Comparison of Clinical Outcomes and Total Cost of Hospitalizations of patients who underwent tonsillectomy using Harmonic Scalpel, Electrocautery and Cold Dissection in Manila Doctors Hospital (August 2013 to December 2014) Group VI
KenerhamM.Abdurahman,MD ,Cyrene GraceM.Briones,MD,Genecarlo MabaleLiwanag,MD,DaphneKayeD.Mabale,MD,
Junfel Marie B. Moralina, MD & Karmina Blanca D.C. Orbe, MD & Ma. Katrina D. Villanueva, MD
Manny Villegas, MD*
Tonsillectomy is one of the most commonly performed surgical procedures in the department of otorhinolaryngology in Manila Doctors Hospital. The most commonly used techniques for tonsillectomy in the institution are: (1) Electrocautery with monopolar or bipolar diathermy (2) Cold Dissection (3) Harmonic scalpel (4) Plasma-mediated Radiofrequency ablation (coblation).4 Issues on which technique will provide better condition and less complication are discussed, however no single technique has encompassed all the criteria to be regarded as the best tonsillectomy method to pract ice.
Methods: This is a retrospective analytical study wherein medical chart records of patients who underwent tonsillectomy of varying techniques from August 2013 to December 2014 in Manila Doctors Hospital were reviewed. Patients who underwent tonsillectomy using harmonic scalpel, electrocautery and cold dissection were selected and compared with regard to their clinical outcomes (mean operating time, post-operative pain, mean length of hospital stay, incidence of readmissions/reoperations due to rebleeding and total hospitalization cost)
Results: Majority of the patients who underwent tonsillectomy are adults (> 19 years old) mostly males. The most number of service types belong to the HMO group (68 out of 141 patients) specifically those under Maxicare covering 23.5% of the total HMO group. The most common indication for tonsillectomy was recurrent tonsillitis in 57 out of 141 patients. For the mean operating time, harmonic scalpel yielded the shortest mean operation time. An F value of 9.649 exceeds that of the tabulated value of F at p=0.0001 <0.05, thus, there is a sufficient evidence that at least one of the methods of tonsillectomy has a mean operating time which is different across group. For the post-operative pain, 43 patients reported of mild pain after the operation, 24 patients for electrocautery, 18 harmonics, and 1 for cold dissection. 52 patients had moderate pain after the operation 23 patients for electrocautery, 18 for harmonics, and 11 for cold dissection. Yielding a p- value of 0.013, it is sufficient to say that the methods of tonsillectomy are associated with post- operative pain of the patients. For the mean length of hospital stay, cold dissection yielded the shortest mean length of hospital stay. An F value of 0.793 exceeds that of the tabulated value of F at p=0.456 >0.05, thus, there is no significant difference in the mean hospital stay for each method.
3 out of 47 patients who underwent electrocautery were readmitted and re-operated due to rebleeding while 1 out of 36 patients for harmonics and none for cold dissection. A p-value 0.532 > 0.05, thus, there is sufficient evidence to say that the methods of tonsillectomy are not associated with incidence of readmissions/reoperations due to rebleeding.
Among the three techniques, cold dissection was the least costly having a mean total cost of PHP 59,891.11, while PHP 68,463.42 and 68,636.41 for electrocautery and harmonic scalpel respectively.
Conclusion: In this study, cold dissection showed better outcomes among the three methods of tonsillectomy, in terms of post-operative pain, length of hospital stay, and hospitalization cost.
*Adviser/Consultant, Department of Otorhinolaryngology