title: Effect of tonsillar fossa closure on postoperative pain and bleeding risk after tonsillectomy.
abstract: OBJECTIVE
  To determine if closing the tonsil fossa after tonsillectomy leads to less pain and bleeding.
  
  
  METHODS
  Interventional, Randomized, Single Blind, Active Control, Single Group Assignment, Safety/Efficacy Study.
  
  
  RESULTS
  2 months.
  
  
  METHODS
  Generalized Estimating Equations (GEE) analyzed effects of tonsillar pillar closure, surgeon experience and interaction on outcomes.
  
  
  METHODS
  Primarily academic tertiary care referral center, institutional practice, primarily children, both ambulatory and hospitalized care.
  
  
  METHODS
  763 subjects (age 8-264 months) undergoing tonsillectomy.
  
  
  METHODS
  suspected malignancy or active peritonsillar abscess. At the discretion of the attending surgeon, patients undergoing tonsillectomy during the 4 year study period were offered participation. A computer selected the side closed. 131 subjects withdrew (complete lack of follow-up information) after the first 72 h.
  
  
  METHODS
  3-0 chromic sutures on tapered needles to close one tonsillar fossa. The subject was not told which side was closed.
  
  
  METHODS
  postoperative bleeding (at any time) and pain reported was sought on days 1, 7, 14, 21, and 28.
  
  
  RESULTS
  Closure of the tonsillar fossa did not change the risk of bleeding. Closing the tonsillar fossa had a 40% increase in the odds ratio of postoperative pain. In the tonsillar fossa sides left open, greater surgeon experience decreased the risk of bleeding. In closed sides, enriched surgeon experience increased the risk of bleeding (p<.0.05).
  
  
  CONCLUSIONS
  Suture closure of the tonsillar fossa after tonsillectomy does not reduce the risk of bleeding. Additionally, closing the tonsillar fossa increased postoperative pain.
  
  
  METHODS
  1b (individual randomized controlled trial).
authors.affiliation: Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA. bmatt@iupui.edu
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Matt
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Krol
authors.forename: Yan
authors.initials: Y
authors.lastname: Ding
authors.forename: Beth E
authors.initials: BE
authors.lastname: Juliar
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D014066:Palatine Tonsil / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D018570:Risk Assessment; D016037:Single-Blind Method; D013536:Suture Techniques; D013537:Sutures; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome