Norwegian clinicians advocate cold-technique tonsillectomy to reduce postoperative bleeding

Clinicians writing in Tidsskrift for Den norske legeforening argue that cold technique should be the default for tonsillectomy. They cite two registry-based cohort studies examining postoperative bleeding: one involving 28,254 patients operated on in Norway and Sweden during 2017–2022, and another involving 25,953 Norwegian patients during 2017–2025. Cold technique combines cold-steel dissection with haemostasis using compression, topical agents or ligatures, rather than heat-based methods.

In the Norway–Sweden cohort, any use of heat-based technique was associated with higher odds of postoperative bleeding than exclusively cold technique after adjustment for factors including age, sex and surgical indication (OR 3.84; 99% CI 2.79–4.56). The Norwegian cohort reported a similar association (OR 3.4; 95% CI 2.5–4.6), with an estimated absolute risk difference of 7.5 percentage points. Separately, the Norwegian tonsil registry reported that 6% of tonsillectomy patients in 2025 were readmitted for postoperative bleeding.

The authors estimate that adopting cold technique could potentially prevent 350–400 postoperative bleeding events annually in Norway. These estimates are based on observational associations and should not be interpreted as demonstrated effects of changing technique. The article is a clinical opinion piece, not a formal guideline; its authors report no conflicts of interest.