss at the time of surgery are important in this group," Isaacson said. "Ear, nose and throat surgeons who care for adults prefer cold techniques, as speed is less important and late bleeding is a greater concern."

More information

The National Library of Medicine can tell you more about tonsillectomies.

SOURCES: Jan van der Meulen, M.D., Ph.D., senior lecturer, health services research, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London School of Hygiene and Tropical Medicine, England; Michael A. Rothschild, M.D., chief, pediatric ear, nose and throat surgery, Mount Sinai Hospital, New York City; Glenn C. Isaacson, M.D., professor and chairman, department of otolaryngology-head and neck surgery, Temple University School of Medicine, Philadelphia; Aug. 21, 2004, The Lancet

Last Updated: