Postoperative hemorrhage following adenoidectomy

Tomkinson, Alun; Harrison, Wendy; Owens, David M.; Fishpool, S J C; Temple, Mark

doi:10.1002/lary.23279

Cited by 40 publications

(32 citation statements)

References 9 publications

(41 reference statements)

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“…The expected bleeding risk for these surgeries are 2% for tonsillectomy and adenoidectomy, 1.5% to 6.5% for hernia repair, 1% for dental surgeries, 2.6% for orthopedic-related surgeries, 6.8% for neurological surgeries, and 2% to 3% for ophthalmologic-related surgeries. [14][15][16][17][18][19][20][21] Of the 60 patients, 1 hemorrhaged after surgery (tonsillectomy and adenoidectomy) and required further surgery to stop the bleeding. This 5-year-old boy had a PBQ-determined BS of 0.…”

Section: Resultsmentioning

confidence: 99%

Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Sim

Bowman

Hopman

et al. 2014

Journal of Pediatric Hematology/Oncology

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To test the Pediatric Bleeding Questionnaire's (PBQ) utility for predicting excessive bleeding during elective surgery, we retrospectively evaluated 60 pediatric patients who had been preoperatively investigated for von Willebrand disease. Of 58 patients with bleeding scores (BS) ≤2 (within normal range), 1 hemorrhaged during surgery. Two had a BS of >2 (positive BS); however, neither bled excessively during surgery. The resulting sensitivity, specificity, positive predictive values, and negative predictive values of the PBQ are 0%, 97%, 0%, and 98%, respectively. On the basis of this small sample, we cannot recommend the PBQ for screening in this setting.

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Section: Resultsmentioning

confidence: 99%

Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Sim

Bowman

Hopman

et al. 2014

Journal of Pediatric Hematology/Oncology

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“…There is a small risk of hemorrhage, which has been separated into primary (within the first 24 h following surgery) and secondary (over 24 h post-surgery) hemorrhage. Primary hemorrhage has a risk of approximately 0.5-0.8%, and there is minimal risk of secondary hemorrhage [5,50,51]. The risk of primary hemorrhage in each procedure appears to be additive, as adenotonsillectomy carries double the risk as one of the procedures performed alone [51].…”

Section: Adenoidectomy Complicationsmentioning

confidence: 99%

“…Primary hemorrhage has a risk of approximately 0.5-0.8%, and there is minimal risk of secondary hemorrhage [5,50,51]. The risk of primary hemorrhage in each procedure appears to be additive, as adenotonsillectomy carries double the risk as one of the procedures performed alone [51]. Interestingly, children with OSA carry higher rates of respiratory compromise postoperatively, but lower rates of postoperative bleeding [52].…”

Section: Adenoidectomy Complicationsmentioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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Purpose of Review Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions. Recent Findings Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscopeassisted removal of the adenoids has proven to be a safe technique, with good short-and long-term outcomes. Novel nonsurgical therapies including immunotherapy have been evaluated. Summary Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.

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“…In published reports, the rate of primary haemorrhage (within 24 h of surgery) has ranged from 0.2% to 2.2% and the rate of secondary haemorrhage (more than 24 h after surgery) from 0.1% to 5.5% [9][10][11][12]. In published reports, the rate of primary haemorrhage (within 24 h of surgery) has ranged from 0.2% to 2.2% and the rate of secondary haemorrhage (more than 24 h after surgery) from 0.1% to 5.5% [9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders

et al. 2015

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Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.

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Postoperative hemorrhage following adenoidectomy

Cited by 40 publications

References 9 publications

Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Predicting Operative Bleeding in Elective Pediatric Surgeries Using the Pediatric Bleeding Questionnaire (PBQ)

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders

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