title: Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity.
abstract: 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.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  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.
  
  
  METHODS
  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: Department of Otolaryngology, Royal Bolton Hospital, Bolton, Lancashire, UK. aruncardi@yahoo.co.uk
authors: A A J
authors: AA
authors: Cardozo
authors: C
authors: C
authors: Hallikeri
authors: H
authors: H
authors: Lawrence
authors: V
authors: V
authors: Sankar
authors: S
authors: S
authors: Hargreaves
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D014068:Tonsillectomy / Q000379:methods*; D014069:Tonsillitis / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology