title: The utility of common surgical instruments for pediatric adenotonsillectomy.
abstract: OBJECTIVE
  To evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage, and associated healthcare cost for pediatric adenotonsillectomy.
  
  
  METHODS
  Retrospective chart analysis.
  
  
  METHODS
  Chart data were collected from pediatric patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and χ(2) analysis was utilized to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.
  
  
  RESULTS
  A total of 1,280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the three instrumentation groups. When examining the various instruments' effect on procedure time in minutes, univariate ANOVA demonstrated a significant difference overall among the three groups (F = 8.79; P < .001). Post-hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either PlasmaBlade (P = .03) or radiofrequency ablation (P < .001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ(2) = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated to be $30.04 for monopolar cautery, $246.95 for PlasmaBlade, and $244.32 for radiofrequency ablation.
  
  
  CONCLUSIONS
  The ideal surgical instrumentation should be cost and time efficient with a low complication rate. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates, and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
  
  
  METHODS
  4.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan, U.S.A; Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, U.S.A; Michigan State University, East Lansing, Michigan, U.S.A.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Christenson
authors.forename: David S
authors.initials: DS
authors.lastname: Cohen
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Metz
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Saraiya
authors.forename: Michael S
authors.initials: MS
authors.lastname: Haupert
mesh_terms: D000233:Adenoidectomy / Q000295:instrumentation*; D000293:Adolescent; D017115:Catheter Ablation / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008824:Michigan / Q000453:epidemiology; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D014068:Tonsillectomy / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Pediatric; PlasmaBlade; adenoidectomy; adenotonsillectomy; coblation; cost analysis; electrocautery; health policy; obstructive sleep apnea; radiofrequency ablation; tonsillectomy; tonsillitis