Question 11: is coblator adenoidectomy in pediatric patients associated with a higher cost?
nasal obstruction, OME
CHRONIC RHINOSINUSITIS, SLEEP APNEA, SECONDARY, RECURRENCE
The last important variable influencing the preferred instrument or technique is cost [In conclusion, the coblator is more expensive than the curette in terms of direct costs with no evidence on indirect costs.Although the above results could guide our decision on the choice of technique, there are several confounding factors that could impair the analysis.Adenoid size is an important confounder. It has been reported to be related to recurrence rate [Another confounding factor to consider is the surgical criteria, as most authors did not specify the surgical criteria. Surgery may be indicated for several reasons including sleep apnea, OME, chronic rhinosinusitis or nasal obstruction and results may differ according to the indication. As an example, a multivariate analysis showed that there is a significant risk of revision adenoidectomy for patients with an ear-related indication for adenoidectomy, (OR 10.8) [Surgical technique and surgeon skills may also influence outcomes. Thus, level of training has been reported to be a factor related to the risk of revision surgery, with patients operated on by trainees being 50% more likely to require revision surgery [Coblator can be utilized following different methods, as it can be used through the nose or through the mouth. As well as the way to visualize the adenoids, using a transnasal endoscope, transoral angulated endoscope or transoral mirror. It can also change the power set, according to the delivered energy. There are no studies comparing these variables.Finally, younger age has been proposed in several studies as a factor positively related to adenoid regrowth and revision surgery, as each year decreases the risk of revision surgery by 30%. However, none of the authors have stratified their results according to age.Another potential confounding factor not considered in this review is the concomitant tonsillectomy. In this review we have excluded studies with concomitant surgery. This sample may not reflect the common patient, as usually adenoidectomy is associated with tonsillectomy.Coblator can be used in different ways, as it can be performed either through the nose or through the mouth. The same applies to the type of instrument used to visualize the adenoids, either using a transnasal endoscope, an angled transoral endoscope or a transoral mirror. Furthermore, the power setting may also vary depending on the energy delivered. In this respect, there are no studies comparing these variables.Regarding to age, younger age has been proposed in several studies as a factor positively related to adenoid regrowth [Another potential confounding factor not considered in this review is concomitant tonsillectomy, as studies with concomitant surgery have been excluded; consequently, it is possible that this sample does not reflect the common patient, thus adenoidectomy is usually associated with tonsillectomy.Finally, it should be kept in mind that coblation adenoidectomy may have its own risks and disadvantages that should be measured against its benefits. The most remarkable is that it may impair the presence of enough tissue to perform histology assessment. In fact, despite the evidence is scarce, some authors have suggested that some secondary effects are more prone to occur with the coblation than microdebrider [