Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Int J Pediatr Otorhinolaryngol. 2020 Sep;136:110197. doi: 10.1016/j.ijporl.2020.110197. Epub 2020 Jun 20.
Coblation and electrocautery are two common techniques used for adenotonsillectomy (T&A). Numerous studies have assessed surgical outcomes of coblation versus electrocautery and overall, postoperative complications are similar with the exception of a decrease in patient reported postoperative pain for coblation. Instrumentation required for coblation is significantly more expensive than that required for electrocautery. With minimal outcome differences, justification for the additional instrumentation costs is difficult. We performed this study to assess if there is a difference between operative & postoperative costs of electrocautery and coblation.
300 patient medical records were reviewed from 2015 to 2017 with equal numbers of electrocautery and coblation surgeries. Outcome measures included finance information, duration and cost of OR and Phase I and Phase II post-anesthesia care unit (PACU), in-hospital pharmacy costs, and postoperative complications. Logistic regression was used for analysis.
The median patient age for each surgical technique was 6 years old. Electrocautery resulted in more time in the OR compared to coblation, (OR:1.11,95%CI:1.07-1.15, p < .001), with greater associated costs, p < .001. Electrocautery patients were under anesthesia longer and had a longer surgical duration, p < .001. These same patients had longer duration in Phase II PACU, p = .028, and were given pain medications an increased number of times, p < .001. Total costs including operative expense, physician charges, OR and anesthesia times, pharmacy, and instrument were significantly higher for electrocautery patients, p = .003. There were no differences in ED visits, post-tonsillectomy bleed, or additional surgery between techniques, p > .05.
T&A electrocautery technique was found to have increased overall indirect costs. Costs of instrumentation in addition to increased operative time, use of analgesics and post-operative care contribute to costs associated with electrocautery and coblation should be used when assessing surgical costs.
等离子和电切是用于腺样体扁桃体切除术（T&A）的两种常见技术。许多研究评估了等离子与电切的手术结果，总体而言，除了等离子术后疼痛报告减少外，术后并发症相似。等离子所需的仪器设备明显比电切贵。由于结果差异极小，很难证明额外仪器设备成本的合理性。我们进行这项研究是为了评估电切和等离子在手术和术后成本方面是否存在差异。
回顾了 2015 年至 2017 年的 300 名患者的病历，电切和等离子手术数量相等。结果衡量标准包括财务信息、手术室和第一阶段及第二阶段麻醉后护理单元（PACU）的时间和成本、住院药房成本以及术后并发症。采用逻辑回归进行分析。
两种手术技术的中位患者年龄均为 6 岁。与等离子相比，电切在手术室的时间更长，（OR：1.11，95%CI：1.07-1.15，p<0.001），相关成本更高，p<0.001。电切患者的麻醉时间更长，手术时间更长，p<0.001。这些患者在第二阶段 PACU 的时间更长，p=0.028，并且接受疼痛药物的次数增加，p<0.001。电切患者的总费用包括手术费用、医生费用、手术室和麻醉时间、药房和仪器费用明显更高，p=0.003。两种技术之间在 ED 就诊、扁桃体切除术后出血或其他手术方面无差异，p>0.05。
T&A 电切技术发现总体间接成本增加。除了手术时间延长、使用镇痛药和术后护理外，仪器设备的成本也增加了与电切和等离子相关的成本，在评估手术成本时应考虑使用。
