Systematic review of the safety of electrosurgery for tonsillectomy.
In the meta-analysis models, compared with cold steel dissection with ties/packs haemostasis (reference technique): * Bipolar diathermy dissection and haemostasis was associated with statistically significant lower odds of primary haemorrhage (OR 0.13, 95% CrI 0.03 to 0.51), including primary haemorrhage requiring return to theatre (OR 0.002, 95% CrI <0.001 to 0.26). * Coblation was associated with statistically significant higher odds of secondary haemorrhage requiring return to theatre (OR 33.82, 95% CrI 1.25 to 5676.00). * Monopolar and bipolar diathermy dissection and haemostasis (OR 4.12, 95% CrI 1.12 to 14.67; OR 2.86, 95% CrI 1.12 to 8.02, respectively), coblation (OR 3.75, 95% CrI 1.29 to 12.12), and cold steel dissection with monopolar or bipolar diathermy haemostasis (OR 4.83, 95% CrI 1.56 to 15.95; OR 9.18, 95% CrI 3.09 to 30.53, respectively) were all associated with statistically significant higher odds of secondary haemorrhage. * In deciding which technique to employ, factors to consider include patient characteristics, the underlying risk of primary or secondary haemorrhage, which is regarded as likely to be more serious, and the clinical significance of the observed differences in haemorrhage rates across techniques.
Mowatt
G
G
Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, UK. g.mowatt@adbn.ac.uk
Cook
J A
JA
Fraser
C
C
McKerrow
W S
WS
Burr
J M
JM
D004564:Electrocoagulation / Q000592:standards; D004598:Electrosurgery / Q000009:adverse effects / Q000592:standards*; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*