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Kim DH, Stybayeva G, Hwang SH. Efficacy and safety of perioperative ibuprofen for pain control after pediatric tonsillectomy: A systemic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 184:112078. [PMID: 39178604 DOI: 10.1016/j.ijporl.2024.112078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/04/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVES To assess the safety and effectiveness of perioperative ibuprofen in pediatric tonsillectomy through a meta-analysis of relevant randomized controlled trials. METHODS We conducted a comprehensive review of studies available in PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to June 2024. This analysis compared perioperative ibuprofen administration to control groups (saline, acetaminophen, or opioids). Outcomes assessed were postoperative pain management, as indicated by the frequency of analgesic use, and morbidity rates, which included the incidence of postoperative nausea and vomiting and post-tonsillectomy hemorrhage (PTH). PTH was further categorized as primary (occurring on the day of operation) or secondary (occurring after the day of operation), and classified as type 1 (observed at home or evaluated in the emergency department without further intervention), type 2 (requiring readmission for observation), or type 3 (necessitating a return to the operating room for hemorrhage control). RESULTS This analysis included nine studies involving a total of 1545 patients. Incidences of primary PTH (OR = 1.0949, 95 % CI [0.4169; 2.8755], I2 = 0.0 %), secondary PTH (OR = 1.6433 95 % CI [0.7783; 3.4695], I2 = 0.1 %), and overall PTH (OR = 1.4296 95 % CI [0.8383; 2.4378], I2 = 0.0 %) were not significantly higher in the ibuprofen group than the control groups. Administration of ibuprofen led to a significant decrease in postoperative nausea and vomiting (OR = 0.4228 95 % CI [0.2500; 0.7150], I2 = 40.0 %) and frequency of postoperative analgesic uptake (OR = 0.4734 95 % CI [0.2840; 0.7893]; I2 = 19.8 %). There was no difference in bleeding by type between the ibuprofen and control groups. CONCLUSIONS Our meta-analysis demonstrated that administration of ibuprofen for pediatric tonsillectomy did not significantly increase the incidence of postoperative bleeding but did decrease postoperative emesis and improve pain control.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Kim DH, Stybayeva G, Hwang SH. Effect and safety of perioperative ibuprofen administration in pediatric tonsillectomy: A systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104461. [PMID: 39098128 DOI: 10.1016/j.amjoto.2024.104461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES This study aimed to evaluate the safety and efficacy of perioperative ibuprofen administration by conducting a meta-analysis of pertinent literature. METHODS We conducted a comprehensive review of studies sourced from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases. The studies covered the period from database inception to June 2024. A perioperative ibuprofen administration group was compared to a control group administered either saline, acetaminophen, paracetamol, or opioids. The primary outcome was post-tonsillectomy bleeding that was categorized into overall bleeding and further classified as type 1 (observed at home or evaluated in the emergency department without additional intervention), type 2 (necessitating readmission for observation), and type 3 (requiring a return to the operating room for hemorrhage control). Morbidity incidence rates for postoperative nausea and vomiting were also assessed. The secondary outcomes assessed were postoperative pain management and the frequency of analgesic drug usage. Postoperative pain management was assessed from the incidence of emergency department visits or nurses' calls for pain independent of the presence or absence of dehydration. RESULTS Twenty-two studies with 27,149 patients were included and reviewed for this meta-analysis. Post-tonsillectomy bleeding (OR = 0.9954, 95 % CI [0.8800; 1.1260], I2 = 0.0 %) was not significantly higher in the ibuprofen administration group compared to the control group. In subgroup analysis of post-tonsillectomy bleeding severity, ibuprofen caused clinically insignificant type 1 post-tonsillectomy bleeding that did not require intervention (OR = 1.1310 [0.7398; 1.7289]). Clinically significant bleeding requiring hospital admission (type 2) or surgical control (type 3) was not observed. Administration of ibuprofen has demonstrated efficacy in reducing the need for analgesic drugs (OR = 0.4734, 95 % CI [0.2840; 0.7893]; I2 = 19.8 %) and is associated with a significant decrease in the incidence of postoperative nausea and vomiting (OR = 0.4886, 95 % CI [0.3156; 0.7562], I2 = 34.3 %). CONCLUSION This study demonstrated that administration of ibuprofen for pediatric tonsillectomy did not increase the incidence of clinically significant postoperative bleeding. Ibuprofen administration decreased the incidence and severity of postoperative pain, nausea, and vomiting.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Jaensch SL, Cheng AT, Waters KA. Adenotonsillectomy for Obstructive Sleep Apnea in Children. Otolaryngol Clin North Am 2024; 57:407-419. [PMID: 38575485 DOI: 10.1016/j.otc.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Obstructed breathing is the most common indication for tonsillectomy in children. Although tonsillectomy is performed frequently worldwide, the surgery is associated with a number of significant complications such as bleeding and respiratory failure. Complication risk depends on a number of complex factors, including indications for surgery, demographics, patient comorbidities, and variations in perioperative techniques. While polysomnography is currently accepted as the gold standard diagnostic tool for obstructive sleep apnea, studies evaluating outcomes following surgery suggest that more research is needed on the identification of more readily available and accurate tools for the diagnosis and follow-up of children with obstructed breathing.
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Affiliation(s)
- Samantha L Jaensch
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Sydney Medical School - Northern, L7 Kolling Building RNSH, Reserve Road, St Leonards, NSW 2065, Australia
| | - Alan T Cheng
- Discipline of Child and Adolescent Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Department of Ear Nose & Throat Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Karen A Waters
- Discipline of Child and Adolescent Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Respiratory Support Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
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Shaikh N, Kais A, Dewey J, Jaffal H. Effect of perioperative ketorolac on postoperative bleeding after pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2024; 180:111953. [PMID: 38653108 DOI: 10.1016/j.ijporl.2024.111953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Ketorolac is a frequently used anesthetic pain agent which is traditionally avoided during tonsillectomy due to concern for postoperative hemorrhage. Our goal was to assess the degree of risk associated with the use of Ketorolac following pediatric tonsillectomy. METHODS The TriNetX electronic health records research database was queried in January 2024 for patients undergoing tonsillectomy with or without adenoidectomy under the age of 18 years and without a diagnosed bleeding disorder. Patients were separated into two cohorts either having received or not having received ketorolac the same day as surgery. Propensity score matching was performed for age at the time of surgery, sex, race, ethnicity, and preoperative diagnoses. The outcomes assessed were postoperative hemorrhage requiring operative control within the first day (primary hemorrhage) and within the first month after surgery (secondary hemorrhage). RESULTS 17,434 patients were identified who had undergone pediatric tonsillectomy with or without adenoidectomy and had received ketorolac the same day as surgery. 290,373 patients were identified who had undergone pediatric tonsillectomy with or without adenoidectomy and had not received ketorolac the same day as surgery. 1:1 propensity score matching resulted in 17,434 patients within each cohort. Receipt of ketorolac the same day as surgery resulted in an increased risk of primary hemorrhage OR 2.158 (95 % CI 1.354, 3.437) and secondary hemorrhage OR 1.374 (95 % CI 1.057, 1.787) requiring operative control. CONCLUSION Ketorolac use during pediatric tonsillectomy with or without adenoidectomy was associated with an increased risk of postoperative primary and secondary bleeding requiring surgery.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - John Dewey
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
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Meiklejohn DA, Khan ZH, Nuñez KM, Imhof L, Osmani S, Benavidez AC, Tarefder R. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024; 134:622-628. [PMID: 37421241 DOI: 10.1002/lary.30866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction. METHODS Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis. RESULTS GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques). CONCLUSION Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use. LEVEL OF EVIDENCE 2, randomized trial Laryngoscope, 134:622-628, 2024.
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Affiliation(s)
- Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Zafrul H Khan
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Karyn M Nuñez
- Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A
| | - Lee Imhof
- Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Sabah Osmani
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Amaris C Benavidez
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Rafiqul Tarefder
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
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Nieri CA, Davies C, Luttrell JB, Sheyn A. Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes. Laryngoscope 2024; 134:954-962. [PMID: 38050924 DOI: 10.1002/lary.30836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate the impact of neighborhood-level social vulnerability on pediatric tonsillectomy outcomes. METHODS This single-center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two-sided Pearson chi-square tests were used, whereas for continuous variables, paired t-tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post-T&A complications and readmissions. RESULTS The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128-22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270-28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275-31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293-79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089-29.396). CONCLUSION Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community-based interventions. Because of the increased risk, it may have implications for preoperative decision-making, treatment plans, and clinic follow-ups. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:954-962, 2024.
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Affiliation(s)
- Chad A Nieri
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Camron Davies
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Jordan B Luttrell
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
- Division of Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, U.S.A
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Odhagen E, Alm F, Axelsson S, Hemlin C, Nerfeldt P, Stalfors J, Sunnergren O. Long-term complications after tonsil surgery: an analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery. Front Surg 2023; 10:1304471. [PMID: 38148748 PMCID: PMC10749945 DOI: 10.3389/fsurg.2023.1304471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Objective This study aims to evaluate long-term complications after tonsil surgery using an exploratory retrospective cohort study design based on data from the Swedish Quality Register for Tonsil Surgery (SQTS). Methods All patients registered in the SQTS between 1 January 2009 and 31 May 2021 were eligible for the study. In this study, a long-term complication is defined as any complication persisting for a minimum of 6 months after surgery. The definition of a complication was based on individual patient reports, provided in a free text format, of any remaining issues 6 months after tonsil surgery. Complications were categorized as follows: disturbed taste or sense of smell, dysphagia, miscellaneous and general symptoms and signs, miscellaneous throat problems, pain or discomfort in the mouth or throat, problems with jaws or teeth, problems with the ears or hearing, problems with the nose or sinuses, problems with throat secretions or throat clearing, problems with voice or speech, and sensory symptoms. A multivariable logistic regression analysis was used to identify independent predictors of long-term complications. Results In total, 54,462 patients were included in the study. A total of 3,780 patients (6.9%) reported one or more long-term complications. The most frequent long-term complications, with a plausible connection to the surgery, were found in the following categories: pain or discomfort in the mouth or throat (1.9%), problems with throat secretions or throat clearing (0.8%), dysphagia (0.6%), and problems with voice or speech (0.6%). Tonsillotomy was associated with a lower risk of long-term complications than tonsillectomy. Conclusion This study suggests that subjective long-term complications after tonsil surgery, in general, are relatively common (6.9%). However, complications with a plausible connection to the surgery were less common (4.0%), and specific complications seemed to be relatively rare, with no single specific problem reaching a prevalence of ≥0.6%.
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Affiliation(s)
- Erik Odhagen
- Department of Otorhinolaryngology, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Research, Education and Innovation, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Alm
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sara Axelsson
- Department of Otorhinolaryngology, Helsingborg Hospital, Helsingborg, Sweden
| | - Claes Hemlin
- Swedish Quality Register for Tonsil Surgery, Stockholm, Sweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Joacim Stalfors
- Department of Research, Education and Innovation, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Kandemir S, Pamuk AE, Özel G, Şencan Z. Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation. Int Arch Otorhinolaryngol 2023; 27:e694-e698. [PMID: 37876704 PMCID: PMC10593530 DOI: 10.1055/s-0042-1758715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 03/31/2023] Open
Abstract
Introduction Tonsillectomy is among the most common otolaryngological surgeries. Objective To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation. Methods The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted. Results The CSD group had less analgesic use and shorter return to normal activity than the MEC group ( p = 0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery ( p < 0.016). The postoperative bleeding rate was similar in all groups ( p = 0.096). Conclusion Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.
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Affiliation(s)
- Süheyla Kandemir
- Department of Otorhinolaryngology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Ahmet Erim Pamuk
- Department of Otorhinolaryngology, Private Practice, Ankara, Turkey
| | - Gökçe Özel
- Department of Otorhinolaryngology, Private Practice, Ankara, Turkey
| | - Ziya Şencan
- Department of Otorhinolaryngology, Kırıkkale University, Faculty of Medicine, Kırıkkale Turkey
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Mao B, Woods CM, Athanasiadis T, MacFarlane P, Boase S, Joshi H, Wood J, Ooi EH. BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series. Clin Otolaryngol 2023. [PMID: 37129013 DOI: 10.1111/coa.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. SETTING Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. DATA COLLECTED patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH. RESULTS One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001). CONCLUSIONS BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.
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Affiliation(s)
- Boyuan Mao
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Theodore Athanasiadis
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Patricia MacFarlane
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - Samuel Boase
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Himani Joshi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - John Wood
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
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Knubb JC, Kaislavuo JM, Jegoroff HS, Piitulainen JM, Routila J. Comparison of three common tonsil surgery techniques: cold steel with hot hemostasis, monopolar and bipolar diathermy. Eur Arch Otorhinolaryngol 2023; 280:2975-2984. [PMID: 36813861 PMCID: PMC10175435 DOI: 10.1007/s00405-023-07892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared to bipolar diathermy was of particular interest. METHODS The data from tonsil surgery patients were retrospectively collected between 2012 and 2018 in the Hospital District of Southwest Finland. The surgical method, instruments, indication, sex and age and their association with a postoperative hemorrhage were analyzed. RESULTS A total of 4434 patients were included. The postoperative hemorrhage rate for tonsillectomy was 6.3% and for tonsillotomy 2.2%. The most frequently used surgical instruments were monopolar diathermy (58.4%) cold steel with hot hemostasis (25.1%) and bipolar diathermy (6.4%) with the overall postoperative hemorrhage rates 6.1%, 5.9% and 8.1%, respectively. In tonsillectomy patients, the risk for a secondary hemorrhage was higher with bipolar diathermy compared to both monopolar diathermy (p = 0.039) and the cold steel with hot hemostasis technique (p = 0.029). However, between the monopolar and the cold steel with hot hemostasis groups, the difference was statistically non-significant (p = 0.646). Patients aged > 15 years had 2.6 times higher risk for postoperative hemorrhage. The risk of a secondary hemorrhage increased with tonsillitis as the indication, primary hemorrhage, tonsillectomy or tonsillotomy without adenoidectomy, and male sex in patients aged ≤ 15 years. CONCLUSION Bipolar diathermy increased the risk for secondary bleedings compared to both monopolar diathermy and the cold steel with hot hemostasis technique in tonsillectomy patients. Monopolar diathermy did not significantly differ from the cold steel with hot hemostasis group regarding the bleeding rates.
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Affiliation(s)
- Jenny Christina Knubb
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
- Department of Otorhinolaryngology, Satakunta Hospital District, Satasairaala Central Hospital, Pori, Finland.
| | - Jasmin Maria Kaislavuo
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Henri Sebastian Jegoroff
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Jaakko Matias Piitulainen
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Johannes Routila
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital, Turku, Finland
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11
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Hu X, Yang Z, Ma Y, Wang M, Liu W, Qu G, Zhong C. Development and validation of a machine learning-based predictive model for secondary post-tonsillectomy hemorrhage. Front Surg 2023; 10:1114922. [PMID: 36824494 PMCID: PMC9941337 DOI: 10.3389/fsurg.2023.1114922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Background The 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. Methods Data 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. Results The 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. Conclusion This 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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Affiliation(s)
- Xiandou Hu
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Zixuan Yang
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Yuhu Ma
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Mengqi Wang
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Weijie Liu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Gaoya Qu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Cuiping Zhong
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,Correspondence: Cuiping Zhong
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12
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Karatas HA. Readmission after OSA surgery in pediatric patients. Eur Arch Otorhinolaryngol 2023; 280:879-884. [PMID: 36149489 DOI: 10.1007/s00405-022-07657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to determine the readmission rate after adenotonsillectomy with the diagnosis of obstructive sleep apnea (OSA) and analyze the factors associated with readmission. METHODS It was planned as a retrospective study conducted in a single institution that included pediatric patients who underwent adenotonsillectomy with OSA diagnosis between December 2018 and March 2021. Patients who were readmitted for bleeding or pain/dehydration were compared with those who did not require readmission. RESULTS The mean postoperative admission time was 7.27 ± 3.49 days in patients with bleeding and 3.5 ± 2.27 days in patients with pain or dehydration. The mean length of stay in the hospital was 2.6 ± 1.6 days in patients with bleeding and 3.13 ± 2.03 days in patients with pain or dehydration. The postoperative admission time was 5.96 ± 3.57 days, and the hospital stay after readmission was 2.78 ± 1.73 days. No statistically significant correlation was found in terms of age, gender, surgeon's experience, use of electrocautery and seasonality factors, and readmission rates. CONCLUSIONS In children who underwent adenotonsillectomy for OSA, the hospitalization period of patients hospitalized due to pain/dehydration is much longer than patients admitted with bleeding. Therefore, measures to reduce pain or dehydration have the most significant potential to reduce the readmission rate and length of stay.
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Affiliation(s)
- Halil Altin Karatas
- Konya Numune Hospital, Ferhuniye Mahallesi Hastane Caddesi No:22, 42060, Selçuklu, Konya, Turkey.
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13
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Xu H, Qiu S, Pu S, Hu B, Liu D, Li X. Multicentre clinical study of haemorrhage after coblation tonsillectomy in children: a prospective study protocol. BMJ Open 2023; 13:e063401. [PMID: 36627154 PMCID: PMC9835949 DOI: 10.1136/bmjopen-2022-063401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Post-tonsillectomy haemorrhage (PTH) is the most common and significant life-threatening complication following tonsillectomy, especially in children. Coblation tonsillectomy (CTE) at low temperature is extensively used in China and has gradually replaced conventional tonsil dissection. However, risk of late PTH has been shown to increase with the use of hot instruments. The aim of this study is to detect post-CTE haemorrhage (PCTH) rates and analyse risk factors of PCTH in China, through a nationwide multicentre prospective study. METHODS AND ANALYSIS This investigator-initiated, prospective, multicentre clinical trial will involve children with tonsil disease who will undergo CTE from 22 research centres in different cities in China. All operations will be performed using the same technique of extracapsular tonsillectomy. Data will be collected for all patients enrolled in this study through a preoperative visit, intraoperative data and a postoperative visit. The measurement data conforming to a normal distribution will be expressed by means±SDs, and a Student's t-test will be used for comparison. The comparison among groups of counting data will be expressed by percentage or rate, and a χ2 test will be used for comparison. Non-conditional logistic regression analysis will be used to analyse the preoperative, intraoperative and postoperative risk factors for haemorrhage rate after CTE. P<0.05 will be considered statistically significant. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee of Shanghai Children's Hospital/Shanghai Jiao Tong University (reference number 2021R096-E01). All patients will provide written informed consent. Results of this study are to be published in respected, peer-reviewed journals and findings presented at scientific conferences in the field of paediatric otorhinolaryngology. TRIAL REGISTRATION NUMBER NCT05206799.
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Affiliation(s)
- Hongming Xu
- Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyao Qiu
- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Shilei Pu
- Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Hu
- Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dabo Liu
- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiaoyan Li
- Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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14
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Say MA, Bilgin E, Baklacı D. Evaluation of Anterior and Posterior Pillar Suturing Following Adult Tonsillectomy in Terms of Hemorrhage, Pain, and Dysphagia Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:5624-5629. [PMID: 36742830 PMCID: PMC9895593 DOI: 10.1007/s12070-021-02965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Postoperative complications, although rare, can be observed in tonsillectomy. This study aimed to investigate the effect of anterior and posterior pillar suturing on dysphagia, hemorrhage, and pain complications following tonsillectomy in adult patients. The study included 80 patients (32 males, 48 females; > 18 years) who underwent tonsillectomy. The patients were divided into two groups: Group 1, in which the tonsillar lodge was closed by anterior-posterior pillar suturing with a 3-0 chromic catgut suture after hemostatic compression and Group 2, in which the tonsillar lodge was exposed following hemostatic compression and bipolar cauterization. Post-surgical pain was assessed using the Numeric Rating Scale (NRS). Oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT)-10. None of the patients experienced postoperative primary hemorrhage. However, postoperative secondary hemorrhage was observed in seven patients, two from Group 1 and five from Group 2. There was no significant difference in postoperative hemorrhage between the two groups (p = 0.449). Furthermore, no statistically significant difference was observed between the two groups in terms of the NRS scores on postoperative day 1 and at postoperative week 2 (p = 0.130 and 0.142, respectively) or the EAT-10 scores at postoperative week 2 and postoperative month 6 (p = 0.925 and 0.090, respectively). Anterior-posterior pillar suturing, which is performed for hemorrhage control after tonsillectomy, is not superior to the conventional bipolar method in terms of postoperative dysphagia, hemorrhage, and pain.
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Affiliation(s)
- Mehmet Ali Say
- Ear, Nose and Throat, Department of Otolaryngology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Ergin Bilgin
- Department Of Otolaryngology, Bülent Ecevit University Medical Faculty, Zonguldak, Turkey
| | - Deniz Baklacı
- Department Of Otolaryngology, Bülent Ecevit University Medical Faculty, Zonguldak, Turkey
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15
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Bugten V, Wennberg S, Amundsen MF, Blindheimsvik MAB. Reducing post-tonsillectomy haemorrhage: a multicentre quality improvement programme incorporating video-based cold technique instruction. BMJ Open Qual 2022; 11:bmjoq-2022-001887. [PMID: 36410782 PMCID: PMC9680151 DOI: 10.1136/bmjoq-2022-001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Data from the Norwegian Tonsil Surgery Register (NTSR) showed large differences between the hospitals in Norway in the readmission rate due to post-tonsillectomy haemorrhage (rrPTH; range, 0%-25%; national average, 8%). Because of these large variations in the rrPTH, we conducted a quality improvement project involving hospitals with good and bad readmission rates. METHODS Seven hospitals with readmission rates greater than 10% and four with rates lower than 5% participated in this project. We recorded videos of ear, nose and throat surgeons from the hospitals with low readmission rates when they performed extracapsular tonsillectomy, and these videos of cold dissection tonsillectomy were used as teaching material for examples of good surgical skills for the other hospitals. After a 2-day workshop, all participants from the hospitals went back to their institutions and prepared local plans to improve their results. We used the Plan-Do-Study-Act model. The primary outcome variable was the patient-reported rrPTH in the NTSR. As secondary goal, we aimed to identify aspects of the tonsillectomy procedure that could help achieve a lower rrPTH. RESULTS The participating hospitals reduced their rrPTH from 18% at baseline (2017/2018) to 7% in 2020. Six of seven hospitals changed their dissection technique significantly to more use of cold dissection. CONCLUSION By learning cold dissection tonsillectomy from surgeons with low rrPTH, it seems possible to decrease the rates of bleeding complications after tonsillectomy. A combination of videos as a teaching tool, new treatment plans, and focus on quality and improvement may effectively improve surgical results. The videos can show details that are difficult to convey in the literature. Quality registers can be used to identify areas requiring improvement and evaluate the effects of changes in practice.
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Affiliation(s)
- Vegard Bugten
- Department of Otolaryngology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Siri Wennberg
- Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Marit Furre Amundsen
- Department of Otolaryngology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway,Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
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16
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Liu Q, Zhang Y, Liu Y. Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis. Ann Saudi Med 2022; 42:377-384. [PMID: 36444922 PMCID: PMC9706718 DOI: 10.5144/0256-4947.2022.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH. OBJECTIVE Investigate whether evaluation of coagulation function by preoperative TEG might help to predict PTH after tonsillectomy by coblation tonsillectomy (TE). DESIGN Post-hoc analysis of randomized controlled study. SETTING Otolaryngology Department between January 2017 and August 2019. PATIENTS AND METHODS This post-hoc analysis included adults who underwent coblation TE for benign tonsillar disorders. Routine blood tests and TEG were performed preoperatively. The TEG parameters evaluated included coagulation reaction time (R) and maximum thrombus amplitude (MA). MAIN OUTCOME MEASURES The main outcome was PTH during the 4-week postoperative period. SAMPLE SIZE AND CHARACTERISTICS 284 RESULTS: The 19 patients (6.7%) that experienced PTH had a higher prevalence of diabetes mellitus, lower use of intraoperative suturing, fewer patients with grade I and II tonsillar enlargement, a higher white blood cell count, lower platelet count, lower fibrinogen level, lower R value, and a lower MA value than patients without PTH (all P<.05). Multivariate logistic regression revealed that diabetes mellitus (P<.053), fibrinogen level ≤2.735 g/L (P<.027), R≤6.55 min (P<.011) and MA≤59.15 mm (P<.012) were independently associated with PTH. A regression model incorporating these four factors predicted PTH with a sensitivity of 73.7% and specificity of 83.8%. CONCLUSION Preoperative evaluation of diabetes mellitus history, fibrinogen level, and TEG parameters might help to identify patients at higher risk of PTH after coblation TE. LIMITATIONS Single-center study with a small sample size; possibly underpowered statistically. TEG measurements might not accurately reflect coagulation function, and a validation cohort was unavailable. CONFLICT OF INTEREST None. CHINESE CLINICAL TRIAL REGISTRY NUMBER OF STUDY USED IN THIS ANALYSIS: ChiCTR2000032171. http://www.chictr.org.cn/showprojen.aspx?proj=52553.
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Affiliation(s)
- Qian Liu
- From the Department of Otolaryngology, Shenzhen People's Hospital, Shenzhen, China
| | - Yanping Zhang
- From the Department of Otolaryngology, 8th Medical Center, PLA General Hospital, Beijing, China
| | - Yanlu Liu
- From the Department of Otolaryngology, Shenzhen People's Hospital, Shenzhen, China
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17
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Reference rate for post-tonsillectomy haemorrhage in Australia—A 2000–2020 national hospital morbidity database analysis. PLoS One 2022; 17:e0273320. [PMID: 36006990 PMCID: PMC9409536 DOI: 10.1371/journal.pone.0273320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to provide a national benchmark rate of post-tonsillectomy haemorrhage (PTH) in Australia. Using data from Australia’s National Hospital Morbidity Database (NHMD) from 1 July 2000 to 30 June 2020, we have conducted a nation-wide population-based study to estimate a reference rate of PTH. Outcomes of interest included the overall rate and time-trend of PTH, the relationship between PTH rates with age and gender as well as the epidemiology of tonsillectomy procedures. A total of 941,557 tonsillectomy procedures and 15,391 PTH episodes were recorded for the study period. Whilst the incidence of tonsillectomy procedures and the number of day-stay tonsillectomy procedures have increased substantially over time, the overall rate of PTH for all ages has remained relatively constant (1.6% [95% CI: 1.61 to 1.66]) with no significant association observed between the annual rates of PTH and time (year) (Spearman correlation coefficient, Rs = 0.24 (95% CI: -0.22 to 0.61), P = 0.3). However, the rate of PTH in adults (aged 15 years and over) experienced a statistically significant mild to moderate upward association with time (year) Rs = 0.64 (95% CI: 0.28 to 0.84), P = 0.003. Analysis of the odds of PTH using the risk factors of increasing age and male gender showed a unique age and gender risk pattern for PTH where males aged 20 to 24 years had the highest risk of PTH odds ratio 7.3 (95% CI: 6.7 to 7.8) compared to patients aged 1 to 4 years. Clinicians should be mindful of the greater risk of PTH in male adolescents and young adults. The NHMD datasets can be continually used to evaluate the benchmark PTH rate in Australia and to facilitate tonsillectomy surgical audit activities and quality improvement programs on a national basis.
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18
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Čampara AJ, Brkić S, Cerovac A, Kovačević M. Hemorrhage after adenotonsillectomy in children: tertiary center experiences. Wien Med Wochenschr 2022; 172:317-321. [PMID: 35759051 DOI: 10.1007/s10354-022-00945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively, is one of the most serious complications. OBJECTIVE To determine the frequency of hemorrhage in children after adenotonsillectomy and to compare postoperative hemorrhage with regard to age and sex. METHODS A cross-sectional longitudinal study was conducted at the Ear, Nose, and Throat Clinic, University Clinical Center Tuzla, and included all children of both sexes, aged 3 to 15 years, who underwent adenotonsillectomy during a 1.5-year period. RESULTS A total of 201 children aged 3-15 years underwent adenotonsillectomy, 113 males and 88 females, which corresponds to a ratio of 1.28: 1. Adenotonsillectomy was performed in 147 (73.1%) patients and adenoidectomy in 54 (27%). In the overall sample, there were 19 (9.5%) subjects with postoperative hemorrhage. Primary hemorrhage occurred in 9 subjects (47%) and secondary hemorrhage in 10 subjects (53%). Significantly more female subjects had postoperative hemorrhage. In the group of subjects with hemorrhage, the mean age (standard deviation) was 8.45 (3.3) years. Tonsillar lodges are common sites of hemorrhage. CONCLUSION The frequency and causes of hemorrhage after adenotonsillectomy in our study are partially comparable to the world data.
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Affiliation(s)
- Alma Jahić Čampara
- Clinic for Anesthesiology and Reanimatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.,Department of Pathophysiology, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Selmira Brkić
- Department of Pathophysiology, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Braće Pobrić 17, 74260, Tešanj, Bosnia and Herzegovina. .,Department of Anatomy, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Mirza Kovačević
- Department of Anaesthesiology and Intensive Care Unit, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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Patel SD, Daher GS, Engle L, Zhu J, Slonimsky G. Adult tonsillectomy: An evaluation of indications and complications. Am J Otolaryngol 2022; 43:103403. [PMID: 35210109 DOI: 10.1016/j.amjoto.2022.103403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate current adult tonsillectomy indications along with risk factors associated with postoperative complications. METHODS In this retrospective chart review, demographic, clinical, and surgical data were collected from 2004 to 2020 of adult patients who underwent tonsillectomy. Indications for surgery were categorized as infectious etiology, biopsy, obstructive sleep apnea (OSA), and tonsillar stones. Data regarding postoperative hemorrhage, emergency department (ED) visits, and readmissions were collected. Multivariable logistic regression models were used to evaluate factors associated with postoperative complications. RESULTS 574 adults (mean age 32 years, 69.9% F vs. 30.1% M) were included. The most common indication was infections (62.2%), followed by biopsy (26.5%), tonsillar stones (6.8%), and OSA (4.5%). The highest frequency of postoperative bleeds (17.9%) occurred in the tonsillar stones cohort; however, the indication for surgery was not a significant predictor on multivariate analysis. Male sex and younger age were independent predictors of postoperative bleeding, while younger age was a significant predictor of postoperative ED visits. There was a significant linear trend of an increasing proportion of tonsillectomies performed for tonsillar stones compared to other indications for 2011-2019. CONCLUSION Infectious etiology was the most common indication for tonsillectomy. Indication for surgery was not a significant predictor of postoperative bleeding; however, male sex and younger age had higher odds of postoperative bleeding. The proportion of tonsillectomies performed for tonsillar stones was steadily increasing.
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Taylor M. Study of Patients’ Return to Surgery Post-Tonsillectomy and/or Adenoidectomy: A Relation Between Patient Age and Timing of Uncontrolled Bleeding. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Tonsillectomy and/or adenoidectomy (T/A) are common surgical procedures. Postoperative uncontrolled bleeding is a well-established complication; however, the relation between certain variables and uncontrolled bleeding are unclear.
Methods: We explored the Pennsylvania Patient Safety Reporting System database for event reports that described a patient who had a T/A procedure and later returned to surgery to control bleeding. We analyzed the post-T/A bleeding events according to numerous variables, such as patient sex and age, timing of the bleed, procedure performed (i.e., tonsillectomy and/or adenoidectomy), and bleeding site.
Results: We identified 219 event reports from 56 healthcare facilities over a four-year period. The study revealed that 78% of the patients were discharged and then returned to surgery to control bleeding. Patients ranged in age from 1–45 years and 53% were female. Among the 219 events, 41% were a primary bleed (0–1 postoperative days) and 59% were a secondary bleed (2–30 postoperative day). Additionally, 0–1 days and 6–7 days after operation were the periods when patients most frequently returned to surgery (range of 0–30 days). We expanded upon much of the previous research by exploring the relation between patient age and days postoperative return to surgery. We found that a majority of patients in age categories 1–10, 11–20, and 21–30 years had a secondary bleed; in contrast, a majority of patients age 31–45 had a primary bleed.
Conclusion: Our findings indicate that the post-T/A timing of uncontrolled bleeding may vary systematically as a function of patient age; however, future research is needed to better understand this topic. We encourage readers to use our findings, along with findings from previous research, to inform their practice and strategies to mitigate risk of patient harm.
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Mohammadpour-Maleki A, Rasoulian B. Post-tonsillectomy Hemorrhage: A Seven-year Retrospective Study. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:311-318. [PMID: 34692578 PMCID: PMC8507943 DOI: 10.22038/ijorl.2021.54962.2882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022]
Abstract
Introduction: Post-tonsillectomy hemorrhage (PTH) is a serious complication that sometimes requires immediate surgical interventions. The present study aimed to assess the association between patients’ age, the time of onset of PTH, and the need for surgery to control bleeding. Materials and Methods: All patients with PTH were retrospectively admitted to two tertiary hospitals in Mashhad, during 2012-2019. Hospital records were investigated to select eligible cases and retrieve their characteristics such as demographics, source and time of bleeding, and type of intervention. Chi-square, independent samples T-test, and binary logistic regression were used as research tools. Results: A total of 227 patients with PTH and a mean age of 14.99±10.34 years were studied, of whom 128 (56.4%) were male and 63 (27.8%) required surgery to control PTH. The mean onset of PTH was 8.14±3.47 days after the surgery and in 59 cases (26.5%) was the seventh day. Those patients aged 6 years or older in whom PTH occurred during the first postoperative week were significantly more likely to need surgery to control it (P= 0.034). Adult (OR= 4.032, 95%CI= 1.932-8.414, P<0.001), bleeding from both tonsils (OR= 2.380, 95%CI= 1.032-5.487, P= 0.042), and receiving blood transfusion (OR= 7.934, 95%CI= 2.003-31.422, P= 0.002) were independent predictors of the need for surgical treatment to control PTH. Conclusion: PTH within the first postoperative week in patients older than 6 years, adults, bleeding from both tonsils, and receiving a blood transfusion is recommended to be considered as a potential predictor of the need for surgery.
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Affiliation(s)
| | - Bashir Rasoulian
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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22
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Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond. CHILDREN 2021; 8:children8110944. [PMID: 34828657 PMCID: PMC8623402 DOI: 10.3390/children8110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy.
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Chen AWG, Chen MK. Comparison of Post-Tonsillectomy Hemorrhage between Monopolar and Plasma Blade Techniques. J Clin Med 2021; 10:jcm10102051. [PMID: 34064672 PMCID: PMC8151987 DOI: 10.3390/jcm10102051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
Abstract
The plasma blade is an innovative device that was recently introduced for performing tonsillectomy. While one of the benefits of the plasma blade is limited thermal damage, the effects of plasma blades on postoperative hemorrhage have not been thoroughly investigated. Patients who underwent tonsillectomy in our institution between January 2013 and September 2018 were retrospectively enrolled in the study. A total of 1214 patients were enrolled in the study, with 759 participants who underwent monopolar tonsillectomy and 455 participants who underwent plasma blade tonsillectomy. In total, 14 bleeding events occurred in the monopolar group, and 10 events occurred in the plasma blade group. The odds ratio for postoperative bleeding in the plasma blade group was 1.20 (95% CI 0.52 to 2.72). After adjusting for potential confounders, the adjusted odds ratio was 1.34 (95% CI 0.58 to 3.07). In conclusion, there is no significant difference in post-tonsillectomy hemorrhage rates between the traditional monopolar technique and plasma blade technique. Plasma blade tonsillectomy can be considered as safe as traditional monopolar tonsillectomy.
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Affiliation(s)
| | - Mu-Kuan Chen
- Correspondence: ; Tel.: +886-4-7238595 (ext. 4966)
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Shotts SD, Welsh DV, Nakamura A, Stromberg AJ. Very-Low Energy Monopolar Reduces Post-Tonsillectomy Hemorrhage Versus Standard Energy Techniques. Laryngoscope 2021; 131:2505-2511. [PMID: 33904597 DOI: 10.1002/lary.29587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare rates of post-tonsillectomy hemorrhage (PTH) between a very-low energy transfer monopolar technique (VLET) and standard energy techniques. STUDY DESIGN Retrospective controlled cohort study. METHODS All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive "hot" technique without exclusive monopolar use [Mixed "Hot"]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared. RESULTS During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed "Hot"), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed "Hot" group experienced similar rates (1.57%, P = .54; 1.68%, P = .64), but the VLET group experienced significantly lower rates (0.15%, P = .0026, adjusted odds ratio [OR] 0.114 [0.028-0.469]; 0.22%, P = .0016, adjusted OR 0.155 [0.048-0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P = .0025, P = .0024, adjusted OR 1.02/year [1.01-1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies. CONCLUSIONS Standard energy techniques had an adjusted odds ratio over 8-fold higher for secondary PTHRSI and over 6-fold higher for total PTHRSI compared to the minimized energy transfer VLET technique. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
| | | | - Aisaku Nakamura
- Dr Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Arnold J Stromberg
- Dr Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
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Factors influencing time to operating room in children presenting with post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol 2021; 141:110581. [PMID: 33359934 DOI: 10.1016/j.ijporl.2020.110581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed to evaluate factors associated with time to return to OR in children presenting with post-tonsillectomy hemorrhage to a tertiary children's hospital. METHODS Retrospective study of pediatric patients presenting to a single institution from January 2012 to January 2020, with post-tonsillectomy hemorrhage (PTH) requiring surgical intervention for control of bleeding. Correlation, univariate, and multivariate analysis were conducted. RESULTS Of 15,984 tonsillectomies performed at our institution during the study period, 144 required return to the OR for bleeding control, in addition to 15 other children whose tonsillectomy had been performed at an outside institution. Mean time to the OR was 119.7 min (SD 101.5) in the morning, 77.4 min (SD 60.6) in the afternoon, 55.6 min (SD 34.8) in the evening, and 49.4 min (SD 26.4) overnight (ANOVA p < 0.0001). The mean hemoglobin decline from pre-to post-tonsillectomy was 1.3 g/dl (SD 1.7). Primary hemorrhages had a mean time to OR of 62.39 min (SD 63.42) while secondary hemorrhages mean time to OR was 85.54 min (SD 76.21) (p = 0.0064). There was no significant difference in time to OR among race/ethnicity (p = 0.928), insurance status (p = 0.359), weekday (p = 0.557), surgeon seniority (p = 0.8104) or by hemoglobin drop (p = 0.2773). When controlling for each of these variables, multiple linear regression showed that only time of day had significant correlation with time to OR (p = 0.0003). CONCLUSION At a tertiary children's hospital, patients presenting with PTH requiring revision surgery waited the longest to get to the OR in the morning versus all other times of day. These results can aid in individualization of anticipatory guidance in order to reduce morbidity and mortality from complications requiring revision in the operating room.
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Dhaduk N, Rodgers A, Govindan A, Kalyoussef E. Post-Tonsillectomy Bleeding: A National Perspective. Ann Otol Rhinol Laryngol 2021; 130:941-947. [PMID: 33435723 DOI: 10.1177/0003489420987438] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Tonsillectomy is one of the most common otolaryngologic procedures. Hemorrhage after tonsillectomy is one of the most feared complications by surgeons and patients alike. The objective of this study was to analyze the risk factors associated with an increase in post-tonsillectomy hemorrhage in the pediatric population using a large national database. METHODS The Kids' Inpatient Database (KID) from 2000 to 2012 was queried for patients between the ages of 1 to 17 years with post-tonsillectomy hemorrhage. Univariate and multivariate analyses were performed to obtain trends in patient demographics, comorbidities, and hospital information. RESULTS Overall 45 940 pediatric cases of tonsillectomy were identified of which 5470 (11.9%) resulted in postoperative hemorrhage. Patients with postoperative hemorrhage were significantly older with mean age of 8.62 (±4.75) compared to all patients. Females were found to have higher rates of hemorrhage when compared to males 14.6% versus 11.5% (P < .001). The rate of white patients who had hemorrhage was 16.3% (P < .001). The most common comorbidities significantly associated with hemorrhage were fluid and electrolyte disorders (6.6% P < .001), deficiency anemia (3.8%; P < .001), and coagulopathy (2.7%; P < .001). Urban nonteaching hospitals had higher rates of hemorrhage (19.6%; P < .001) and the Northeast was the most common region (15.2%; P < .001). On multivariate analysis, older patients and white ethnicity showed a significantly increased risk of hemorrhage. Patients with pre-existing comorbidities such as coagulopathy, deficiency anemia, and fluid and electrolyte disorders circulation were also found to have higher odds ratios of bleeding. CONCLUSION Postoperative hemorrhage is a common complication following tonsillectomy with a rate of 11.9% in this study. A higher rate of hemorrhage was seen with increasing age, white race, and males overall, as well as patients with fluid and electrolyte disorders. Urban non-teaching hospitals and the Northeast region also saw increased rates of hemorrhage.
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Affiliation(s)
- Nehal Dhaduk
- Department of Otolaryngology-Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ashley Rodgers
- Department of Otolaryngology-Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelyne Kalyoussef
- Department of Otolaryngology-Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Leung P, DeVore EK, Kawai K, Yuen S, Kenna M, Irace AL, Roberson D, Adil E. Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy? Otolaryngol Head Neck Surg 2020; 165:187-196. [PMID: 33170769 DOI: 10.1177/0194599820970943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate risk factors for pediatric posttonsillectomy hemorrhage (PTH) and the need for transfusion using a national database. STUDY DESIGN Retrospective cohort study. SETTING The study was conducted using the Pediatric Health Information System (PHIS) database. METHODS Children ≤18 years who underwent tonsillectomy with or without adenoidectomy (T±A) between 2004 and 2015 were included. We evaluated the risk of PTH requiring cauterization according to patient demographics, comorbidities, indication for surgery, medications, year of surgery, and geographic region. RESULTS Of the 551,137 PHIS patients who underwent T±A, 8735 patients (1.58%) experienced a PTH. The risk of PTH increased from 1.33% (95% confidence interval [CI]: 1.15%, 1.53%) in 2010 to 1.91% (95% CI: 1.64%, 2.24%) in 2015 (P < .001). Older age (≥12 vs <5 years old: adjusted odds ratio [aOR] 3.17; 95% CI: 2.86, 3.52), male sex (aOR 1.11; 95% CI: 1.05, 1.17), medical comorbidities (aOR 1.18; 95% CI: 1.08, 1.29), recurrent tonsillitis (aOR 1.15; 95% CI: 1.07, 1.24), and intensive care unit admission (aOR 1.74; 95% CI: 1.55, 1.95) were significantly associated with an increased risk of PTH. Use of ibuprofen (aOR 1.36; 95% CI: 1.22, 1.52), ketorolac (aOR 1.39; 95% CI: 1.14, 1.69), anticonvulsant (aOR 1.23; 95% CI: 1.03, 1.76), and antidepressants (aOR 1.35; 95% CI: 1.03, 1.76) were also associated with an increased risk of PTH. The need for blood transfusion was 2.1% (181/8735). CONCLUSION The incidence of PTH increased significantly between 2011 and 2015, and ibuprofen appears to be one contributing factor. Given the benefits of ibuprofen, it is unclear whether this increased risk warrants a change in practice.
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Affiliation(s)
- Peggy Leung
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School Department of Otolaryngology, Boston, Massachusetts, USA
| | - Sonia Yuen
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School Department of Otolaryngology, Boston, Massachusetts, USA
| | - Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Roberson
- Bayhealth Medical Center, Milford, Delaware, USA.,The Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
| | - Eelam Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School Department of Otolaryngology, Boston, Massachusetts, USA
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Karpishchenko SA, Kolesnikova OM, Legkova YV. [Conducting bilateral tonsillectomy in patients after kidney transplantation. Clinical observation]. Vestn Otorinolaringol 2020; 85:83-87. [PMID: 32628389 DOI: 10.17116/otorino20208503183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The experience of performing bilateral tonsillectomy under general anesthesia for two patients with a transplanted kidney receiving immunosuppressive therapy is presented. In both patients after surgery, pain and inflammatory changes in the postsurgery wound were minimal. However, in the postsurgery period, infection was observed in patients, this required the prescription of systemic antibacterial drugs. On the background of immunosuppressive therapy, the clinical course of chronic tonsillitis proceeded without severe symptoms, despite the decompensation of the chronic process in the tonsils. Due to severe concomitant renal pathology and with a transplanted kidney, such patients need to be examined and treated in a multidisciplinary hospital. Indications for surgical treatment of these patients should be substantiated together with nephrologists, otolaryngologists and anesthetists.
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Affiliation(s)
- S A Karpishchenko
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - O M Kolesnikova
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Yu V Legkova
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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Aldrees T, Alzuwayed A, Majed A, Alzamil A, Almutairi M, Aloqaili Y. Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP135-NP142. [PMID: 32830579 DOI: 10.1177/0145561320944662] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia. METHOD This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors. RESULTS A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate (P = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; P = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; P = .006). CONCLUSION This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.
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Affiliation(s)
- Turki Aldrees
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 204568Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdullah Alzuwayed
- Department of Otolaryngology-Head and Neck Surgery, 48168King Abdulaziz Medical City Hospital, Riyadh, Saudi Arabia
| | - Abdullah Majed
- Department of Otolaryngology-Head and Neck Surgery, 48168King Abdulaziz Medical City Hospital, Riyadh, Saudi Arabia
| | - Abdulrhman Alzamil
- 48150King Saud Bin Abdulaziz for Health Sciences, College of Medicine, Riyadh, Saudi Arabia
| | - Mohammed Almutairi
- 48150King Saud Bin Abdulaziz for Health Sciences, College of Medicine, Riyadh, Saudi Arabia
| | - Yazeed Aloqaili
- Department of Otolaryngology-Head and Neck Surgery, 48168King Abdulaziz Medical City Hospital, Riyadh, Saudi Arabia
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Lundström F, Stalfors J, Østvoll E, Sunnergren O. Practice, complications and outcome in Swedish tonsil surgery 2009-2018. An observational longitudinal national cohort study. Acta Otolaryngol 2020; 140:589-596. [PMID: 32436799 DOI: 10.1080/00016489.2020.1746396] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: To assure a high quality in tonsil surgery, it is necessary to monitor trends in clinical practice, complications and outcome.Aims/objectives: To describe rates and trends regarding indications, methods, techniques, complications, and outcome of tonsil surgery.Material and method: 98 979 surgeries from the National Tonsil Surgery Register 2009-2018. Groups were categorised by indication and method.Results: The proportion of patients undergoing tonsillotomy with adenoidectomy due to obstruction-snoring (mean age 5.3 y.) increased from 2009-2018. Hot tonsillectomy, but not tonsillotomy, techniques were related to a higher risk for postoperative bleeding. The use of cold techniques increased for all types of surgeries. The rates of patients reporting contact due to postoperative pain were associated with indication and method, with the lowest rate reported for tonsillotomy (4.5% in 2018) and the highest for tonsillectomy (34.5% in 2009). The rate of patients reporting that their symptoms were gone 6 months after surgery decreased.Conclusions and significance: All hot tonsillectomy techniques should be avoided as they are related to a higher risk for postoperative bleeding. The high rate of postoperative contacts due to pain after tonsillectomy indicates a need for improvement in pain management. The declining rates of symptom relief must be investigated further.
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Affiliation(s)
- Filip Lundström
- Department of Otorhinolaryngology, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joacim Stalfors
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
- Sheikh Khalifa Medical City, Ajman, United Arab Emirates
| | - Eirik Østvoll
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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31
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Gonçalves AI, Rato C, de Vilhena D, Duarte D, Lopes G, Trigueiros N. Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors. Eur Arch Otorhinolaryngol 2020; 277:3095-3102. [PMID: 32451667 DOI: 10.1007/s00405-020-06060-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a potentially fatal complication. We aim to assess the incidence of hemorrhage after tonsillectomy in our institution, and to evaluate and identify the possible associated risk factors. METHODS This retrospective study included 897 patients who underwent tonsillectomy between January 2015 and December 2018, 50.7% women and 49.3% men, aged between 2 and 83 years. No coagulopathies were identified. Comparison of age, gender, surgical indication, coagulation profile, concomitant adenoidectomy, surgical technique, surgeon's experience and hemostasis method between groups with and without post-operative bleeding was made. RESULTS Our incidence of post-tonsillectomy hemorrhage was 6%. Most patients (83.3%) had secondary bleeding (> 24 h after surgery). In 22.2% of the bleeding cases, it was necessary to revise the hemostasis in the operating room. Adulthood (age ≥ 18 years) (p < 0.001), INR values ≥ 1.2 (p = 0.014), aPTT values ≥ 35 s (p = 0.001), as well as concomitant adenoidectomy (p < 0.001) were the predictors of post-tonsillectomy bleeding. CONCLUSION Recognition of adult age, INR ≥ 1.2, aPTT ≥ 35 s and concomitant adenoidectomy as risk factors can be useful in identifying the patients at higher risk for bleeding complications.
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Affiliation(s)
- Ana Isabel Gonçalves
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal.
| | - Catarina Rato
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Ditza de Vilhena
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Delfim Duarte
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Gustavo Lopes
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Nuno Trigueiros
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
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Prevalence of Post-Tonsillectomy Hemorrhage in Adults and Children. JOURNAL OF CLINICAL AND BASIC RESEARCH 2020. [DOI: 10.52547/jcbr.4.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nami Saber C, Klug TE. Post-operative haemorrhage after acute bilateral tonsillectomy in patients with peritonsillar abscess: prevalence, treatment, risk factors, and side of bleeding. Acta Otolaryngol 2020; 140:66-71. [PMID: 31671024 DOI: 10.1080/00016489.2019.1682189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Bilateral quinsy tonsillectomy (QT) in patients with peritonsillar abscess (PTA) is associated with the risk of post-tonsillectomy haemorrhage (PTH) and current literature finds a significantly higher risk of PTH contralaterally to the quinsy.Aims: To determine the prevalence of PTH in a large cohort of patients undergoing QT, explore risk factors for PTH, describe our methods of treatment, and evaluate if contralateral haemorrhage is more common than ipsilateral haemorrhage.Materials & methods: All patients undergoing QT at Aarhus University Hospital in the period 2001-2017 were included in the study.Results: One hundred sixteen of 1671 (6.9%) QT patients were admitted with PTH. PTH patients were significantly more frequently males (66%) and infected with Streptococcus group A (GAS) (31%) compared to QT patients without PTH (53% and 18%, respectively) (p = .005 and p = .002, respectively). Haemostasis was obtained in general anaesthesia (n = 61) or local anaesthesia (n = 28) and stopped spontaneously in 25 patients. The side of PTH was not associated with the side of PTA (ipsilateral (n = 41), contralateral (n = 43), and bilateral PTH (n = 23), p = .93).Conclusions and significance: Our findings question if unilateral QT is preferable to bilateral QT when the PTA does not respond to conservative treatment, especially in males with GAS-positive PTA.
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Affiliation(s)
- Camelia Nami Saber
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Lindquist NR, Feng Z, Patro A, Mukerji SS. Age-related causes of emergency department visits after pediatric adenotonsillectomy at a tertiary pediatric referral center. Int J Pediatr Otorhinolaryngol 2019; 127:109668. [PMID: 31526936 DOI: 10.1016/j.ijporl.2019.109668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/20/2019] [Accepted: 08/31/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The complications of tonsillectomy and adenoidectomy (T&A) are well-described and include bleeding, dehydration, nausea, respiratory complications, and pain. After the immediate postoperative phase, the overall 30-day emergency department (ED) return rate is as high as 13.3%. However, few studies have examined the types and rates of late post-operative complications for children undergoing T&A stratified base on patient age. Herein, we aim to better characterize ED return visits for children of all ages, with special attention to those patients under three years of age. METHODS This is a retrospective case series at a tertiary academic pediatric medical center. All patients 18 years of age or younger who underwent T&A over eighteen months were included. Data including ED return diagnosis, post-operative day of presentation, and need for surgical intervention was recorded for patients who presented to the ED within 30 days of their original surgery. RESULTS 5,225 patients were identified, with an overall late complication rate of 12.8%. There was no difference in the 30-day ED readmission rate for children under the age of three, although children under the age of two were more likely to present to the ED. There was a significantly higher risk of dehydration for children under the age of four years, and a significantly higher bleeding risk and need for reoperation for control of post-tonsillectomy hemorrhage (PTH) for children over the age of six. CONCLUSIONS The overall ED visit rate in this study is 12.8%, with no difference based on age. Patients younger than three years of age are more likely to return to ED for dehydration, while bleeding and need for control of oropharyngeal hemorrhage is more common in older children. Knowledge of the age-related late complications of T&A may direct appropriate anticipatory peri-operative counseling of risks and return precautions.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology, Head and Neck Surgery at Baylor College of Medicine, Houston, TX, USA
| | - Zipei Feng
- Department of Otolaryngology, Head and Neck Surgery at Baylor College of Medicine, Houston, TX, USA
| | - Ankita Patro
- Vanderbilt Department of Otolaryngology, Nashville, TN, USA
| | - Shraddha S Mukerji
- Texas Children's Hospital, Department of Otolaryngology, Head and Neck Surgery at Baylor College of Medicine, Houston, TX, USA.
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Manimaran V, Mohanty S, Jayagandhi SK, Umamaheshwaran P, Jeyabalakrishnan S. A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital. Int Arch Otorhinolaryngol 2019; 23:e403-e407. [PMID: 31649759 PMCID: PMC6805177 DOI: 10.1055/s-0039-1696702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/03/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction
Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage.
Objective
The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage.
Methods
A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate.
Results
A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (
p
= 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (
p
< 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases.
Conclusion
The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Sanjeev Mohanty
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Satish Kumar Jayagandhi
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Preethi Umamaheshwaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Shivapriya Jeyabalakrishnan
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Kim SJ, Walsh J, Tunkel DE, Boss EF, Ryan M, Lee AH. Frequency of post-tonsillectomy hemorrhage relative to time of day. Laryngoscope 2019; 130:1823-1827. [PMID: 31566748 DOI: 10.1002/lary.28302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Postoperative hemorrhage is a serious complication of tonsillectomy, with secondary bleeding rates affecting up to 0.8% to 3% of patients. Although these bleeds are anecdotally perceived as occurring more frequently at night, the occurrence of hemorrhage relative to the time of day has not been investigated. We measured the frequency of post-tonsillectomy hemorrhage onset relative to the time of day. METHODS We reviewed electronic medical records of all patients who experienced postprocedural hemorrhage (International Classification of Disease, Ninth Edition [ICD-9] 998.11, ICD-10 J95.830 at two hospitals within a tertiary academic health system in a 10-year period). Patient demographics, time of bleed onset, emergency room [ED] arrival time, and management (operating room vs. observation) were abstracted. Patients without a recorded bleeding time were excluded. Time of bleed onset was categorized as morning (6:01 am-12 pm), afternoon (12:01 pm-6 pm), evening (6:01 pm-12 am), or overnight (12:01 am-6 am). Chi-square goodness of fit test was used to assess the distribution of hemorrhage timing (P ≤ 0.05). RESULTS A total of 7,396 patients underwent tonsillectomy May 2008 through May 2018, among whom 121 (2%) post-tonsillectomy hemorrhage patients were identified. Among the 104 patients with ED arrival times, 29 (28%) arrived in the morning; 15 (14%) arrived in the afternoon; 40 (38%) arrived in the evening; and 20 (19%) arrived overnight (P = 0.003). Sixty patients (mean age 17.1 years, standard deviation 16.6) had a recorded timing of bleed onset. Bleed onset occurred most commonly overnight (24, 40%), followed by evening (21, 35%), afternoon (11, 18%), and morning (4, 7%) (P = 0.0007). CONCLUSION In this cohort, post-tonsillectomy hemorrhage occurred most frequently between midnight and 6 am. Our findings confirm anecdotal experience and provide data in setting caregiver expectations. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1823-1827, 2020.
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Affiliation(s)
- Sun Joo Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Marisa Ryan
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Andrew H Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Zhou X, Xu A, Zhen X, Gao K, Cui Z, Yue Z, Han J. Coblation tonsillectomy versus coblation tonsillectomy with ties in adults. J Int Med Res 2019; 47:4734-4742. [PMID: 31456472 PMCID: PMC6833402 DOI: 10.1177/0300060519867822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to compare the intraoperative and postoperative courses of coblation tonsillectomy and coblation tonsillectomy with ties in adults. Methods All patients who underwent tonsillectomy from July 2012 to September 2016 were retrospectively reviewed. Intraoperative and postoperative bleeding, pain, and return to normal food intake were compared between patients who underwent coblation tonsillectomy and those who underwent coblation tonsillectomy with ties. Results Of 515 patients, 300 (58.3%) underwent coblation tonsillectomy and 215 (41.7%) underwent coblation tonsillectomy with ties. Twenty-five (4.9%) patients developed postoperative hemorrhage, 22 (88.0%) of whom had undergone coblation tonsillectomy and 3 (12.0%) of whom had undergone coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy reported less pain than those who underwent coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy with ties resumed a normal diet significantly later than those who underwent coblation tonsillectomy (10.0 ± 3.2 vs. 8.2 ± 1.9 days, respectively). Conclusion Coblation tonsillectomy is associated with less intraoperative bleeding, a shorter surgery time, less postoperative pain, and fewer days to recovery of a normal diet than is coblation tonsillectomy with ties. However, coblation tonsillectomy with ties is associated with remarkably reduced postoperative hemorrhage.
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Affiliation(s)
- Xuanchen Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Anting Xu
- Department of Otorhinolaryngology and Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xiaoyue Zhen
- Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Kun Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhaoyang Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhiyong Yue
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Han
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Yamasaki A, Bhattacharyya N. Rare electrosurgical complications in tonsillectomy: Analysis of national adverse event reporting. Laryngoscope 2019; 130:1138-1143. [DOI: 10.1002/lary.28181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Alisa Yamasaki
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Neil Bhattacharyya
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
- Division of Otolaryngology—Head and Neck SurgeryBrigham and Women's Hospital Boston Massachusetts U.S.A
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Aljabr IK, Hassan FM, Alyahya KA. Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hopkins ME, Harris AS, Davids JD, Owens D. Are core surgical trainees being trained to operate? ACTA ACUST UNITED AC 2019. [DOI: 10.1308/rcsbull.2019.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A national prospective study of tonsil and adenoid surgery between 2004 and 2015.
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Affiliation(s)
- ME Hopkins
- Department of Ear, Nose and Throat Surgery, University Hospital of Wales, Cardiff, UK
| | - AS Harris
- Department of Ear, Nose and Throat Surgery, University Hospital of Wales, Cardiff, UK
| | - JD Davids
- Cardiff and Vale University Health Board, Cardiff, UK
| | - D Owens
- Department of Ear, Nose and Throat Surgery, University Hospital of Wales, Cardiff, UK
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Wulu JA, Chua M, Levi JR. Does suturing tonsil pillars post-tonsillectomy reduce postoperative hemorrhage?: A literature review. Int J Pediatr Otorhinolaryngol 2019; 117:204-209. [PMID: 30611028 DOI: 10.1016/j.ijporl.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Literature review comparing post-tonsillectomy hemorrhage in pediatric and adult patients with and without suturing tonsil pillars to investigate whether suturing tonsil pillars reduces the risk of post-tonsillectomy hemorrhage. REVIEW METHODS Online journal databases were searched using the key phrases "post tonsillectomy hemorrhage", "post tonsillectomy bleed", and "tonsil pillar suture". 10 published studies were found regarding tonsil pillar suturing, four directly related to postoperative bleeding and five focusing on postoperative pain reduction. There was one study that evaluated both pain and bleeding. The pain reduction studies were comprised of 225 patients while the postoperative bleeding studies included 3987 patients. CONCLUSIONS Suturing tonsil pillars after tonsillectomy may be beneficial after cold tonsillectomy. IMPLICATIONS FOR PRACTICE Post-operative bleeding is one of the most common complications that can result in increased patient distress and hospitalization. In this article, we provide a literature review of tonsil pillar suturing and post-tonsillectomy hemorrhage. Our study suggests suturing the tonsil pillars immediately post-tonsillectomy may reduce the risk of severe post-operative bleeding requiring return to the operating room for certain patients.
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Affiliation(s)
- Jacqueline A Wulu
- Otolaryngology- Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA.
| | - Melissa Chua
- Boston University School of Medicine, Boston, MA, 02118, USA
| | - Jessica R Levi
- Otolaryngology- Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
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McKeon M, Kirsh E, Kawai K, Roberson D, Watters K. Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children. Laryngoscope 2018; 129:2765-2770. [PMID: 30536682 DOI: 10.1002/lary.27719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. STUDY DESIGN Retrospective chart review. METHODS A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary-care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. RESULTS Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47-6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06-4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. CONCLUSIONS Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2765-2770, 2019.
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Affiliation(s)
- Mallory McKeon
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Elliana Kirsh
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Roberson
- Global Tracheostomy Collaborative, Raleigh, North, Carolina, U.S.A
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Postoperative hemorrhage following tonsillectomy in adults: Analysis of population-based inpatient cohort in Taiwan. Auris Nasus Larynx 2018; 46:397-406. [PMID: 30392979 DOI: 10.1016/j.anl.2018.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 10/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Because of the lack of population-based analyses, this study elucidated the epidemiology and 30-day postoperative complications of inpatient adult tonsillectomies in Taiwan. METHODS Using the Taiwan National Health Insurance Research Database, we identified all inpatient adult tonsillectomies (age>20years) in Taiwan during 1997-2012 through International Codes of Diseases, 9th Revision. Trend of the inpatient tonsillectomy in adult during the study period was explored. Major complications of readmission, reoperation, and mortality within 30days after tonsillectomies were identified. Factors associated with major complications were analyzed using multivariate logistic model. RESULTS In total, 27,365 adults received inpatient tonsillectomies (mean age, 38.4±13.0years; 57.2% male). The overall incidence was 10.2 per 100,000 population per year among adults. Incidence rates increased from 1997 (8.2/100,000 adults) to 2012 (11.2/100,000 adults) (P trend<0.001). The rate of readmission for any reason, readmission for bleeding, reoperation for bleeding, and mortality were 4.9%, 2.2%, 1%, and 0.1%, respectively. Young age increased the risk of bleeding-related readmission and reoperation, whereas old age increased the risk of readmission for any reason and mortality. Male gender increased the risk of all major complications. Hypertension was associated with an increased risk of bleeding-related readmission (odds ratio [OR]=2.21; 95% confidence interval [CI] 1.68-2.92) and reoperation (OR=2.17; 95% CI 1.44-3.27). Existing catastrophic illness increased the risk of readmission (OR=4.28; 95% CI 3.60-5.08) for any reason and mortality (OR=3.24; 95% CI 1.37-7.65). Nonsteroidal anti-inflammatory drugs and steroids were associated with an increased risk of readmission or reoperation for bleeding. CONCLUSION Incidence rates of inpatient adult tonsillectomy increased during 1997-2012 in Taiwan. Age, gender, comorbidity, and drug administration characteristics were associated with major complications of adult tonsillectomies in this cohort.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan.
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
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Susaman N, Kaygusuz I, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk Factors For Post-Tonsillectomy Hemorrhage. ENT UPDATES 2018. [DOI: 10.32448/entupdates.459027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Population-based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997-2012. Int J Pediatr Otorhinolaryngol 2018; 108:55-62. [PMID: 29605366 DOI: 10.1016/j.ijporl.2018.02.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Tonsil surgery in children is a common surgical procedure, and is mostly performed as an inpatient procedure in Taiwan. This study elucidates the epidemiology and postoperative hemorrhage of inpatient tonsillectomies in Taiwanese children. METHODS This study used the Taiwan National Health Insurance Research Database for analysis. From 1997 to 2012, all in-hospital children (aged <18 years) who underwent tonsillectomies were identified through the International Codes of Diseases (9th Revision). Incidence rates and trends of inpatient pediatric tonsillectomies during the study period were identified. Major complications, including readmission, reoperation, and mortality were identified. The factors associated with major complications were analyzed. RESULTS From 1997 to 2012, 17326 children received inpatient tonsillectomies (mean age, 8.6 ± 3.8 y; 65% boys). The overall incidence rate was 20.6 per 100,000 children. The incidence rate was highest in children who were 6-8 years of age, and boys exhibited a higher rate than girls (P < 0.001). Longitudinal data indicated that the incidence rate increased from 1997 (15.7/100,000 children) to 2012 (19.2/100,000 children) (P trend < 0.001). The proportions of readmission for any reason, readmission for bleeding, and reoperation were 1.8%, 0.9%, and 0.3%, respectively. No mortality occurred within 30 days of the tonsillectomy. A multivariable logistic model indicated that toddlers were associated with an increased risk of readmission for any reason (OR, 2.70; 95% CI 1.60-4.56), and adolescents were at risk of bleeding-related readmission (OR, 2.81; 95% CI 1.91-4.14) and reoperation (OR, 2.86; 95% CI 1.47-5.55). Children with comorbidities (OR, 3.14; 95% CI 1.93-5.09) or a surgical indication of tumor (OR, 11.73; 95% CI 4.93-27.91) had a higher risk of readmission. The use of nonsteroidal anti-inflammatory drugs or steroids is associated with an increased risk of readmission or reoperation. Moreover, concurrent procedures (i.e., adenoidectomy, ear surgery, or nasal surgery) did not increase the risk of readmission or reoperation. CONCLUSIONS The incidence rate and indications of obstructive sleep disorders for inpatient pediatric tonsillectomy increased during 1997-2012 in Taiwan. Postoperative readmission and reoperation were rare. Age, surgical indication, comorbidities, and drug administration were associated with readmission or reoperation in this study cohort.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan.
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
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Systematic review of tonsil surgery quality registers and introduction of the Nordic Tonsil Surgery Register Collaboration. Eur Arch Otorhinolaryngol 2018; 275:1353-1363. [DOI: 10.1007/s00405-018-4945-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
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Odhagen E, Sunnergren O, Söderman ACH, Thor J, Stalfors J. Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study. Eur Arch Otorhinolaryngol 2018; 275:1631-1639. [PMID: 29574597 PMCID: PMC5951893 DOI: 10.1007/s00405-018-4942-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/17/2018] [Indexed: 12/12/2022]
Abstract
Purpose Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates. Methods Six ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project’s primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP. Results The QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis. Conclusions The rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.
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Affiliation(s)
- Erik Odhagen
- Department of Otorhinolaryngology, Södra Älvsborgs Hospital, Brämhultsvägen 53, 501 82, Borås, Sweden.
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Ryhov County Hospital Jönköping, Jönköping, Sweden
| | | | - Johan Thor
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Joacim Stalfors
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sheikh Khalifa Medical City, Ajman, United Arab Emirates
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Katsumata H, Yamamoto I, Komatsuzaki Y, Kawabe M, Okabayashi Y, Yamakawa T, Katsuma A, Nakada Y, Kobayashi A, Tanno Y, Miki J, Yamada H, Ohkido I, Tsuboi N, Yamamoto H, Yokoo T. Successful treatment of recurrent immunoglobulin a nephropathy using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation: a case presentation. BMC Nephrol 2018. [PMID: 29540152 PMCID: PMC5852954 DOI: 10.1186/s12882-018-0858-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Both prevention and treatment of recurrent immunoglobulin A nephropathy (IgAN) in kidney transplant recipients are important since recurrent IgAN seems to affect long-term graft survival. We present here a case of recurrent IgAN that was successfully treated using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation. Case presentation A 46-year-old male was admitted for an episode biopsy with a serum creatinine level of 1.8 mg/dl and proteinuria (0.7 g/day). Histological features showed recurrent IgAN (only focal segmental mesangial proliferation) and severe arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity, with limited interstitial fibrosis and tubular atrophy (5%) (IF/TA) 8 years after transplantation. Sodium restriction and conversion from cyclosporine to tacrolimus successfully reduced his proteinuria to the level of 0.15 g/day. However, 2 years later, his proteinuria increased again (1.0 g/day) and a second episode biopsy showed global mesangial proliferation with glomerular endocapillary and extracapillary proliferation accompanied by progressive IF/TA (20%). The steroid pulse therapy plus tonsillectomy successfully decreased his proteinuria and he achieved clinical remission 3 years after this treatment. Conclusion This case, presented with a review of relevant literature, demonstrates the difficulty and importance of the treatment of recurrent IgAN and calcineurin inhibitor arteriolopathy, especially in long-term kidney allograft management.
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Affiliation(s)
- Haruki Katsumata
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yo Komatsuzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mayuko Kawabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takafumi Yamakawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ai Katsuma
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuyuki Nakada
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Akimitsu Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Yamada
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroyasu Yamamoto
- Department of internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Miyamoto Y, Shinzawa M, Tanaka S, Tanaka-Mizuno S, Kawakami K. Perioperative Steroid Use for Tonsillectomy and Its Association With Reoperation for Posttonsillectomy Hemorrhage. Anesth Analg 2018; 126:806-814. [DOI: 10.1213/ane.0000000000002681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe hemorrhage. Patients with minor or self-resolving bleeding should be observed in the emergency department or admitted for monitoring. Patients with severe bleeding should be immediately assessed for airway and hemodynamic stability. Management of severe bleeding includes immediate surgical consultation or initiation of the transfer process to a center with surgical capabilities, direct pressure to the site of hemorrhage with or without the additional of a hemostatic agent, possible rapid sequence intubation, and management of hemodynamic instability with volume resuscitation.
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Affiliation(s)
- Jessica J Wall
- Department of Emergency Medicine, Penn Presbyterian Medical Center, 51 North 39th Street, Philadelphia, PA 19104, USA.
| | - Khoon-Yen Tay
- Division of Emergency Medicine, Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, USA
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