The Utility of Various Common Surgical Instruments for Pediatric Adenotonsillectomy: Analysis of Time, Hemorrhage, and Cost

Abstract

Objectives: Evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage and associated health care cost for pediatric adenotonsillectomy. Methods: Retrospective chart analysis from a tertiary care pediatric hospital of 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 chi-square analysis was used to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed. Results: A total of 1280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the 3 instrumentation groups. When examining the various instruments’ effects on procedure time in minutes, univariate ANOVA did demonstrate a significant difference overall between the 3 groups ( F = 8.79; P < .001). Post hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either both 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 (χ2 = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated as $30.04 for monopolar cautery, $246.95 for PlasmaBlade and $244.32 for radiofrequency ablation. Conclusions: The ideal surgical instrumentation would be efficient, have a low complication rate, and be relatively inexpensive. 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.