¿Influye la técnica quirúrgica en las hemorragias postamigdalectomía? Nuestra experiencia

Betancourt, Andreina R.; López, C.; Zerpa, Vanessa Zerpa; Carrasco, Marina; Dalmau, José

doi:10.1016/j.otorri.2014.09.009

Cited by 16 publications

(1 citation statement)

References 14 publications

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“…Betancourt et al (8) presented the lowest haemorrhage rate after cold dissection with monopolar forceps haemostasis (2.09%), which could be seen as our „combined” technique, which contradicts our results. Similarly, Lee et al (9) showed that the rate of post-tonsillectomy haemorrhage was higher using the hot technique (12.5%) than the rate of haemorrhage after using the cold dissection (5.5%).…”

Section: Discussioncontrasting

confidence: 88%

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Brkic¹,

Mujic²,

Softic³

et al. 2017

Med Arch

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Introduction:Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate.Aims:To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists.Methods:We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1st 2015 and October 31st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis).Results:1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012).Conclusion:We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.

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Section: Discussioncontrasting

confidence: 88%

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Brkic¹,

Mujic²,

Softic³

et al. 2017

Med Arch

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Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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Objectives/Hypothesis Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. Study Design Retrospective chart review. Methods A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary‐care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. Results Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47‐6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06‐4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. Conclusions Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. Level of Evidence 4 Laryngoscope, 129:2765–2770, 2019

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Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use

et al. 2021

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Objectives/Hypothesis Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post‐tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non‐steroidal anti‐inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. Study Design Retrospective chart review. Methods We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. Results A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69–1.49; P = .95). Conclusions This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher‐powered study is needed. Level of Evidence 3 Laryngoscope, 132:949–953, 2022

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¿Influye la técnica quirúrgica en las hemorragias postamigdalectomía? Nuestra experiencia

Cited by 16 publications

References 14 publications

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use

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