Post-tonsillectomy dietary advice and haemorrhage risk: Systematic review

Bannister, Miles; Thompson, Chris

doi:10.1016/j.ijporl.2017.09.031

Cited by 14 publications

(10 citation statements)

References 16 publications

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“…A posttonsillectomy mechanical soft diet was uniformly recommended by the surgeons, despite a lack of evidence that postoperative diet impacts PTH risk. 26 Multivariable analysis demonstrated that only the type of procedure and surgical technique were associated with a higher risk for developing PTH. Specifically, tonsillectomies with cold steel or Coblation technique (OR 1.9) were more likely to develop a PTH.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Gross

Lindburg

Kallogjeri

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: To describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time. Study Design: Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed. Setting: A single, tertiary-care institution. Subjects and Methods: Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression. Results: Our institutional PTH rate of 1.9% (130 of 6949) included 124 patients; 15% (19) were primary (≤24 hours), with 50% (9) occurring within 5 hours. Twenty-one percent (4 of 19) of primary PTH patients received operative intervention. Eighty-five percent (105 of 124) of all cases were secondary PTH, and 47% (49) of those patients received operative intervention. Cold steel (OR 1.9, 95% CI 1.1-3.3) and Coblation (OR 1.9, 95% CI 1.2-3.1) techniques and tonsillectomy alone (OR 3.7, 95% CI 1.9-7.2) increased odds of PTH. Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0, 95% CI 1.6-10.0). Conclusion: We conducted a rigorous case-control study for PTH, finding that PTH was associated with use of cold steel and Coblation techniques and with tonsillectomy alone. Patients with a postoperative respiratory event may be more likely to develop a PTH and should be counseled accordingly. A PACU monitoring time of 4 hours is sufficient for outpatient tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

“…A post-tonsillectomy mechanical soft diet was uniformly recommended by the surgeons, despite a lack of evidence that postoperative diet impacts PTH risk. 26…”

Section: Discussionmentioning

confidence: 99%

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Gross

Lindburg

Kallogjeri

et al. 2020

Ann Otol Rhinol Laryngol

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“…Our findings are in agreement with the results of a systematic review conducted by Bannister and Thompson. 32 One of the strengths of our study was its design, which was a randomized clinical trial, and the other was that all the operations were performed by a single surgeon. Hence, level of expertise was not a confounding factor.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings are in agreement with the results of a systematic review conducted by Bannister and Thompson. 32…”

Section: Discussionmentioning

confidence: 99%

Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding

Faramarzi

Safari

Roosta

2018

Otolaryngol.--head neck surg.

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Objective Tonsillectomy is a common operation; however, there are controversial opinions regarding the posttonsillectomy diet. The aim of this study was to compare the effects of cold/liquid diet vs regular diet on posttonsillectomy pain and bleeding. Study Design Prospective randomized controlled trial. Setting Tertiary referral center. Subjects and Methods In total, 194 children who underwent tonsillectomy (with or without adenoidectomy) were randomly allocated into 2 groups. A total of 100 patients were allocated in the cold/liquid diet, and 94 patients were allocated in the regular diet group. Pain score was recorded for the first 7 days, and rate of hemorrhage was recorded for 10 days after surgery. Results The participants' age range was 3 to 17 years. The mean pain score level in the regular diet group after breakfast, lunch, and dinner was not statistically significant in comparison with the cold/liquid diet group. One patient in the regular diet group was admitted to the hospital due to secondary bleeding, but it stopped without any intervention. Conclusion Most otolaryngologists believe in dietary restrictions following tonsillectomy. However, there is much controversy regarding posttonsillectomy dietary advice in the literature. In addition, only a few randomized clinical trials have focused on this subject. We found that there was no difference between regular diet and cold/liquid diet in terms of posttonsillectomy pain and bleeding. Hence, we do not recommend a limited posttonsillectomy diet.

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“…Additionally, in one study parents were found to be more satisfied with a regular diet due to their inability to obey the restrictive dietary instructions [82]. Therefore, in the light of the contemporary views, traditionalist approach of recommending a soft food diet of ice cream and jelly is not accepted as superior to regular diet [83]. Citrus fruits and milk products that could coat the mouth and throat, thereby causing the need to clear the throat, could be potential irritants after the surgery and may initiate bleeding.…”

Section: Postoperative Tonsillectomy Dietmentioning

confidence: 99%