A surgeon performing a tonsillectomy can use two different techniques: "cold," the traditional way to handle surgery, and "hot" techniques, introduced in the 1960s, in which the surgeon burns the flesh so it won't bleed during surgery. Hot techniques have been becoming more popular, but there wasn't much evidence to show which way is better, so researchers are looking at hemorrhaging, the most common serious complication of tonsillectomies.

What the researchers wanted to know: Is hemorrhaging more common with some tonsillectomy techniques than others?

What they did: The National Prospective Tonsillectomy Audit collected data on all tonsillectomies in England and Northern Ireland starting July 7, 2003. By Feb. 23, 2004, the audit had data on nearly 12,000 tonsillectomies, performed using seven different techniques. For this study, the researchers defined primary hemorrhaging as bleeding so badly that the patient had to stay in the hospital longer, go back to the operating room while still in the hospital, or have a blood transfusion; secondary hemorrhaging was any bleeding within four weeks of surgery that required the patient to be readmitted to the hospital. Hemorrhaging occurred in 389 patients; 241 of those cases were severe enough that the patients had to return to the operating room. Most of the hemorrhaging was secondary, happening after the patient had been discharged from the hospital.

What they found: Patients who'd had plain old cold-steel surgery were the least likely to hemorrhage—only about 1 percent of them did so. Using any hot technique significantly increased the risk. The highest rate of hemorrhaging was with monopolar diathermy, the least common of the tissue-burning techniques; 6 percent of those patients hemorrhaged.

What the study means to you: The hot techniques, used in almost 90 percent of tonsillectomies in this study, are more likely to cause a hemorrhage. The authors aren't ready to throw out the hot techniques—they're valuable for stopping bleeding during surgery—but say they should be used with caution.

Caveats: Not all patients agreed to let their records be used in the audit.

Find out more: The National Prospective Tonsillectomy Audit: www.tonsil-audit.org

Read the article: National Prospective Tonsillectomy Audit. "Tonsillectomy Technique as a Risk Factor for Postoperative Hemorrhage." Lancet. Aug. 21, 2004, Vol. 364, pp. 697–702.

Abstract online: www.ncbi.nlm.nih.gov