Incidence of Post Tonsillectomy Bleeding between Harmonic versus Cold steel Techniques: A Comparative Study

Abstract

Tonsillectomy is one of the most commonly performed otolaryngological procedures. Post-tonsillectomy bleeding remains the most significant complication and may occur in the early or late postoperative period, leading to increased morbidity and hospital readmission. To compare the incidence of post-tonsillectomy bleeding between conventional (cold steel) and ultrasonic techniques (harmonic). This comparative interventional study was conducted at two hospitals in Babylon government Al-Hilla Teaching Hospital and Al-Imam Al-Sadiq Hospital over a 12-month period from October 2024 to October 2025.A total of 260 patients underwent tonsillectomy were included. Patients were divided into two groups: (1) Group 1: 130 patients that were treated with Cold-steel dissection; (2) Group 2: 130 patients that were treated with Harmonic (ultrasonic) dissection. Data collected included age, sex, indication for surgery, surgical technique, season of surgery, occurrence and timing of post-tonsillectomy bleeding, and initial management. Statistical analysis was performed using appropriate tests, with a p-value < 0.05 considered to be statistically significant. Post-tonsillectomy bleeding occurred in 13 patients (5%). Secondary bleeding (≥24 hours) was more common than primary bleeding. A statistically significant association was observed between post-tonsillectomy bleeding and the primary surgical technique, as well as obstructive sleep apnea as an indication for surgery. Age, sex, and season showed no statistically significant association with bleeding. Most of secondary bleeding episodes (8 patients) were managed conservatively and (2 patients) were managed surgically, while all primary bleeding (3 patients) required operative intervention. Harmonic tonsillectomy appears to be associated with a higher incidence of post-tonsillectomy bleeding compared to the cold steel technique, particularly regarding secondary bleeding.