OBJECTIVES: Approximately 880,000 tonsillectomy/adenoidectomy procedures are performed in the US annually. Hemostatic matrix (FLOSEAL) is used for adjunctive hemostasis in a variety of surgeries, but the health economic rationale supporting its application in tonsillectomy and adenoidectomy has yet to be established. A systematic literature review was conducted in order to examine the evidence for hemostatic matrix and to consider its value in reducing the burden of these procedures. METHODS: Applying keywords and inclusion criteria, the PubMed, EMBASE, and Centre for Reviews and Dissemination databases were queried for studies published in English up to March 1, 2011. Reference lists and the American Academy of Otolaryngology-Head and Neck Surgery database were also manually searched.  Data on costs, resource utilization, and health outcomes were extracted and summarized. RESULTS: Four prospective, randomized controlled trials provided data on 187 patients treated with hemostatic matrix. In the two studies utilizing crossover design, no patients in the hemostatic matrix groups required electrocautery, whereas 3 of 35 (9%) and 4 of 34 (12%) patients, respectively, required adjunctive hemostatic matrix intraoperatively after failing electrocautery. In all three studies measuring operating room time, use of hemostatic matrix resulted in significantly shorter mean durations (range, 0.93 to 24.6 minutes) compared to electrocautery (range, 9.53 to 32.6 minutes) (all studies, P<0.05). Although postoperative bleeding rates did not differ, hemostatic matrix-treated patients in three of four studies reported significant reductions in postoperative pain scores and narcotic consumption compared to electrocautery-treated patients (P<0.05). CONCLUSIONS: Published evidence suggests that hemostatic matrix is effective in achieving intraoperative hemostasis during tonsillectomy/adenoidectomy. Given the high volume of procedures, using hemostatic matrix during tonsillectomy and adenoidectomy may be potentially cost saving due to resulting reductions in operating time and postoperative narcotic consumption. Further research may identify patients who are more likely to benefit from hemostatic matrix in this indication.