Advanced ENT and Allergy, Louisville, Kentucky, U.S.A.
Dr Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A.
Laryngoscope. 2021 Nov;131(11):2505-2511. doi: 10.1002/lary.29587. Epub 2021 Apr 27.
OBJECTIVES/HYPOTHESIS: To compare rates of post-tonsillectomy hemorrhage (PTH) between a very-low energy transfer monopolar technique (VLET) and standard energy techniques.
Retrospective controlled cohort study.
All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive "hot" technique without exclusive monopolar use [Mixed "Hot"]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared.
During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed "Hot"), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed "Hot" group experienced similar rates (1.57%, P = .54; 1.68%, P = .64), but the VLET group experienced significantly lower rates (0.15%, P = .0026, adjusted odds ratio [OR] 0.114 [0.028-0.469]; 0.22%, P = .0016, adjusted OR 0.155 [0.048-0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P = .0025, P = .0024, adjusted OR 1.02/year [1.01-1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies.
Standard energy techniques had an adjusted odds ratio over 8-fold higher for secondary PTHRSI and over 6-fold higher for total PTHRSI compared to the minimized energy transfer VLET technique.
3 Laryngoscope, 131:2505-2511, 2021.
目的/假设：比较超低能量传输的单极技术（VLET）与标准能量技术在扁桃体切除术后出血（PTH）方面的发生率。
回顾性对照队列研究。
确定 2010 年 1 月 1 日至 2019 年 8 月 31 日期间由执业医师实施的所有扁桃体切除术。根据外科医生的技术应用，将患者分为三组：研究组（VLET）和两组对照组（单独使用标准能量的单极技术[标准]；不单独使用单极技术的“热”技术[混合“热”]）。确定每组需要手术干预的 PTH 发生情况（PTHRSI）并比较发生率。
在研究期间，共进行了 11348 例扁桃体切除术（标准组 4427 例，VLET 组 1374 例，混合“热”组 5547 例），发现 167 例（1.47%）PTHRSI 事件（14 例为原发性[<24 小时]，153 例为继发性[>24 小时]，12 例为重复[>1 次 PTHRSI/患者]）。与标准组的继发性和总 PTHRSI 发生率（1.47%，1.60%）相比，混合“热”组的发生率相似（1.57%，P=0.54；1.68%，P=0.64），但 VLET 组的发生率显著较低（0.15%，P=0.0026，调整后的优势比[OR]0.114[0.028-0.469]；0.22%，P=0.0016，调整后的 OR 0.155[0.048-0.494]）。年龄是继发性和总 PTHRSI 的显著危险因素（P=0.0025，P=0.0024，调整后的 OR 每增加 1 岁为 1.02[1.01-1.03]）。在任何年龄组中，均未观察到原发性 PTHRSI 的发生率有显著差异。在 1060 例扁桃体切除术中，<12VLET 组无继发性 PTHRSI 发生，总 PTHRSI 发生率为 0.09%。
与最小化能量传递的 VLET 技术相比，标准能量技术的继发性 PTHRSI 和总 PTHRSI 的调整后的优势比分别高出 8 倍和 6 倍以上。
3《喉镜》，131：2505-2511，2021。
