Time to Functional Recovery After Laser Tonsillotomy Performed Under Local Anesthesia vs Conventional Tonsillectomy With General Anesthesia Among Adults: A Randomized Clinical Trial.

Autor:	Wong Chung JERE; Department of Otolaryngology Head and Neck Surgery, Hagaziekenhuis, The Hague, the Netherlands.; Department of Otolaryngology Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands., van Geet R; Department of Otolaryngology Head and Neck Surgery, Hagaziekenhuis, The Hague, the Netherlands.; Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium., van Helmond N; Department of Anesthesiology, Cooper University Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey., Kastoer C; Department of Otolaryngology Head and Neck Surgery, Hagaziekenhuis, The Hague, the Netherlands.; Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.; Department of Otolaryngology Head and Neck Surgery, Haaglanden Medical Center, The Hague, the Netherlands., Böhringer S; Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands., van den Hout WB; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands., Verschuur HP; Department of Otolaryngology Head and Neck Surgery, Haaglanden Medical Center, The Hague, the Netherlands., Peek FAW; Department of Otolaryngology Head and Neck Surgery, Reinier de Graaf, Delft, the Netherlands., Dammeijer PFM; Department of Otolaryngology Head and Neck Surgery, VieCuri Medical Center, Venlo, the Netherlands., van Wermeskerken GKA; Department of Otolaryngology Head and Neck Surgery, Amphia Hospital, Breda, the Netherlands., van Benthem PPG; Department of Otolaryngology Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands., Blom HM; Department of Otolaryngology Head and Neck Surgery, Hagaziekenhuis, The Hague, the Netherlands.; Department of Otolaryngology Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.; Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Feb 01; Vol. 5 (2), pp. e2148655. Date of Electronic Publication: 2022 Feb 01.
DOI:	10.1001/jamanetworkopen.2021.48655
Abstrakt:	Importance: Carbon dioxide laser tonsillotomy performed under local anesthesia may be an effective and less invasive alternative than dissection tonsillectomy for treatment of tonsil-related afflictions. Objective: To compare functional recovery and symptom relief among adults undergoing tonsillectomy or tonsillotomy. Design, Setting, and Participants: This randomized clinical trial was conducted at 5 secondary and tertiary hospitals in the Netherlands from January 2018 to December 2019. Participants were 199 adult patients with an indication for surgical tonsil removal randomly assigned to either the tonsillectomy or tonsillotomy group. Interventions: For tonsillotomy, the crypts of the palatine tonsil were evaporated using a carbon dioxide laser under local anesthesia, whereas tonsillectomy consisted of total tonsil removal performed under general anesthesia. Main Outcomes and Measures: The primary outcome was time to functional recovery measured within 2 weeks after surgery assessed for a modified intention-to-treat population. Secondary outcomes were time to return to work after surgery, resolution of primary symptoms, severity of remaining symptoms, surgical complications, postoperative pain and analgesics use, and overall patient satisfaction assessed for the intention-to-treat population. Results: Of 199 patients (139 [70%] female; mean [SD] age, 29 [9] years), 98 were randomly assigned to tonsillotomy and 101 were randomly assigned to tonsillectomy. Recovery within 2 weeks after surgery was significantly shorter after tonsillotomy than after tonsillectomy (hazard ratio for recovery after tonsillectomy vs tonsillotomy, 0.3; 95% CI, 0.2-0.5). Two weeks after surgery, 72 (77%) patients in the tonsillotomy group were fully recovered compared with 26 (57%) patients in the tonsillectomy group. Time until return to work within 2 weeks was also shorter after tonsillotomy (median [IQR], 4.5 [3.0-7.0] days vs 12.0 [9.0-14.0] days; hazard ratio for return after tonsillectomy vs tonsillotomy, 0.3; 95% CI, 0.2-0.4.). Postoperative hemorrhage occurred in 2 patients (2%) in the tonsillotomy group and 8 patients (12%) in the tonsillectomy group. At 6 months after surgery, fewer patients in the tonsillectomy group (25; 35%) than in the tonsillotomy group (54; 57%) experienced persistent symptoms (difference of 22%; 95% CI, 7%-37%). Most patients with persistent symptoms in both the tonsillotomy (32 of 54; 59%) and tonsillectomy (16 of 25; 64%) groups reported mild symptoms 6 months after surgery. Conclusions and Relevance: This randomized clinical trial found that compared with tonsillectomy performed under general anesthesia, laser tonsillotomy performed under local anesthesia had a significantly shorter and less painful recovery period. A higher percentage of patients had persistent symptoms after tonsillotomy, although the intensity of these symptoms was lower than before surgery. These results suggest that laser tonsillotomy performed under local anesthesia may be a feasible alternative to conventional tonsillectomy in this population. Trial Registration: Netherlands Trial Register Identifier: NL6866 (NTR7044).
Databáze:	MEDLINE
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