Adenotonsillectomy Bleeding: Microdebrider vs Electrocautery

Abstract

Objective: 1) Describe the intraoperative blood loss during adenotonsillectomy in a pediatric population during the transition to a new technique. 2) Confirm or refute the suspicion that intraoperative blood loss is greater when using the microdebrider than when using traditional curette and electrocautery techniques. Method: Retrospective evaluation of 148 children who underwent tonsillectomy and/or adenoidectomy by a single surgeon transitioning from curette and electrocautery to microdebrider in 2008. Primary outcome was percentage of circulating blood volume lost. Surgical methods were compared by multiple linear regression and chi-squared to evaluate incidence of “bleeders” (>5% loss). Results: Median age was 6.8 years (range, 2.2-20.6 years). 84 had adenotonsillectomy, 39 had adenoidectomy, and 25 had tonsillectomy. Blood loss ranged from 0% to 15% (median = 2%) blood volume. Sixteen of 148 patients (11%) lost >5% blood volume. A total of 2.3% of blood volume was lost with adenoidectomy by curette or microdebrider compared to no adenoidectomy ( P = 6e-07). Microdebrider tonsillectomy was associated with more blood loss than electrocautery; an additional 1.7% of blood volume ( P = 9e-06). A total of 15 of 84 (18%) who had adenotonsillectomy lost >5% blood volume. 26% of microdebrider patients lost >5% blood volume compared to 12% of electrocautery tonsillectomy patients ( P = .16). Conclusion: Adenoid and/or tonsil surgery can result in significant blood loss (>5% of blood volume), which occurred in 11% of our cases. Most of the blood loss is from the nasopharynx. Tonsillectomy by electrocautery is associated with significantly lower intraoperative blood loss than the microdebrider.