How do electrocautery, microdebrider, and coblation techniques compare with regard to costs and complications of outpatient pediatric adenoidectomy?
Bottom line: These results suggest that adenoidectomy with electrocautery is significantly less expensive than microdebrider and coblator, with no differences in complication rates or surgical times among the techniques. However, microdebrider was associated with a longer overall OR time and a higher rate of revision surgery.
Explore this issue:March 2018
Background: An estimated 132,000 outpatient adenoidectomy procedures are performed in the United States annually, excluding those performed in conjunction with tonsillectomy. In the last decades, a movement from cold techniques to electrosurgical methods such as electrocautery, coblation, and microdebrider has taken place. However, there is a paucity of data comparing newer techniques for adenoidectomy.
Study design: Observational retrospective cohort study of children younger than 18 years of age who underwent outpatient adenoidectomy between January 2008 and September 2015 at 23 medical facilities (seven outpatient surgical centers, 16 hospitals).
Setting: Intermountain Healthcare, Salt Lake City, Utah.
Synopsis: A total of 1,065 adenoidectomy cases were performed by 64 different surgeons. Electrocautery was used in 372 cases, microdebrider in 278, and coblation in 415. There were 90 electrocautery cases in which curettage was used in conjunction with the cauterization, three in which the microdebrider was used with the curette, and none with the coblator combined with the curette. The average direct cost was $597 for electrocautery, $833 for microdebrider, and $797 for coblator, a statistically significantly lower cost for electrocautery compared to the other two methods. Average surgical times were not statistically significant, at 9.3 minutes for electrocautery, 10.8 minutes for microdebrider, and 9.5 minutes for coblation.
Overall, complications were infrequent, and there was no significant difference in incidence among surgical methods. The incidence of revision adenoidectomy procedures was significantly greater for microdebrider when compared to both electrocautery and coblator. The average incidence of repeat adenoidectomy by method per individual surgeon was not significantly different. Limitations included a potential instrument selection bias, lack of ER visit data outside of the network, lack of control of instrument settings, and the consistency of reporting
Citation: Sjogren PP, Thomas AJ, Hunter BN, et al. Comparison of pediatric adenoidectomy techniques. Laryngoscope. 2018;128:745–749.