Postoperative morbidity of different tonsillectomy techniques: a systematic review and network meta‐analysis

Objective: To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. Methods: An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and second- ary outcomes were postoperative bleeding incidence and mean postoperative pain score. Results: A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74  0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67  1.43). Conclusions: ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings.