Hot versus cold tonsillectomy: A systematic review of the literature

OBJECTIVE: We systematically reviewed the literature comparing monopolar electrocautery versus cold knife dissection tonsillectomy. METHODS: The MEDLINE database was searched using the key words "tonsillectomy," "hot," "cold," "sharp," "bleeding," and "cautery." Selection criteria included prospective trials comparing electrodissection versus cold knife dissection on posttonsillectomy pain and hemorrhage. Six of the 815 articles met the selection criteria. RESULTS: Pooled data for the paired studies showed significantly more patients with pain worse on the electrodissection side (148 of 293 = 51%) than the cold knife side (33 of 293 (11%); P = 0.001) on postoperative days 4 to 10. There were significantly more analgesic doses after surgery with electrodissection (means 26.7 versus 19.2; P = 0.028) and higher pain scores for adults undergoing electrodissection (means, 2.6 versus 0.8; significance could not be determined). There were no differences in hemorrhage rates. CONCLUSIONS: Electrodissection increases pain in comparison to sharp dissection for tonsillectomy. Postoperative hemorrhage rates are not significantly different when comparing the 2 methods.