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

McLean, James E.; Hill, Christopher J.; Riddick, Jeanelle Braxton; Folsom, Craig

doi:10.1002/lary.29844

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…The most important complication after extracapsular tonsillectomy is PTH. In the present study, PTH occurred in 5.80% (17/293) of patients, similar to the rates of 1.4%–11.9% reported previously 21–23 . Most previous studies have reported an increased risk of PTH after coblation extracapsular tonsillectomy 3–6,24 .…”

Section: Discussionsupporting

confidence: 89%

“…In the present study, PTH occurred in 5.80% (17/293) of patients, similar to the rates of 1.4%–11.9% reported previously. 21 , 22 , 23 Most previous studies have reported an increased risk of PTH after coblation extracapsular tonsillectomy. 3 , 4 , 5 , 6 , 24 However, Glade et al 25 reported similar rates of primary and secondary PTH between coblation and electrocautery groups.…”

Section: Discussionmentioning

confidence: 99%

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A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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Objective: The aim of this study was to compare intraoperative blood loss, postoperative pain, post-tonsillectomy hemorrhage (PTH), and medical costs associated with extracapsular tonsillectomy between coblation and monopolar electrocautery in children. Materials and methods:This study included 293 patients aged 6-15 years planned to undergo extracapsular tonsillectomy. Data on estimated blood loss, postoperative pain score, operation time, PTH, and the cost of disposable equipment were collected.Results: Coblation extracapsular tonsillectomy was associated with significantly lower mean pain scores than monopolar technique on postoperative days 1 (p <.001) and 2 (p = 0.02). However, the pain score was similar between the groups at all other time points. The monopolar group had a significantly shorter operation time compared to the coblation group (11.09 ± 7.53 vs. 17.12 ± 4.29 min, p <.001).Intraoperative estimated blood loss was not significantly different between the groups (p = .43).The cost of extracapsular tonsillectomy was significantly lower in the monopolar compared to the coblation group (US$ 28.18 vs. US$ 430.48, p <.001). PTH occurred in 17 patients (5.80%) and required a second surgery. Secondary PTH occurred in 6.16% (9/146) and 0.68% (1/147) of patients in the coblation and monopolar groups, respectively (p <.001). The PTH was significantly higher in the tonsillitis compared to in the tonsillar hypertrophy (12.37% vs. 2.55%, p = .002), However, the difference of PTH was not significant among mean pain scores subgroups. Of the 17 patients with PTH, the lower pole, middle portion, and upper pole were involved in 15 (88.24%), 2 (11.76%), and 0 cases, respectively.Conclusions: Coblation and novel monopolar electrocautery extracapsular tonsillectomy are associated with similar postoperative pain scores except on postoperative days 1 and 2. However, monopolar technique offers significant advantages over coblation method with less operative time, decreased secondary PTH, and cost.Level of Evidence: NA.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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“…The incidence of PTH is approximately 1%–19%. PTH is regarded as a primary cause of death related with tonsillectomy and has been suggested to be a potentially lethal complication, particularly in children ( 3 , 4 ). Anemia and hemodynamic abnormalities, which can hinder the patient’s recovery and even necessitate repeat surgery, are possible PTH hazards that could have a negative psychological impact on the patient as well as physical harm.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a machine learning-based predictive model for secondary post-tonsillectomy hemorrhage

Yang

et al. 2023

Front. Surg.

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BackgroundThe main obstacle to a patient's recovery following a tonsillectomy is complications, and bleeding is the most frequent culprit. Predicting post-tonsillectomy hemorrhage (PTH) allows for accurate identification of high-risk populations and the implementation of protective measures. Our study aimed to investigate how well machine learning models predict the risk of PTH.MethodsData were obtained from 520 patients who underwent a tonsillectomy at The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army. The age range of the patients was 2–57 years, and 364 (70%) were male. The prediction models were developed using five machine learning models: decision tree, support vector machine (SVM), extreme gradient boosting (XGBoost), random forest, and logistic regression. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was used to interpret the results of the best-performing model.ResultsThe frequency of PTH was 11.54% among the 520 patients, with 10.71% in the training group and 13.46% in the validation set. Age, BMI, season, smoking, blood type, INR, combined secretory otitis media, combined adenoidectomy, surgical wound, and use of glucocorticoids were selected by mutual information (MI) method. The XGBoost model had best AUC (0.812) and Brier score (0.152). Decision curve analysis (DCA) showed that the model had a high clinical utility. The SHAP method revealed the top 10 variables of MI according to the importance ranking, and the average of the age was recognized as the most important predictor variable.ConclusionThis study built a PTH risk prediction model using machine learning. The XGBoost model is a tool with potential to facilitate population management strategies for PTH.

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“…In addition, the bleeding rate of the 432 patients prescribed NSAIDs postoperatively was nearly identical to that of the 625 patients not prescribed NSAIDs (12.6% vs. 11.7%, adjusted OR 1.01). 1 Drs Onal and Onal note that we failed to include background data regarding the use of perioperative dexamethasone and ketorolac and this is true. However, between the authors' combined experience at this institution, which spans the years 2012-present, it is believed that nearly 100% of adult tonsillectomy patients have received dexamethasone preoperatively whereas we cannot recall one instance of ketorolac being administered.…”

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confidence: 99%

In Response to The Effect of NSAID Use on Post‐Tonsillectomy Hemorrhage in Adults

2022

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Dear Editor,We appreciate the points raised by Drs Onal and Onal for the opportunity to engage in collegial academic discussion. In their recent letter in reply to our publication Investigation of adult post-tonsillectomy hemorrhage rates and the impact on NSAID use, they astutely raise several points that warrant further discussion in regards to post-tonsillectomy hemorrhage.For those not familiar with our work, we had previously reported on 1057 adult tonsillectomies performed over a 7-year period, noting an 11.9% hemorrhage rate. Hemorrhage was intentionally liberally defined as any observation of blood that prompted an action on the part of the patient, from ER visit to return to OR. In addition, the bleeding rate of the 432 patients prescribed NSAIDs postoperatively was nearly identical to that of the 625 patients not prescribed NSAIDs (12.6% vs. 11.7%, adjusted OR 1.01). 1 Drs Onal and Onal note that we failed to include background data regarding the use of perioperative dexamethasone and ketorolac and this is true. However, between the authors' combined experience at this institution, which spans the years 2012-present, it is believed that nearly 100% of adult tonsillectomy patients have received dexamethasone preoperatively whereas we cannot recall one instance of ketorolac being administered. This was not verified with chart review and therefore must be taken with a grain of salt. Nonetheless, we do not believe that this omission would affect the primary outcomes of our study.An additional critique of our study was the failure to collect data on alcohol use from our patients' records. This is potentially a significant oversight given that concomitant alcohol use can potentiate the bleeding risk associated with NSAID use. However, we believe this to be a moot point. First of all, this potentiating effect requires that patients imbibe alcohol during the perioperative period, a time in which extreme postoperative throat pain often prevents PO intake to the point of dehydration. Writing about the increased risk of upper gastrointestinal bleeds with concomitant NSAID and alcohol use, Pfau and Lichtenstein state that the

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

Cited by 9 publications

References 21 publications

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Development and validation of a machine learning-based predictive model for secondary post-tonsillectomy hemorrhage

In Response to The Effect of NSAID Use on Post‐Tonsillectomy Hemorrhage in Adults

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