Effect of tonsillar fossa closure on postoperative pain and bleeding risk after tonsillectomy

Objective: To determine if closing the tonsil fossa after tonsillectomy leads to less pain and bleeding. Study design: Interventional, Randomized, Single Blind, Active Control, Single Group Assignment, Safety/Efficacy Study. Follow-up: 2 months. Methods: Generalized Estimating Equations (GEE) analyzed effects of tonsillar pillar closure, surgeon experience tend interaction on outcomes. Setting: Primarily academic tertiary care referral center, institutional practice, primarily children, both ambulatory and hospitalized care. Subjects: 763 subjects (age 8-264 months) undergoing tonsillectomy. Exclusions: suspected malignancy or active peritonsillar abscess. At the discretion of the attending surgeon, patients undergoing tonsillectomy during the 4 year study period were offered participation. A computer selected the side closed. 131 subjects withdrew (complete lack of follow-up information) after the first 72 h. Intervention: 3-0 chromic sutures on tapered needles to close one tonsillar fossa. The subject was not told which side was closed. Main outcome measures: postoperative bleeding (at any time) and pain reported was sought on days 1, 7, 14, 21, and 28. Results: Closure of the tonsillar fossa did not change the risk of bleeding. Closing the tonsillar fossa had a 40% increase in the odds ratio of postoperative pain. In the tonsillar fossa sides left open, greater surgeon experience decreased the risk of bleeding. In closed sides, enriched surgeon experience increased the risk of bleeding (p < .0.05). Conclusions: Suture closure of the tonsillar fossa after tonsillectomy does not reduce the risk of bleeding. Additionally, closing the tonsillar fossa increased postoperative pain. Level of evidence: 1b (individual randomized controlled trial). (C) 2012 Elsevier Ireland Ltd. All rights reserved.