Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis

Alexios Tsikopoulos; Athanasios Fountarlis; Konstantinos Tsikopoulos; Fotios Dilmperis; Konstantinos Garefis; Ioannis Tsikopoulos; Charalampos Skoulakis; Petros Karkos; Stefanos Triaridis

doi:10.1007/s00405-022-07294-x

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis

Eur Arch Otorhinolaryngol. 2022 May;279(5):2245-2257. doi: 10.1007/s00405-022-07294-x. Epub 2022 Feb 15.

Authors

Alexios Tsikopoulos¹, Athanasios Fountarlis², Konstantinos Tsikopoulos³, Fotios Dilmperis⁴, Konstantinos Garefis⁵, Ioannis Tsikopoulos⁶, Charalampos Skoulakis², Petros Karkos⁷, Stefanos Triaridis⁷

Affiliations

¹ 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, 546 21, Thessaloniki, Greece. alextsikop@yahoo.gr.
² Department of Otorhinolaryngology, University General Hospital of Larissa, University of Thessaly, Larissa, Greece.
³ Department of Orthopedics, 424 Army General Training Hospital, Thessaloniki, Greece.
⁴ School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ 2nd Department of Otorhinolaryngology-Head and Neck Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁶ Department of Urology, 424 Army General Training Hospital, Thessaloniki, Greece.
⁷ 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, 546 21, Thessaloniki, Greece.

PMID: 35169892
DOI: 10.1007/s00405-022-07294-x

Abstract

Objectives: Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy.

Methods: The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively.

Results: Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively).

Conclusions: This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.

Keywords: Meta-analysis; Peritonsillar abscess; Quinsy; Systematic review; Tonsillectomy; Tonsillitis.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Blood Loss, Surgical
Humans
Operative Time
Peritonsillar Abscess* / diagnosis
Peritonsillar Abscess* / surgery
Postoperative Hemorrhage / epidemiology
Postoperative Hemorrhage / etiology
Postoperative Hemorrhage / surgery
Tonsillectomy* / adverse effects
Tonsillectomy* / methods