Resultados y utilidad de la electrocauterización ambulatoria de epistaxis

Abstract

Introduction and objective: On February 5th, 2021, we started at Hospital Clínico Universitario in Valladolid to use outpatient electrocautery with a monopolar suction coagulator and a rigid nasal endoscope to treat epistaxis. From that day until December 31st, 2021, we had treated 42 patients. The objective of our study is to prove is the use of electrocautery has lowered the number of hospital admissions to treat the epistaxis, the number of patients that require surgical treatment and predict the risk factors for rebleeding. Method: Retrospective observational longitudinal study. We have created a database with the electrocauterized patients until December 31st, 2021, collecting the risk factors, if nasal packing was needed and why, if there was rebleeding and if they required hospital admission or surgical treatment. We also collected the total number of epistaxis treated in the Emergency Room between February 5th and December 31st of the years 2021, 2020 and 2019 and the total number of epistaxis that required hospital admission between February 5th and December 31st of the years 2021, 2020 and 2019. Results: The 95% of the epistaxis were unilateral. 90% anterior, 81% septal. 62% of them used antiplatelet or anticoagulant treatment. Of all the electrocauterized we had 31% of rebleeding and 31% needed nasal packing. It is 5 times more frequent (IC 3-10) to rebleed after nasal packing than after electrocautery. Patients with just antiplatelet or anticoagulant do not need more nasal packing or suffer more rebleeding, but patients using both treatments at the same time do. The hospital admissions have lowered 15% compared to 2020 and 45.7% compared to 2019 (p<0.001). The number of patients that need surgical treatment has lowered 50% compared to 2020 and 66.6% compared to 2019 (p<0.001). 64% of the electrocauterized patients did not rebleed nor need nasal packing. Discussion: The use of electrocautery requires specific materials, takes longer and takes more personnel than standard treatment with nasal packing. On the other hand, it has lowered the number of patients rebleeding, the need to use nasal packing in most of the patients, the hospital admissions and the patients that require surgical treatment. We consider this technique worthwhile economically as well as for the well-being of the patient. Conclusions: The treatment of epistaxis using outpatient electrocautery has proved a worthwhile technique to improve care quality for the patients and, acquiring basic equipment, could be included to most of the ENT units’ services portfolio.