Clinical Outcomes, Complications, and Device Costs of Septoplasty Using a Modified Killian Incision With Three-Electrode Submucous Diathermy: A Retrospective Study of 800 Cases

BackgroundSeptal deviation and inferior turbinate hypertrophy frequently coexist and contribute to chronic nasal obstruction.This study evaluated clinical outcomes, complications, and device costs associated with septoplasty through a modified Killian incision and inferior turbinate submucous diathermy (SMD) using three reusable electrosurgical electrodes. MethodsThis retrospective cohort study reviewed 800 adults who underwent septoplasty with concomitant inferior turbinate SMD at Buraidah Central Hospital, Saudi Arabia, between January 2022 and December 2025 after failed medical therapy.A locally procured, unbranded, China-manufactured electrosurgical pencil was used with reusable monopolar needle, ball, and spatula electrodes applied sequentially.Bilateral silicone septal splints and one-day chlorhexidine-impregnated paraffin gauze packing were used.All 800 patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale and visual analog scale (VAS) for obstruction before surgery and at the final available postoperative assessment (6-12 months after surgery).The data-collection cutoff date was 30 June 2026.Paired scores were compared using the Wilcoxon signedrank test. ResultsThe mean age was 34.2 ± 11.5 years, and 496 patients (62.0%) were male.Mean NOSE scores decreased from 78.4 ± 12.6 to 18.2 ± 8.4, an absolute reduction of 60.2 points (76.8%).Mean VAS obstruction scores decreased from 8.2 ± 1.1 to 1.4 ± 0.9, an absolute reduction of 6.8 points (82.9%); both comparisons had p < 0.001.The study's composite improvement criterion, defined as a greater than 50% reduction in NOSE score with endoscopic improvement, was met by 762 patients (95.2%).Severe crusting occurred in 60 patients (7.5%), minor epistaxis in 24 (3.0%), transient reduction in smell or taste in 18 (2.3%),synechiae in 12 (1.5%),suture-site infection in eight (1.0%), and septal perforation in four (0.5%).Each reusable electrode cost SAR 6; the three-electrode set cost SAR 18 and, when allocated across five procedures, had a reported acquisition cost of SAR 3.6 per case compared with SAR 120 for a disposable microdebrider blade. ConclusionsThe combined procedure was associated with substantial symptom improvement and infrequent major complications in this retrospective cohort.The reusable SMD instrumentation had a lower reported acquisition cost than a disposable microdebrider blade.Because there was no comparator group and the cost analysis excluded total care costs and health-economic outcomes, comparative effectiveness and formal cost-effectiveness remain unproven.