Secondary post-tonsillectomy haemorrhage and informed consent

Alexander, Ronika; Kukreja, Rajesh; Ford, G. R.

doi:10.1258/0022215042790619

Cited by 35 publications

(42 citation statements)

References 14 publications

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“…Our 0.6% RTT rate for primary haemorrhage is therefore comparable to the result found in the NPTA. Although our 1.1% secondary RTT haemorrhage rate is higher than the NPTA, it is still comparable to other published studies [6,7]. Our RTT rate for secondary haemorrhage could be explained by our low threshold for taking patients back to theatre for haemorrhage control compared to other centres, or it could be a reXection of the higher number of patients re-admitted with secondary haemorrhage.…”

Section: Discussionsupporting

confidence: 73%

“…Many studies have shown that secondary haemorrhage can occur between 24 h and 28 days post-operation, but generally tends to present in the Wrst week following surgery [6,8], and signiWcant bleeding which would require surgical arrest is rare after 10 days post-operation [9,10]. In our study, 65% (17/26) of the secondary haemorrhage cases required RTT in the Wrst postoperative week, seven of these cases (41%) were presented on the seventh post-operative day.…”

Section: Discussionmentioning

confidence: 99%

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Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques

Amir

Belloso

Broomfield

et al. 2011

Eur Arch Otorhinolaryngol

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The aim of this study is to examine the incidence of return to theatre (RTT) for post-operative haemorrhage following coblation and dissection tonsillectomy and to investigate those that required RTT more than 10 days post-surgery. Retrospective review of post-tonsillectomy haemorrhages requiring RTT from April 2005 to March 2009 was conducted. Of 2,541 tonsillectomies performed, 81% were by coblation and 19% by dissection methods. The overall RTT rate was 1.7%. No difference was found in the overall RTT rates for primary and secondary haemorrhage between the two techniques. However, the overall RTT rates for primary and secondary haemorrhage were higher in adults than children (P = 0.0456 and P = 0.0215, respectively). RTT for secondary haemorrhage during the first ten post-operative days occurred in both coblation and dissection tonsillectomy with no significant difference. After the first post-operative week, late secondary bleeding requiring RTT occurred only in the coblation group (P = 0.0676). Four patients required blood transfusion; all were in the coblation group, three of which were required during RTT in the late secondary haemorrhage (after 10 days). The post-operative RTT rates for coblation tonsillectomy did not reveal a change of trend over the 4-year study period. Our RTT rate for secondary haemorrhage is higher than earlier published results. A learning curve could not be identified in RTT for coblation tonsillectomy haemorrhage. Late secondary haemorrhages requiring surgical intervention have only been identified in cases performed by coblation and could potentially be life threatening as 33% (3/9) required blood transfusion. This phenomenon may be explained by a particular physiological healing process associated with coblation.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques

Amir

Belloso

Broomfield

et al. 2011

Eur Arch Otorhinolaryngol

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“…If only active bleeds were counted, the PTH rate was less than half (3.4%). A British study of secondary PTH distinguished between 'severe bleeding', which required blood transfusion or RTT, and 'nonsevere' bleeds [8] . They reported a 9% overall risk of bleeding, but only a 1.4% risk of severe bleeding.…”

Section: Discussionmentioning

confidence: 99%

A 4-Year Consecutive Study of Post-Tonsillectomy Haemorrhage

Attner¹,

Haraldsson²,

Hemlin³

et al. 2009

ORL

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Objective: To analyse consecutive material over a period of 4 years concerning the incidence and consequences of post-tonsillectomy haemorrhages (PTH). Design: Prospective study. Setting: University hospital. Participants: All non-oncological cases of tonsillectomy (TE) and adenotonsillectomy (TA) performed at the ENT department at the Karolinska University Hospital between March 2000 and April 2004. Main Outcome Measures: Rate, timing and classification of PTH. Results: During the study period, 2,813 cases (mean age 13 ± 12.8 years; SD) of TE and TA were included. The majority (62%) were children aged below 12 years, and 69% were performed as day surgery. In total, 212 (7.5%) patients were readmitted due to PTH, of which 98 (3.4%) presented with ongoing haemorrhage. The rates of primary and secondary bleeding were 1.9 and 5.5%, respectively. The PTH occurred in 0–19 days post-operatively, in a typical twin peak mode around the day of surgery and then days 4–7. No case of serious PTH was noted. Multiple bleedings (2–3 times) occurred in 19 patients. Only a minority (31%) of the single PTH patients required active treatment, surgery in the theatre (35 patients) or diathermy under local anaesthesia in the emergency room (24 patients). However, almost all received systemic haemostatic treatment. Three patients required blood transfusion due to repeated PTH. Of the 114 patients that did not present with an active PTH, only 1 returned to the operating theatre due to later bleeding. Almost half (43%) of the patients with multiple episodes of PTH had also experienced primary bleedings. Conclusions: A primary PTH seems to indicate a risk of further episodes of bleedings, and should necessitate extra post-operative observation. Patients with a history of a single self-limiting PTH showed low risk of developing a haemorrhage requiring return to the theatre.

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“…Seconder tonsil haemorrhages tend to occur in the first week after surgery (5,28) and rarely require surgery after the first 10 days (29,30). When the patient data in the study were examined, it was observed that the hemorrhage occurred mainly between postoperative 6th and 10th days and there was no hemorrhage requiring surgery after the 13th day of surgery.…”

Section: Discussionmentioning

confidence: 99%