1
|
Smaily H, Cherfane P. The Utility and Safety of Prophylactic Tranexamic Acid in Tonsillectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39353153 DOI: 10.1002/ohn.973] [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: 04/01/2024] [Revised: 09/01/2024] [Accepted: 09/04/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of tranexamic acid (TXA) in reducing posttonsillectomy hemorrhage (PTH). DATA SOURCES We searched MEDLINE, EMBASE, and CENTRAL for RCT comparing prophylactic TXA to control in patients undergoing tonsillectomy. REVIEW METHODS Per Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, the databases were searched from date of inception through October 2023. RCTs of patients undergoing tonsillectomy or adenotonsillectomy and receiving prophylactic TXA versus control were included. Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. Standardized mean difference with 95% confidence interval (CI) was applied for continuous variables. Dichotomous data were expressed as relative risk with 95% CI. RESULTS A total of 10 RCT were included in our quantitative analysis. Eight studies reported on PTH rate. Prophylactic TXA showed non-significant decrease in PTH (relative risk or risk ratio [RR]: 0.62 [0.35, 1.10]). Sensitivity analysis showed significant decrease in PTH after exclusion of High-risk bias studies (RR: 0.48 [0.30, 0.77]). Intraoperative blood loss volume was significantly lower in the TXA group (35.59 mL [-48.19, -22.99]). CONCLUSION Overall, this study showed a tendency toward lesser PTH rate with prophylactic TXA. However, this tendency only reaches statistical significance when studies with high risk of bias are excluded. Well-designed trials are still needed to support our observations.
Collapse
Affiliation(s)
- Hussein Smaily
- Department of Otolaryngology-Head and Neck Surgery, Laval University, Quebec, Canada
| | - Patrick Cherfane
- Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| |
Collapse
|
2
|
Maksimoski M, McCauley M, Osoba M, Pirotte M, Liddy W. Treatment of Post-Tonsillectomy Hemorrhage With Nebulized Tranexamic Acid: Initial Investigation of a Novel Therapeutic Modality. Ann Otol Rhinol Laryngol 2024; 133:729-734. [PMID: 38801210 DOI: 10.1177/00034894241254697] [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: 05/29/2024]
Abstract
OBJECTIVES The use of nebulized tranexamic acid (TXA) in massive pulmonary hemorrhage is well-described. Published utilization in post-tonsillectomy bleeding (PTB) is limited to a single case. This study examines whether TXA resulted in change of operative intervention necessity and narcotic utilization. METHODS This was a retrospective cohort study at a single, urban academic medical center in the United States. Chart review was conducted of all patients who presented to the hospital for post-tonsillectomy bleed (PTB) between 3/1/2018 and 7/1/2020. Demographic data, intervention modality, need for control under general anesthesia, and opioid use were collected and analyzed. RESULTS Twenty-one patients underwent a total of 23 visits for PTB over the study period. Control of hemorrhage without need for operating room intervention for PTB was 100% (6/6) for patients receiving TXA nebulizer and 53% (9/17) for those receiving other treatment modalities. Opioid usage in hospital and on discharge was also lower in patients receiving TXA nebulizers. All results were statistically significant. CONCLUSIONS Our study supports nebulized TXA as an effective, non-invasive mode of hemostasis in patients presenting to the emergency department for post-tonsillectomy hemorrhage. Nebulized TXA may prevent the need for general anesthesia and operative intervention. Otolaryngologists should consider addition of this novel treatment appropriation of TXA to their management options for postoperative tonsillar hemorrhage.
Collapse
Affiliation(s)
- Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Matthew McCauley
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Muyinat Osoba
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Matthew Pirotte
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| |
Collapse
|
3
|
Güllüev M, Yücel A, Demirci B, Kaplan D, Özdemir LE. The relationship between posttonsillectomy bleeding to hemogram and coagulation parameters. Eur Arch Otorhinolaryngol 2024; 281:2569-2574. [PMID: 38315176 DOI: 10.1007/s00405-024-08487-2] [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: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Tonsillectomy is a common surgery performed for indications such as chronic tonsilitis, tonsil hypertrophy and obsructive sleep apnea. Although posttonsillectomy bleeding (PTB) is rare and can be controlled with simple interventions in many patients, it is one of the most feared complications of tonsillectomy surgery. In our study, we investigated the effects of changes in hemogram and coagulation values and seasonal effects on PTB. METHODS Pediatric and adult patients who underwent tonsillectomy with cold knife method between August 2020 and August 2023 in our clinic were retrospectively reviewed. Demographic data, hemogram and coagulation values of the patients in the control and study groups were recorded and the differences between the two groups in terms of these parameters were evaluated. RESULTS Our study included 991 patients aged 1-51 years. The rate of PTB was calculated as 2.82%. No patient with primary PTB was found. The duration of bleeding development was 7.03 days. Age, WBC and neutrophil values were statistically significantly higher in the study group. There were no significant differences between two groups in terms of gender, season and other hemogram and coagulation parameters. CONCLUSIONS Age, high WBC and neutrophil levels were determined as possible risk factors for PTB. Seasonal and gender distribution, aPTT and INR values were similar in the two groups. In order to prevent and predict bleeding, detailed infection investigation should be performed and the risk of bleeding should be considered to increase with increasing age.
Collapse
Affiliation(s)
- Mustafa Güllüev
- Department of Otorhinolaryngology, Develi State Hospital, Kayseri, 38100, Turkey.
| | - Abitter Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Berat Demirci
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Duygu Kaplan
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Latif Emre Özdemir
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| |
Collapse
|
4
|
Fushimi K, Gyo K, Okunaka M, Watanabe M, Sugihara A, Tsuzuki K. Analysis of risk factors for post-tonsillectomy hemorrhage in adults. Auris Nasus Larynx 2022; 50:389-394. [PMID: 36272864 DOI: 10.1016/j.anl.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify the risk factors for post-tonsillectomy hemorrhage (PTH) in adult patients (>19 years). METHODS 275 adult patients who underwent tonsillectomy between 2009 and 2019 were retrospectively analyzed. Possible risk factors associated with PTH were investigated by univariate and multivariate logistic regression analyses. RESULTS PTH occurred in 39 of 275 patients (14.2%). Regarding underlying diseases, PTH occurred more frequently in focal infection of IgA nephropathy. Furthermore, bipolar electrocautery was the other risk factor for PTH on multivariate analysis. CONCLUSION Focal infection of IgA nephropathy and bipolar electrocautery were identified as the risk factors for PTH.
Collapse
|
5
|
McLean JE, Hill CJ, Riddick JB, Folsom CR. Investigation of Adult Post-Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use. Laryngoscope 2022; 132:949-953. [PMID: 34473351 DOI: 10.1002/lary.29844] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post-tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non-steroidal anti-inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. STUDY DESIGN Retrospective chart review. METHODS We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. RESULTS A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69-1.49; P = .95). CONCLUSIONS This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher-powered study is needed. LEVEL OF EVIDENCE 3 Laryngoscope, 132:949-953, 2022.
Collapse
Affiliation(s)
- James E McLean
- Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Christopher J Hill
- Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Jeanelle B Riddick
- Clinical Investigations Department, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Craig R Folsom
- Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Kuo CC, DeGiovanni JC, Carr MM. The efficacy of Tranexamic Acid Administration in Patients Undergoing Tonsillectomy: An Updated Meta-Analysis. Ann Otol Rhinol Laryngol 2021; 131:834-843. [PMID: 34515540 DOI: 10.1177/00034894211045264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is controversy regarding the efficacy and safety of tranexamic acid (TXA) in reducing tonsillectomy-related hemorrhage. We conducted a systematic review and meta-analysis to evaluate the prophylactic role of TXA in tonsillectomy. METHODS We searched 6 databases to identify studies that directly compare the effect of TXA versus controls in tonsillectomy patients. Standardized mean difference was applied to summate the findings across the studies. Dichotomous data were expressed as relative risk. RESULTS Ten studies representing a total of 111 898 patients were included. The pooled results showed a significant reduction of intraoperative blood loss by 39.02 ml (SMD = -1.05, 95% CI: -1.91 to -0.20, P = .016) and the rate of post-tonsillectomy hemorrhage (RR = 0.42, 95% CI: 0.28 to 0.65, P < .0001), with no significant difference in reduction of further intervention risk (RR = 0.78, 95% CI: 0.45 to 1.35, P = .373). CONCLUSIONS Overall, this study indicates that TXA may reduce blood loss and frequency of post-operative hemorrhage associated with tonsillectomy. Further large, high-quality clinical trials are still needed to explore TXA's effect on post-tonsillectomy hemorrhage and the safety of its use.
Collapse
Affiliation(s)
- Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jason C DeGiovanni
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
8
|
Inuzuka Y, Mizutari K, Kamide D, Sato M, Shiotani A. Risk factors of post-tonsillectomy hemorrhage in adults. Laryngoscope Investig Otolaryngol 2020; 5:1056-1062. [PMID: 33364394 PMCID: PMC7752073 DOI: 10.1002/lio2.488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Tonsillectomy is an essential surgery and is conducted on both children and adults. However, the risk factors of post-tonsillectomy hemorrhage for adult patients remain unclear. In this study, we analyzed post-tonsillectomy hemorrhage in adult patients. METHODS We retrospectively analyzed 325 adult patients who underwent a tonsillectomy between 2014 and 2018 in our facilities. RESULTS The average age of this study's population was 31.7 ± 10.5 years (range: 19-70 years), and 250 (76.9%) patients were male. Overall, post-tonsillectomy hemorrhage occurred in 71 (21.8%) patients and 5 (1.5%) patients required a second surgery for hemostasis. Post-tonsillectomy hemorrhage often occurred on postoperative day zero or six. Using multiple logistic regression analysis, current smoking status (odds ratio 3.491; 95% confidence interval 1.813-6.723), male sex (odds ratio 3.924; 95% confidence interval 1.548-9.944), and perioperative non-steroidal anti-inflammatory drug administration (odds ratio 7.930; 95% confidence interval 1.004-62.64) were revealed as overall post-tonsillectomy hemorrhage risk factors. To analyze the hemorrhage period after tonsillectomy, we categorized the post-tonsillectomy hemorrhage patients into the primary (bleeding within postoperative day one) and secondary hemorrhage (bleeding on or after postoperative day two) groups. The current smoking status and older age were risk factors for primary hemorrhage and the current smoking status and sex (male) were risk factors for secondary hemorrhage. CONCLUSIONS In this study, smoking status, sex, and perioperative non-steroidal anti-inflammatory drug administration were the clinical risk factors for adult post-tonsillectomy hemorrhage. Thus, smoking cessation is, at least, mandatory for patients who receive tonsillectomy to avoid post-tonsillectomy hemorrhage. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Yoshiaki Inuzuka
- Department of Otolaryngology‐Head and Neck SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Kunio Mizutari
- Department of Otolaryngology‐Head and Neck SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Daisuke Kamide
- Department of Otolaryngology‐Head and Neck SurgerySelf‐Defense Forces Central HospitalSetagaya‐kuJapan
| | - Michiya Sato
- Department of Otolaryngology‐Head and Neck SurgerySelf‐Defense Forces Central HospitalSetagaya‐kuJapan
| | - Akihiro Shiotani
- Department of Otolaryngology‐Head and Neck SurgeryNational Defense Medical CollegeTokorozawaJapan
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Seyhun N, Dizdar SK, Çoktur A, Bektaş ME, Albuz O, Erol ZN, Turgut S. Response to letter to editor regarding "Risk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact?". Am J Otolaryngol 2020; 41:102711. [PMID: 32943273 DOI: 10.1016/j.amjoto.2020.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nurullah Seyhun
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey.
| | - Senem Kurt Dizdar
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Alican Çoktur
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Merve Ekici Bektaş
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Onuralp Albuz
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Zeynep Nur Erol
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Suat Turgut
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| |
Collapse
|
11
|
Seyhun N, Dizdar SK, Çoktur A, Bektaş ME, Albuz O, Erol ZN, Turgut S. Risk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact? Am J Otolaryngol 2020; 41:102341. [PMID: 31732315 DOI: 10.1016/j.amjoto.2019.102341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Nurullah Seyhun
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey.
| | - Senem Kurt Dizdar
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Alican Çoktur
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Merve Ekici Bektaş
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Onuralp Albuz
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Zeynep Nur Erol
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| | - Suat Turgut
- Sisli Hamidiye Etfal Training and Research Hospital, ENT Clinic, Sisli, Istanbul, Turkey
| |
Collapse
|
12
|
Leader BA, Wiebracht ND, Meinzen‐Derr J, Ishman SL. The impact of resident involvement on tonsillectomy outcomes and surgical time. Laryngoscope 2019; 130:2481-2486. [DOI: 10.1002/lary.28427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Brittany A. Leader
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
| | - Nathan D. Wiebracht
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
| | - Jareen Meinzen‐Derr
- Division of Biostatistics & Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology Cincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Burckardt E, Rebholz W, Allen S, Cash E, Goldman J. Predictors for hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2019; 117:143-147. [PMID: 30579069 DOI: 10.1016/j.ijporl.2018.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine risk factors and trends for posttonsillectomy hemorrhage (PTH) following adenotonsillectomy (T&A) at a single children's tertiary referral hospital. METHODS Charts from all patients 2-12 years old undergoing T&A alone at a single children's hospital from January 1, 2010 through December 31, 2015 were reviewed. Data was collected on patient demographics, indication for procedure, time of year, academic affiliation of surgeon, surgical technique and method, post-operative pain medication prescribed,and readmission for PTH. Univariate chi-square analyses and logistic regression along with multivariable stepwise logistic regression were used to identify predictors of PTH. SPSS version 24 was used for statistical analyses with p < .05 indicating statistical significance. RESULTS There were 2565 children undergoing T&A during the study period. One hundred seventy-three (6.7%) patients were readmitted, of which 53 (30.6%) were due to PTH. Univariate analyses identified children at the highest age quartile of the study, 7.72-12.97 years old (odds ratio [OR] = 5.775, 95% confidence interval [CI] = 2.248-14.837, p < .001) and children with a BMI z-score of 2 or greater (OR = 3.391, 95% CI = 1.497-7.680, p = .003) were at increased risk for PTH. Multivariable analyses also identified both the highest age quartile and BMI z-score of 2 or greater to be a risk factor for PTH. CONCLUSION In children undergoing T&A, age greater than 7.72 years old and BMI z-score of 2 or greater are significant risk factors for PTH. Replication of these findings in a more highly powered trial is needed.
Collapse
Affiliation(s)
- Elizabeth Burckardt
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Whitney Rebholz
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Samantha Allen
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth Cash
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Department of Psychological & Brain Sciences, James Graham Brown Cancer Center, Louisville, KY, USA.
| | - Julie Goldman
- Department of Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA.
| |
Collapse
|
15
|
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
|
16
|
Post-tonsillectomy hemorrhage: Underlying factors and prevention. Am J Otolaryngol 2018; 39:230-231. [PMID: 29305220 DOI: 10.1016/j.amjoto.2017.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/27/2017] [Indexed: 01/06/2023]
|
17
|
El Rassi E, de Alarcon A, Lam D. Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey. Int J Pediatr Otorhinolaryngol 2017; 102:108-113. [PMID: 29106855 DOI: 10.1016/j.ijporl.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate practice patterns amongst pediatric otolaryngologists in the management of post-tonsillectomy hemorrhage. METHODS A cross-sectional survey of the American Society of Pediatric Otolaryngology membership was administered electronically. The survey contained questions related to practice type, availability of resident and fellow call coverage, and management of different scenarios of post-tonsillectomy hemorrhage. Anonymous responses were collected and tabulated. RESULTS The response rate was 157/443 (35%). For patients presenting with a convincing history of post-tonsillectomy hemorrhage but no clot or bleeding on exam, the most common management was overnight observation (55%) or discharge home with close follow-up (29%). In patients presenting with tonsillar clot but no active bleeding, the most common management was operating room for control (50%), followed by observation (25%) and bedside topical treatment (13%). In the same scenario with a cooperative teenager, bedside topical treatment was most common (45%), followed by operating room for control (27%) and observation (16%). In patients presenting with active tonsillar bleeding, operating room for control was most common (83%) while few (6%) attempted bedside treatment. If the patient was a cooperative teenager, 38% attempted bedside treatment while 52% would still go to the operating room. CONCLUSIONS There is substantial variation in the management of post-tonsillectomy hemorrhage amongst the pediatric otolaryngologists. Further studies to determine outcomes associated with differing treatment strategies would be useful in establishing practice recommendations.
Collapse
Affiliation(s)
- Edward El Rassi
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
| | - Alessandro de Alarcon
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA; Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Derek Lam
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA; Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, OR, USA
| |
Collapse
|
18
|
Lee WT, Witsell DL, Parham K, Shin JJ, Chapurin N, Pynnonen MA, Langman A, Nguyen-Huynh A, Ryan SE, Vambutas A, Roberts RS, Schulz K. Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg 2017; 155:28-32. [PMID: 27371623 DOI: 10.1177/0194599816630523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/13/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES (1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines. STUDY DESIGN Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients. SETTING Multisite practice-based network. SUBJECTS AND METHODS A total of 8347 subjects underwent tonsillectomy as determined by procedure code within the retrospective data collection database, and 107 had postoperative hemorrhage. These subjects had demographic information and related diagnoses based on the CPT and ICD-9 codes collected. Postoperative ICD-9 and CPT codes were used to identify patients who also had postoperative bleed. Variables included age (<12 vs ≥12 years), diagnoses (infectious vs noninfectious), and practice type (community vs academic). Statistical analysis included multivariate logistic regression variables predictive of postoperative bleeding, with P < .05 considered significant. RESULTS Thirteen sites contributed data to the study (7 academic, 6 community). There was postoperative bleeding for an overall bleed rate of 1.3%. Patients ≥12 years old had a significantly increased bleed rate when compared with the younger group (odds ratio, 5.98; 95% confidence interval: 3.79-9.44; P < .0001). There was no significant difference in bleed rates when practices or diagnoses were compared. CONCLUSION A site descriptor database built to expedite clinical research can be used for practice assessment and quality improvement. These data were also useful to identify patient risk factors for posttonsillectomy bleed.
Collapse
Affiliation(s)
- Walter T Lee
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA Section of Otolaryngology-Head and Neck Surgery, Durham VA Medical Center, Durham, North Carolina, USA
| | - David L Witsell
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikita Chapurin
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alan Langman
- Northwest Hearing & Balance, University of Washington, Seattle, Washington, USA
| | - Anh Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Sheila E Ryan
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Rhonda S Roberts
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kris Schulz
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
19
|
Abstract
Tonsillectomy is a commonly performed procedure with an accepted risk of posttonsillectomy hemorrhage (PTH) approaching 5%, but catastrophic effects of hemorrhage are exceedingly rare. A variety of surgical techniques and hemostatic agents have been used to reduce the rate of hemorrhage, although none eliminate the risk. Numerous patient, surgical, and postoperative care factors have been studied for an association with PTH. The most consistent risk factors for PTH seem to be patient age and coagulopathies. Surgeon skill and surgical technique are most consistently associated with primary PTH.
Collapse
Affiliation(s)
- Ryan M Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 256515, Seattle, WA 98195, USA
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 256515, Seattle, WA 98195, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OA.9.329, Seattle, WA 98105, USA.
| |
Collapse
|
20
|
Kim SJ, Kwon C, Koh TK, Lee KH, Kim SW. Lower-pole intracapsular tonsillectomy in obstructive sleep apnea patients. Acta Otolaryngol 2017; 137:302-305. [PMID: 27868462 DOI: 10.1080/00016489.2016.1236214] [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: 10/20/2022]
Abstract
CONCLUSION Lower-pole intracapsular tonsillectomy (LPIT) is a valuable surgical technique capable of decreasing post-operative bleeding in obstructive sleep apnea (OSA) patients. OBJECTIVE This study performed LPIT to simultaneously reduce post-operative bleeding of lower pole and prevent recurrent tonsillitis of upper pole and compared its effects to extracapsular tonsillectomy (ET). METHODS ET was performed in the extracapsular plane, with complete monopolar dissection. In LPIT, the upper pole of palatine tonsil was removed by electrocautery with the extracapsular plane, followed by removal of the lower-pole by plasma ablation with the intracapsular plane. Post-operative bleeding incidence, bleeding site, and degree of pain were compared between the two groups. RESULTS Three hundred and forty-seven patients diagnosed of OSA with polysomnography were enrolled. ET was performed in 152 patients and LPIT in 195 patients. There were no significant differences in post-operative pain between the two groups. The LPIT group showed significantly lower total bleeding incidence than the ET group (4.1% vs 9.2%; p = .05). In particular, lower-pole bleeding incidence was lower in the LPIT group than the ET group (1.0% vs 5.3%; p = .02).
Collapse
|
21
|
Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg 2017; 156:442-455. [PMID: 28094660 PMCID: PMC5639328 DOI: 10.1177/0194599816683915] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 01/21/2023]
Abstract
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
Collapse
Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Chris Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Nila Sathe
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Siva Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center
| |
Collapse
|
22
|
Is celecoxib a useful adjunct in the treatment of post-tonsillectomy pain in the adult population? A randomised, double-blind, placebo-controlled study. The Journal of Laryngology & Otology 2017; 131:S18-S28. [PMID: 28164777 DOI: 10.1017/s0022215116009476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of celecoxib for pain management in post-tonsillectomy adult patients. DESIGN A randomised, double-blind, placebo-controlled, phase 3 clinical trial was conducted in an adult population (aged 18-55 years), with a parallel group design using an allocation ratio of 1:1. METHODS Eighty patients underwent elective tonsillectomy or adenotonsillectomy, operated on by one surgeon. They were discharged home with randomly assigned celecoxib or placebo, together with regular post-tonsillectomy medications (paracetamol and Endone). Pain scores were measured from post-operative days 1 to 10. All patients were assessed on post-operative days 5, 12 and 28. RESULTS There were no statistically significant differences in the daily or overall pain scores, the total intake of Endone, or the time taken to achieve freedom from pain after tonsillectomy between the study arms (n = 40 each arm). The celecoxib-treated group experienced significantly more vomiting (celecoxib vs placebo p < 0.001 (Mann-Whitney test), confidence interval = 0.57 to 0.76). CONCLUSION Celecoxib usage was associated with significantly more vomiting and did not reduce narcotic analgesia requirement post-tonsillectomy.
Collapse
|
23
|
Mohammed H, ALtamimi ZAR, Sheikh R, Al Taweel H, Ganesan S. Recurrent Post Tonsillectomy Secondary Hemorrhage in Patients with Factor XIII Deficiency: A Case Series and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:850-854. [PMID: 27843132 PMCID: PMC5111571 DOI: 10.12659/ajcr.900391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Case series Patients: Male, 20 • Male, 4 • Male, 27 • Male, 25 • Female, 5 • Female, 26 Final Diagnosis: Post tonsillectomy secondary hemorrhage Symptoms: Bleeding • bleeding per oral Medication: — Clinical Procedure: Control of post tonsillectomy secondary hemorrhage Specialty: Otolaryngology
Collapse
Affiliation(s)
- Hassen Mohammed
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zaid Abu Rajab ALtamimi
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rashid Sheikh
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hayam Al Taweel
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shanmugam Ganesan
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
24
|
Gender-specific risk factors in post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 2016; 273:4535-4541. [DOI: 10.1007/s00405-016-4146-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
|
25
|
|
26
|
Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol 2016; 84:151-5. [PMID: 27063772 DOI: 10.1016/j.ijporl.2016.03.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine pre-operative risk factors for post-tonsillectomy secondary hemorrhage in children, and quantify the magnitude of their risk. MATERIALS AND METHODS Retrospective case-control study of all pediatric tonsillectomy patients experiencing post-operative bleeding from 2005 to 2010 in a community practice consisting of three fellowship-trained pediatric otolaryngologists were identified. The 91 cases were matched with 151 controls that underwent tonsillectomy by the same surgeon on the same day as each identified case. All charts were reviewed, and 41 pre-operative variables were extracted and statistically analyzed with contingency and regression analysis to calculate significance and odds ratios. RESULTS Three significant predictors of post-operative bleeding were identified. Performing a tonsillectomy on a child with recurrent tonsillitis (vs. other indications) increased the risk of post-operative hemorrhage by 4.5 times (p<0.0001, 95% confidence intervals 2.41-8.38). Performing a tonsillectomy on a child with attention deficit hyperactivity disorder (ADHD) increased the risk by 8.7 times (p=0.029, 95%CI 1.4-53.6). Older children were more predisposed to post-operative bleeding. For every increase in age by one year, the hemorrhage risk increased by 1.1 times (p=0.0025, 95%CI 1.032-1.162). Children 11 years of age and older had double the risk of bleeding compared to younger children (odds ratio 1.98, p=0.0381, 95%CI 1.04-3.79). None of the remaining 38 variables showed significant differences between cases and controls. CONCLUSIONS The risk of post-tonsillectomy hemorrhage is significantly increased in older children and those with recurrent tonsillitis and ADHD.
Collapse
|
27
|
|
28
|
Siupsinskiene N, Žekonienė J, Padervinskis E, Žekonis G, Vaitkus S. Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms. Eur Arch Otorhinolaryngol 2014; 272:271-8. [PMID: 24691853 DOI: 10.1007/s00405-014-3023-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/20/2014] [Indexed: 12/20/2022]
Abstract
Pain after tonsillectomy remains the main issue of postoperative morbidity and the search for an effective post-tonsillectomy analgesic is of increasing relevance. The aim of this study was to evaluate the effectiveness of topical sucralfate during an early post-tonsillectomy period. Fifty patients of both genders from 6 to 58 years submitted to tonsillectomy or adenotonsillectomy were randomly included into either a sucralfate treatment group (N = 25) or into a control group (N = 25). Patients of the sucralfate group received topical sucralfate four times a day for 7 days. No topical treatment was applied to patients of the control group. A systemic analgesic was standardized. Post-tonsillectomy symptoms, including throat pain, odynophagia and otalgia, were evaluated during the period of seven postoperative days. Secondary outcomes were analgesic use, well being in general, return to regular daily activities, secondary hemorrhage and side effects of sucralfate. This study revealed that during the period of the second to seventh postoperative days average throat pain scores of the sucralfate using patients were significantly lower than those of the control group patients (p < 0.05); the same could be applied to odynophagia scores during the period of all seven postoperative days (p < 0.01) and otalgia scores from the 4th postoperative day (p < 0.05). The sucralfate group patients also had a significantly smaller need for analgesics, better scores of well being in general and early return to regular daily activities with no side effects of the treatment. Topical sucralfate could be recommended for the everyday clinical practice as a safe, adjuvant medicine of treatment during the period of the first post-tonsillectomy week.
Collapse
Affiliation(s)
- Nora Siupsinskiene
- Department of Otorhinolaryngology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania,
| | | | | | | | | |
Collapse
|
29
|
Muratori E, Meccariello G, Deganello A, Mannelli G, Gallo O. Tonsillectomy and residents: a safe match? Clin Otolaryngol 2013; 38:279-80. [PMID: 23745541 DOI: 10.1111/coa.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2013] [Indexed: 11/30/2022]
|
30
|
Kim JW, Mun SJ, Lee WH, Mo JH. Post-tonsillectomy hemorrhage in children: a single surgeon’s experience with coblation compared to diathermy. Eur Arch Otorhinolaryngol 2012; 270:339-44. [DOI: 10.1007/s00405-012-2098-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 06/18/2012] [Indexed: 11/24/2022]
|
31
|
Coblation tonsillectomy: is it inherently bloody? Eur Arch Otorhinolaryngol 2011; 269:579-83. [DOI: 10.1007/s00405-011-1609-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
|
32
|
Common Postoperative Complications in Otolaryngology Presenting to the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2010. [DOI: 10.1016/j.cpem.2010.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|