Post-tonsillectomy hemorrhage: Cold versus hot dissection

Abstract

The aim of our study was to assess the rate of reactionary and secondary posttonsillectomy hemorrhage using "cold" dissection and bipolar diathermy and to determine whether there was any difference in the postoperative hemorrhage rate between the 2 methods. This was a prospective study of all patients undergoing tonsillectomy between November 8, 1999 and November 7, 2000 in a tertiary medical centre. The data collected included patient identity, age, gender, date of surgery, method of operation, and complications (if any). The timing of reactionary or secondary posttonsillectomy hemorrhage and the treatment were recorded. We hypothesized no difference in posttonsillectomy hemorrhage rates using the 2 methods. Chi2 test was used for statistical analysis. A total of 349 patients underwent tonsillectomy in the period (134 males, 215 females, mean age was 16.7 years). Of these, 337 were bilateral procedures, 145 patients had tonsillectomy using cold dissection, and 192 patients had bipolar diathermy. Reactionary hemorrhage occurred in 1 patient (0.3%) and 31 patients (9.2%) developed secondary hemorrhage. The hemorrhage rates using cold dissection (n = 8) and bipolar diathermy (n = 24) were 5.5% and 12.5%, respectively ( P < 0.05). The primary and secondary posttonsillectomy hemorrhage rates were 0.3 and 9.2%, respectively. Tonsillectomy using bipolar diathermy has a statistically significant higher secondary hemorrhage rate than using cold dissection (12.5% vs. 5.5%, P < 0.05).