Intracapsular Tonsillectomy and Adenoidectomy Is Associated With Higher Rates of Postoperative Fever: Prospective Cohort Study

Abstract

Objectives: There are limited data on the incidence of postoperative fever in children undergoing tonsillectomy and whether the surgical technique has an influence on it. This study aimed to examine the association between surgical technique—cold adenotonsillectomy versus powered intracapsular tonsillectomy and adenoidectomy(PITA)—and the incidence of postoperative fever in children. Design: Prospective cohort study conducted between June 1, 2023, and November 30, 2024. Setting: Tertiary referral center. Participants: Children who underwent tonsillectomy with or without adenoidectomy. Main Outcome Measures: The primary outcome was the incidence of high postoperative fever (> 37.9°C/100.2°F) within 1-week postoperatively. Secondary outcomes included haemorrhage rates, pain levels, days to normal diet, halitosis, referral to treating physician, and readmissions within 1-week postoperatively. Results: Of the 82 children (46[56%] males, mean age:5.1 years interquartile range: [3–5]), 40(48.8%) underwent cold adenotonsillectomy, while the other 42(51.2%) underwent PITA (22 with coblation and 20 with microdebrider). One-week postoperative fever rate was 24.4%. Compared to cold adenotonsillectomy, PITA was associated with higher rates of fever 1-week postoperatively (odds ratio: 4.81, 95% confidence interval:1.29–22.02) and referrals to treating physician (15/42[35.7%] vs. 6/40[15%], p = 0.023). However, PITA showed lower pain levels (mean 1-week daily visual analogue scale: 3.4 ± 0.05 vs. 4.13 ± 0.82, p = 0.001) and shorter time to resuming a normal diet (mean 3.4 ± 0.77 vs. 4.07 ± 0.69 days, p = 0.001). No significant differences were observed in haemorrhage, readmission, or halitosis rates between the different surgical techniques. Conclusions: PITA was associated with higher rates of fever 1-week postoperatively. Parents should be informed about the possibility of fever and educated on how to manage it.