Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors

Gonçalves, Ana Isabel; Rato, Catarina; Vilhena, Ditza de; Duarte, Delfim; Lopes, Gustavo; Trigueiros, Nuno

doi:10.1007/s00405-020-06060-1

Cited by 24 publications

(30 citation statements)

References 25 publications

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“…Although male sex has been reported as a higher independent risk factor for PTH in some studies, it has not been proven in the literature. [2,3,5,7] In a study conducted in Germany, it was observed that the cold tonsillectomy method and other methods did not create a statistical difference in terms of PTH. [7] In their study, Ikoma et al [3] performed all tonsillectomies with cold dissection under general anesthesia.…”

Section: Discussionmentioning

confidence: 98%

“…[1] In the literature, the overall prevalence of PTH ranges between 1.5 and 20%, consisting of a primary PTH (occurring the first 24 h of the surgery) rate of 0.2 to 2.2% and a secondary PTH (occurring after the first 24 h of the surgery) rate of 0.1 to 3.5%. [2,3] As reported previously, risk factors for PTH include sex, age, tonsillectomy indication, type of operation, and how skilled the surgeon is. [2][3][4][5][6][7] In this study, we aimed to investigate the role of preoperative hematologic factors to predict PTH in adults.…”

mentioning

confidence: 87%

“…[2,3] As reported previously, risk factors for PTH include sex, age, tonsillectomy indication, type of operation, and how skilled the surgeon is. [2][3][4][5][6][7] In this study, we aimed to investigate the role of preoperative hematologic factors to predict PTH in adults.…”

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confidence: 87%

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Can the preoperative hematologic factors play a role in predicting adult post-tonsillectomy hemorrhage?

Bal¹

2022

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OBJECTIVE: This study aimed to assess the preoperative hematologic factors for predicting post-tonsillectomy hemorrhage (PTH). METHODS: In the retrospective study, the records of 44 patients (21 males, 23 females; mean age 30.5±9.4 years; range, 18 to 55 years) who underwent tonsillectomy for chronic or recurrent tonsillar infections were reviewed. Age, sex, coagulation profile [international normalized ratio (INR), activated partial thromboplastin time (aPTT)], complete blood cell count [hematocrit (HTC), neutrophil (NEU) count, lymphocyte (LYMP) count, platelet (PLT) count, mean platelet volume (MPV), red cell distribution width (RDW)] such values have been recorded. Patients were divided into two groups according to the presence of PTH. Group A (8 males, 13 females; mean age 30.5±11.1 years) included patients without PTH and Group B (13 males, 10 females; mean age 30.5±7.8 years) was comprised of patients with PTH. RESULTS: In the evaluation of the coagulation profile, aPTT values were 24.5±1.9 sec in Group A and 26.4±17 sec in Group B (p= 0.017). Median value of INR was similar between the groups (p=0.60). No difference was detected between the groups regarding the following parameters of the complete blood count: HTC (p=0.49), NEU (p=0.17), LYMP (p=0.45), PLT (p=0.71), MPV (p=0.27), and RDW (p=0.29). CONCLUSION: It is important to perform relevant blood tests should in the preoperative period, in addition to INR and aPTT tests. New studies are needed to determine the relationship of MPV and RDW with PTH.

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confidence: 98%

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confidence: 87%

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Can the preoperative hematologic factors play a role in predicting adult post-tonsillectomy hemorrhage?

Bal¹

2022

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“…Bizim çalışmamızda da bununla uyumlu olarak kanama ile ilişkili olan PLT, aPTT değerlerinde kontrol grubu ve kanayan grup arasında istatistiksel olarak anlamı bir fark bulunmadı. Gonçalves ve ark.nın [9] 897 hasta üzerinde yaptıkları retrospektif çalışmada, INR >1.2 ve aPTT >35 olan hastalarda kanama riskinin fazla olduğu belirtilmiştir. Bu çalışmanın diğer bir özelliği ise literatürle uyumlu olarak yaş arttıkça kanama riskinin arttığının ortaya konulmasıdır.…”

Section: Discussionunclassified

“…Ameliyat öncesi kanama riski açısından pıhtılaşma faktörlerini içeren çalışmalar literatürde mevcuttur. [8][9][10][11] Çalışmamızda ameliyat öncesi rutin bakılan hemogram ve pıhtılaşma değerlerinin ameliyat sonrası dönemde kanama riskine etkisi araştırıldı. Tonsillektomi sonrası kanama nedeniyle tekrar ameliyat edilen hastalar ile tekrar ameliyata ihtiyaç duyulmayan diğer hastalar arasında PLT, RDW, MPV değişkenleri bakımından istatistiksel olarak anlamlı fark olmadığı görüldü (sırasıyla p=0.875, p=0.309, p=0.814).…”

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The relationship between post-tonsillectomy bleeding and preoperative blood parameters in pediatric patients

Alagöz¹

2022

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OBJECTIVE: In our study, the significance of preoperative whole blood and coagulation test values in predicting post-tonsillectomy bleeding were investigated. METHODS: The files of 115 pediatric patients who underwent bilateral tonsillectomy for chronic tonsillitis by the same surgical team between January 1, 2019, and December 31, 2020, in the ear, nose, and throat clinic of Adana City Training and Research Hospital were retrospectively reviewed. Patients with a history of coagulopathy and missing data were excluded from the study. The remaining 81 pediatric patients (34 females, 47 males; mean age 8.5±3 years; range, 3 to 17 years) were included in the study. All surgeons had at least five years of professional experience. RESULTS: After tonsillectomy, the patients were divided into two groups as those without (Group 1, n=53) and with (Group 2, n=28) bleeding in the operative field. Although the days of bleeding changed between the 1st and 14th days after surgery, it was most frequently observed on the 7th and 8th days. CONCLUSION: In our study, the age of the patient and the preoperative whole blood and coagulation parameters, hematocrit, neutrophil, and mean platelet volume, were found to be associated with bleeding after tonsillectomy.

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Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Johnson

Beams

Zaniletti

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe American Academy of Otolaryngology–Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored.ObjectiveTo use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event.Design, Settings, and ParticipantsThis retrospective cohort study used data from the Pediatric Health Information System for all pediatric (&lt;18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children’s hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023.Main Outcomes and MeasuresRevisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy.ResultsOf the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%.Conclusions and RelevanceThis retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

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Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors

Cited by 24 publications

References 25 publications

Can the preoperative hematologic factors play a role in predicting adult post-tonsillectomy hemorrhage?

Can the preoperative hematologic factors play a role in predicting adult post-tonsillectomy hemorrhage?

The relationship between post-tonsillectomy bleeding and preoperative blood parameters in pediatric patients

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

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