Safety and efficacy of powered intracapsular tonsillectomy in children

A multi-center retrospective case series

Clementino Arturo Solares, Jeffery A. Koempel, Keiko Hirose, Tom I. Abelson, James S. Reilly, Steven P. Cook, Max M. April, Robert F. Ward, John P. Bent, Meng Xu, Peter J. Koltai

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objective: To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample. Study design and setting: Multi-center retrospective case series. Patients and methods: We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I. DuPont Hospital for Children, and the New York Otolaryngology Institute. For comparison, we reviewed the outpatient and inpatient records of all children who underwent conventional tonsillectomy performed by the same surgeons at the Children's Hospital at the Cleveland Clinic and Alfred I. DuPont Hospital for Children during the same period. No comparison group was available for the New York Otolaryngology Institute group. Three outcome measures were recorded: regrowth, bleeding and re-admission for dehydration rates. All statistical analyses were performed using SAS, and P < 0.05 was considered statistically significant. Results: We identified 870 children that underwent PIT at three different institutions. In addition, 1121 children underwent conventional tonsillectomy at two of the three institutions. The mean follow-up for the PIT group was 1.2 years (range, 0.1-2.6 years) and 1.5 years (range, 0.1-3.0 years) for the conventional tonsillectomy group. The incidence of and 95% Cl for the outcome measures were as follows regrowth 0.5% (0%, 1.4%), delayed post-operative bleeding 0.7% (0%, 1.9%), re-admission for dehydration 1.3% (0.05%, 2.6%), and overall major complications 0.46% (0.009%, 0.9%). When comparing conventional tonsillectomy to PIT, the bleeding rate, re-admission for dehydration, and the overall incidence of major complications were significantly lower in the PIT group (P = 0.001, P = 0.002, and P < 0.001, respectively). Conclusion: PIT is a safe and effective technique in the management of obstructive sleep disordered breathing in children. PIT has the advantages of decreased pain, dehydration and post-operative bleeding, and with a mean follow-up of 1.2 years, a low incidence of tonsillar regrowth thus far.

Original languageEnglish (US)
Pages (from-to)21-26
Number of pages6
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume69
Issue number1
DOIs
StatePublished - Jan 1 2005

Fingerprint

Tonsillectomy
Safety
Dehydration
Hemorrhage
Otolaryngology
Incidence
Outcome Assessment (Health Care)
Sleep Apnea Syndromes
Inpatients
Outpatients
Pain

Keywords

  • Obstructive sleep disordered breathing
  • Pediatric tonsillar hypertrophy
  • Powered intracapsular tonsillectomy
  • Surgical safety
  • Tonsillar regrowth
  • Tonsillotomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

Safety and efficacy of powered intracapsular tonsillectomy in children : A multi-center retrospective case series. / Solares, Clementino Arturo; Koempel, Jeffery A.; Hirose, Keiko; Abelson, Tom I.; Reilly, James S.; Cook, Steven P.; April, Max M.; Ward, Robert F.; Bent, John P.; Xu, Meng; Koltai, Peter J.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 69, No. 1, 01.01.2005, p. 21-26.

Research output: Contribution to journalArticle

Solares, CA, Koempel, JA, Hirose, K, Abelson, TI, Reilly, JS, Cook, SP, April, MM, Ward, RF, Bent, JP, Xu, M & Koltai, PJ 2005, 'Safety and efficacy of powered intracapsular tonsillectomy in children: A multi-center retrospective case series', International Journal of Pediatric Otorhinolaryngology, vol. 69, no. 1, pp. 21-26. https://doi.org/10.1016/j.ijporl.2004.07.006
Solares, Clementino Arturo ; Koempel, Jeffery A. ; Hirose, Keiko ; Abelson, Tom I. ; Reilly, James S. ; Cook, Steven P. ; April, Max M. ; Ward, Robert F. ; Bent, John P. ; Xu, Meng ; Koltai, Peter J. / Safety and efficacy of powered intracapsular tonsillectomy in children : A multi-center retrospective case series. In: International Journal of Pediatric Otorhinolaryngology. 2005 ; Vol. 69, No. 1. pp. 21-26.
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AU - Solares, Clementino Arturo

AU - Koempel, Jeffery A.

AU - Hirose, Keiko

AU - Abelson, Tom I.

AU - Reilly, James S.

AU - Cook, Steven P.

AU - April, Max M.

AU - Ward, Robert F.

AU - Bent, John P.

AU - Xu, Meng

AU - Koltai, Peter J.

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N2 - Objective: To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample. Study design and setting: Multi-center retrospective case series. Patients and methods: We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I. DuPont Hospital for Children, and the New York Otolaryngology Institute. For comparison, we reviewed the outpatient and inpatient records of all children who underwent conventional tonsillectomy performed by the same surgeons at the Children's Hospital at the Cleveland Clinic and Alfred I. DuPont Hospital for Children during the same period. No comparison group was available for the New York Otolaryngology Institute group. Three outcome measures were recorded: regrowth, bleeding and re-admission for dehydration rates. All statistical analyses were performed using SAS, and P < 0.05 was considered statistically significant. Results: We identified 870 children that underwent PIT at three different institutions. In addition, 1121 children underwent conventional tonsillectomy at two of the three institutions. The mean follow-up for the PIT group was 1.2 years (range, 0.1-2.6 years) and 1.5 years (range, 0.1-3.0 years) for the conventional tonsillectomy group. The incidence of and 95% Cl for the outcome measures were as follows regrowth 0.5% (0%, 1.4%), delayed post-operative bleeding 0.7% (0%, 1.9%), re-admission for dehydration 1.3% (0.05%, 2.6%), and overall major complications 0.46% (0.009%, 0.9%). When comparing conventional tonsillectomy to PIT, the bleeding rate, re-admission for dehydration, and the overall incidence of major complications were significantly lower in the PIT group (P = 0.001, P = 0.002, and P < 0.001, respectively). Conclusion: PIT is a safe and effective technique in the management of obstructive sleep disordered breathing in children. PIT has the advantages of decreased pain, dehydration and post-operative bleeding, and with a mean follow-up of 1.2 years, a low incidence of tonsillar regrowth thus far.

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KW - Pediatric tonsillar hypertrophy

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