Postoperative Bleeding, Revision Surgery, and Outcome of Cold Steel Tonsillotomy in Children With Upper Airway Obstruction

ABSTRACT Objective To evaluate the safety and clinical outcomes (bleeding rate, requirement for revision surgery, and patient‐reported symptom relief) of pediatric cold steel tonsillotomy with or without adenoidectomy (TT/TTA). Methods Patients aged ≤ 18 years who underwent cold steel TT/TTA for the management of upper airway obstruction in Region Jönköping County, Sweden, between October 1, 2013, and September 31, 2023, were included in this single center, retrospective, cohort study. Data regarding postoperative bleeding and revision surgery were extracted from electronic medical records. Patient‐reported outcomes were obtained from the Swedish Quality Register of Tonsil Surgery. Results Among the 1810 cold steel TT/TTA procedures included in the analysis, 36 (2.0%) bleeding events were identified, comprising 12 (0.7%) and 24 (1.3%) cases involving tonsils and adenoid beds, respectively. Four (0.2%) and seven (0.4%) patients with tonsil and adenoid bleeding, respectively, required surgical intervention. No significant risk factors for postoperative bleeding were identified. The rate of revision surgery owing to regrowth of tonsil tissue or recurrent infections was 5.1%. Younger age at the time of the first surgery was a significant risk factor for revision surgery ( p < 0.001). Complete (64.9%) or almost complete (29.5%) resolution of symptoms was reported in 94.4% ( n = 868) of the patients 6 months postoperatively. Conclusion Cold steel TT/TTA is a safe and efficient surgical procedure for pediatric patients with upper airway obstruction owing to tonsil and adenoid hypertrophy. Level of Evidence: 4.