Post‐Tonsillectomy Bleeding: A Meta‐Analysis

Krishna, Priya; Lee, Dennis

doi:10.1097/00005537-200108000-00008

Cited by 215 publications

(190 citation statements)

References 15 publications

(11 reference statements)

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“…Regarding elective tonsillectomy for any condition, the data cover a wide range, but reasonable rates for readmissions seem to be between 0% and 7.8% and for reoperations between 0% and 3.8%. [6][7][8][9] In contrast to elective tonsillectomy, large series (reporting at least 100 patients) on PTH after quinsy tonsillectomy are rather rare (Table 3). High rates of PTH were reported by Dünne et al, 10 with an incidence of 25% for hospital readmission.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhage Risk After Quinsy Tonsillectomy

Giger

Landis

Dulguerov

2005

Otolaryngol.--head neck surg.

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Section: Discussionmentioning

confidence: 99%

Hemorrhage Risk After Quinsy Tonsillectomy

Giger

Landis

Dulguerov

2005

Otolaryngol.--head neck surg.

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“…5 The pooled rate of bleeding after tonsillectomy, a common pediatric procedure, has been reported as 3.3% in patients without bleeding disorders. 6 The identification of the child with pathologic bleeding may therefore prove difficult, given the relative frequency of nonpathologic bleeding and similarities between pathologic and nonpathologic bleeding. Common bleeding sites (eg, skin and mucous membranes) are similar, and whereas bleeding often occurs spontaneously in the setting of bleeding disorders, affected individuals may initially present with bleeding only after trauma or surgery or, in girls, at menarche.…”

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confidence: 99%

Rare Bleeding Disorders in Children: Identification and Primary Care Management

Acharya

2013

Pediatrics

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Bleeding symptoms are common in healthy children but occasionally may indicate an underlying congenital or acquired bleeding diathesis. The rare bleeding disorders (RBDs) comprise inherited deficiencies of coagulation factors I (congenital fibrinogen deficiencies), II, V, VII, X, XI, and XIII and combined factor deficiencies, most notably of factors V and VIII and of vitamin K-dependent factors. These disorders often manifest during childhood and may present with recurrent or even serious or life-threatening bleeding episodes, particularly during the neonatal period. Accordingly, primary care and other nonhematologist pediatric providers should be familiar with the clinical presentation and initial evaluation of these rare disorders. Bleeding manifestations generally vary within the same RBD and may be indistinguishable from 1 RBD to another or from other more common bleeding disorders. Serious bleeding events such as intracranial hemorrhage may be heralded by less serious bleeding symptoms. The results of initial coagulation studies, especially prothrombin time and activated partial thromboplastin time, are often helpful in narrowing down the potential factor deficiency, with factor XIII deficiency being an exception. Consultation with a hematologist is advised to facilitate accurate diagnosis and to ensure proper management and follow-up. The approach to bleeding episodes and invasive procedures is individualized and depends on the severity, frequency, and, in the case of procedures, likelihood of bleeding. Prophylaxis may be appropriate in children with recurrent serious bleeding and specifically after life-threatening bleeding episodes. When available, specific purified plasma-derived or recombinant factor concentrates, rather than fresh frozen plasma or cryoprecipitate, are the treatment of choice. Pediatrics 2013;132:882-892

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“…Moreover, they did not confirm any beneficial effect of antibiotic prophylaxis on the risk of secondary postoperative bleeding. On the basis of findings reported by Krishna and Lee [28], they suggested that secondary postoperative bleeding is mostly caused by fibrinolytic mechanisms associated with the degradation of fibrin, usually taking place on postoperative days 9-10. This was confirmed by Lowe and van der Meulen [18], who observed that the use of diathermy for tonsillectomy was associated with more severe tissue injury, a larger and thicker fibrin layer on the wound surface and a higher number of postoperative bleeding episodes.…”

Section: Discussionmentioning

confidence: 98%