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Keshari S, Singh SP, Jain S, Niranjan AS, Kumar P, Patel BK. Effect of Body Mass Index on Post Tonsillectomy Hemorrhages. Indian J Otolaryngol Head Neck Surg 2023; 75:3585-3589. [PMID: 37974868 PMCID: PMC10645914 DOI: 10.1007/s12070-023-04060-1] [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: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS Obesity affects adverse outcomes in patients undergoing various surgeries. The study was carried out to assess the clinical association between body mass index and post tonsillectomy hemorrhages. MATERIALS AND METHODS This prospective study was carried out on 60 patients, age between 5 and 40 years, admitted in Department of ENT with chronic tonsillitis. Body mass index and post tonsillectomy hemorrhage were evaluated in all patients who underwent surgery. Bleeding episode were categorized according to the Austrian tonsil study. RESULTS This prospective study was carried out on 60 patients (adults and children), between December 2021 and November 2022. All patients underwent tonsillectomy under general anaesthesia. It was seen that most of the patients did not have any significant bleeding i.e., Grade A1 (Dry, no clot), and A2 (Clot, but no active bleeding after clot removal) whereas 4 patients (6.7%) had Grade B1 post tonsillectomy hemorrhage (Minimal bleeding requiring minimal intervention by vasoconstriction using adrenaline swab). Post tonsillectomy hemorrhage was seen more in adults. Post tonsillectomy bleeding of Grade B1 was recored in 28.6% of underweight patients, 8% of normal weight patients and no significant bleeding occurred in any of the overweight and obese patients (p-value 0.256). CONCLUSION Overweight and obesity (higher BMI) did not increase the risk of post tonsillectomy hemorrhage in either children or adults.
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Affiliation(s)
- Sankalp Keshari
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
| | - Shivendra Pratap Singh
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
| | - Sachin Jain
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
| | - Arvind Singh Niranjan
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
| | - Pramod Kumar
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
| | - Bhavishya Kumar Patel
- Department of ENT and Head Neck Surgery, M.L.N Medical college, Prayagraj, Uttar Pradesh India
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Vaughn WL, Cordray H, Baranwal N, Rahman R, Mahendran GN, Clark A, Wright EA, Pak-Harvey E, Patel C, Evans SS. Evaluating obesity as a risk factor for complications after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2022; 163:111333. [PMID: 36257170 DOI: 10.1016/j.ijporl.2022.111333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate associations between childhood obesity and post-adenotonsillectomy complications, informing guidelines for postoperative management. METHODS The retrospective review assessed outpatient pediatric tonsillectomy/adenoidectomy cases performed at 2 ambulatory surgery centers in 2020. Complications in the recovery unit and within 2 weeks of surgical discharge were reviewed along with clinical and demographic variables. Obesity was defined as sex-specific body mass index-for-age, or weight-for-age if height data were unavailable, at/above the 95th percentile. The 99th percentile served as the threshold for severe obesity. Analyses used Chi-square/Fisher's exact tests and independent-samples t-tests with relative risk or effect sizes. RESULTS The review included 707 cases (180 patients with obesity). Overall incidence of complications in the recovery unit was 9.1%. Patients with obesity were significantly more likely to require supplemental blow-by oxygen (P = .02); relative risk was 1.65 (95% CI: 1.16-2.35) times greater in the cohort with obesity. Obesity had a small effect on postoperative oxygen saturation nadirs, which were significantly lower among patients with obesity (d = -0.34; P < .001). No differences emerged between cohorts with and without obesity in the incidence of any other complications before or after surgical discharge. Overall incidence of post-discharge returns was 7.9%. Incidence of complications did not vary by obesity severity. CONCLUSION From this cohort, childhood obesity without other significant comorbidities may not warrant routine inpatient care following adenotonsillectomy. Patients with obesity should receive additional monitoring for oxygen desaturation events during the first hours of recovery. Further prospective studies should continue to address this important topic.
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Affiliation(s)
| | - Holly Cordray
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Navya Baranwal
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rahiq Rahman
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Geethanjeli N Mahendran
- Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Atlanta, GA, USA
| | - Addison Clark
- Department of Biological and Environmental Sciences, Georgia College and State University, USA
| | | | | | - Chhaya Patel
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean S Evans
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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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.
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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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Lee AC, Haché M. Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions. Int J Gen Med 2022; 15:63-69. [PMID: 35027837 PMCID: PMC8749229 DOI: 10.2147/ijgm.s312866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
After medical stabilization, several techniques are considered for anesthesia in the surgical intervention of post-tonsillectomy bleeding in children. Hypoxia during induction of general anesthesia occurs more frequently than aspiration for this population. While classical (apneic) rapid sequence induction and intubation with cricoid pressure still has a role, controlled rapid sequence induction and intubation that incorporates mask ventilation at low pressure (<12 cm H2O) before direct laryngoscopy under a deep plane of anesthesia is a viable alternative for cases of slow venous bleeding. Supplemental oxygen delivery during laryngoscopy to permit apneic oxygenation is a future trend in management. While the routine administration of tranexamic acid during tonsillectomy has not been shown to be of benefit, it may have a role in post-tonsillectomy hemorrhage with further study.
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Affiliation(s)
- Angela C Lee
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Manon Haché
- Division of Pediatric Anesthesia, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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Kolb CM, Jain N, Schillinger K, Born K, Banker K, Aaronson NL, Nardone HC. Does perioperative ketorolac increase bleeding risk after intracapsular tonsillectomy? Int J Pediatr Otorhinolaryngol 2021; 147:110781. [PMID: 34052574 DOI: 10.1016/j.ijporl.2021.110781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
IMPORTANCE Conflicting evidence exists regarding the post-tonsillectomy bleed risk associated with perioperative ketorolac use in the pediatric population. Surgical technique for tonsillectomy can further confound this risk. OBJECTIVE The primary objective was to retrospectively quantify the post-tonsillectomy bleed rate after single-dose administration of ketorolac in pediatric patients following intracapsular tonsillectomy. The secondary objective was to determine if age, sex, body mass index, medical comorbidities, and indication for surgery increased post-tonsillectomy bleed risk. DESIGN Retrospective cohort study of 1920 children who underwent intracapsular tonsillectomies between January 2017 and December 2018. SETTING This study was completed at a tertiary-care pediatric referral center. PARTICIPANTS 1920 children who underwent intracapsular tonsillectomies between January 2017 and December 2018 at a single tertiary-care children's hospital. EXPOSURES Patients were divided into two cohorts: 1458 patients (75.9%) received ketorolac (K+), and 462 (24.1%) did not (NK). Age, sex, body mass index, comorbidities, and indication for surgery also were evaluated for association with post-tonsillectomy bleed risk. MAIN OUTCOME(S) AND MEASURE(S) Primary study outcome for both cohorts was post-tonsillectomy hemorrhage requiring operative intervention. RESULTS 1920 study participants were included with an average age of 6.5 years; 51.5% of participants were males; and, 63.9% were white. Overall, the postoperative bleeding rate was 1.5%. However, there was no significant difference when comparing bleeding rates for the ketorolac group and the non-keterolac group (1.4%-1.7%; P = .82) Age, chronic tonsillitis, higher body mass index Z-scores, attention-deficit/hyperactivity disorder, and behavioral diagnoses were statistically significant risk factors for post-tonsillectomy hemorrhage. CONCLUSIONS AND RELEVANCE Single-dose postoperative ketorolac does not appear to be associated with increased risk of post-tonsillectomy bleed in pediatric patients undergoing intracapsular tonsillectomy. Providers should not avoid using ketorolac in patients undergoing intracapsular tonsillectomy due to concerns over bleeding risk.
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Affiliation(s)
- Caroline M Kolb
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA; Department of Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA
| | - Nikhita Jain
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107, USA
| | - Kristen Schillinger
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Kristen Born
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Karen Banker
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Nicole L Aaronson
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA; Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107, USA.
| | - Heather C Nardone
- Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA; Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107, USA
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The Reliability of Transoral Robotic Surgery in Revision Tonsillectomy. J Craniofac Surg 2021; 32:e313-e314. [PMID: 27536912 DOI: 10.1097/scs.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Tonsillectomy is one of the most frequently performed elective operations throughout the world. Although conventional methods are still valid, transoral robotic surgery (TORS) is preferred in some special situations. In this report, we will discuss the usage and reliability of TORS in the revision tonsillectomy procedure.
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Should there be a body mass index eligibility cutoff for elective airway cases in an ambulatory surgery center? A retrospective analysis of adult patients undergoing outpatient tonsillectomy. J Clin Anesth 2021; 72:110306. [PMID: 33905901 DOI: 10.1016/j.jclinane.2021.110306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE It is unclear what the body mass index (BMI) should be when performing surgery involving the airway at an outpatient surgery facility. The objective of this study was to evaluate the association of Class 3 obesity versus a composite cohort of Class 1 and 2 obesity with same-day hospital admission following outpatient tonsillectomy in adults. DESIGN Retrospective cohort study. SETTING Multi-institutional. PATIENTS Patients undergoing outpatient tonsillectomy. INTERVENTION None. MEASUREMENTS We used the National Surgical Quality Improvement Program (NSQIP) to analyze association of BMI to same-day admission and 30-day readmission following outpatient tonsillectomy from 2017 to 2019. We looked at six BMI cohorts: 1) ≥30 and < 40 kg/m2 (reference cohort), 2) ≥20 and < 30 kg/m2, 3) <20 kg/m2, 4) ≥40 and < 50 kg/m2, 5) ≥50 and < 60 kg/m2, and 6) ≥60 kg/m2. We used multivariable Poisson regression with robust standard errors and controlled for various confounders to calculate risk ratios (RR) and 99% confidence intervals (CI). MAIN RESULTS There were 12,287 patients included in the final analysis, at which 697 (5.7%) and 283 (2.3%) had a same-day admission or 30-day readmission, respectively. On Poisson regression with robust standard errors, the relative risks for BMI ≥40 kg/m2 and < 50 kg/m2, ≥50 kg/m2 and < 60 kg/m2, and ≥ 60 kg/m2 (BMI ≥30 kg/m2 and < 40 kg/m2 was the reference group) were 1.31 (99% CI 1.03-1.65, p = 0.03), 1.99 (99% CI 1.43-2.78, p = 0.002), and 1.80 (99% CI 1.00-3.25, p = 0.07), respectively. Furthermore, Class 3 obesity was not associated with 30-day readmission. CONCLUSION These results contribute data that may help practices - especially freestanding ambulatory surgery centers - decide appropriate BMI cutoffs for surgery involving the airway. Whether this is considered clinically significant enough to rule out eligibility will differ from practice-to-practice and will depend on surgical volume, resources available and financial interests.
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Gross JH, Lindburg M, Kallogjeri D, Molter M, Molter D, Lieu JEC. Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study. Ann Otol Rhinol Laryngol 2020; 130:825-832. [PMID: 33291963 DOI: 10.1177/0003489420978010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time. STUDY DESIGN Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed. SETTING A single, tertiary-care institution. SUBJECTS AND METHODS Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression. RESULTS Our institutional PTH rate of 1.9% (130 of 6949) included 124 patients; 15% (19) were primary (≤24 hours), with 50% (9) occurring within 5 hours. Twenty-one percent (4 of 19) of primary PTH patients received operative intervention. Eighty-five percent (105 of 124) of all cases were secondary PTH, and 47% (49) of those patients received operative intervention. Cold steel (OR 1.9, 95% CI 1.1-3.3) and Coblation (OR 1.9, 95% CI 1.2-3.1) techniques and tonsillectomy alone (OR 3.7, 95% CI 1.9-7.2) increased odds of PTH. Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0, 95% CI 1.6-10.0). CONCLUSION We conducted a rigorous case-control study for PTH, finding that PTH was associated with use of cold steel and Coblation techniques and with tonsillectomy alone. Patients with a postoperative respiratory event may be more likely to develop a PTH and should be counseled accordingly. A PACU monitoring time of 4 hours is sufficient for outpatient tonsillectomy.
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Affiliation(s)
- Jennifer H Gross
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Miranda Lindburg
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michelle Molter
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - David Molter
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Judith E C Lieu
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
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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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Intraoperative intravenous ibuprofen use is not associated with increased post-tonsillectomy bleeding. Int J Pediatr Otorhinolaryngol 2020; 133:109965. [PMID: 32120134 DOI: 10.1016/j.ijporl.2020.109965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Intravenous (IV) ibuprofen was approved by the FDA for use in pediatric patients in November 2015. The objective of this study was to compare bleeding rates in pediatric tonsillectomy patients who received intraoperative intravenous ibuprofen versus those who did not. Secondary objectives included analyzing factors that correlated with return to the Emergency Department (ED) for pain or dehydration. METHODS Charts were reviewed for all patients 0-18 years of age who underwent a tonsillectomy with or without adenoidectomy at a tertiary care children's hospital from 1/1/2017 through 5/21/2018. Demographic information and perioperative medications including the use of intraoperative intravenous ibuprofen were recorded. ED visits and operating room (OR) returns for bleeding were tracked for up to 30 days after surgery. RESULTS 1085 charts were analyzed. Intraoperative IV ibuprofen was used in 132 cases (12.2%). Primary bleeds, defined as bleeding within 24 h of surgery, occurred in 1 (0.76%) of 132 patients who received IV ibuprofen, and 1 (0.10%) of 953 patients who did not receive IV ibuprofen. Secondary bleeds, defined as bleeds after 24 h from surgery occurred in 2 (1.52%) of 132 patients who received IV ibuprofen and 38 (3.99%) of 953 patients who did not receive IV ibuprofen. No statistical difference was found between the two groups in rates of overall (primary plus secondary) bleeding requiring return to ED (p = 0.759) or return to OR (p = 0.710). CONCLUSION The observed bleeding rate after pediatric tonsillectomy was not statistically different in patients who received intraoperative IV ibuprofen versus those who did not receive this medication. LEVEL OF EVIDENCE III.
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Tertiary hospital retrospective observational audit of tonsillectomy. Int J Pediatr Otorhinolaryngol 2019; 121:20-25. [PMID: 30852447 DOI: 10.1016/j.ijporl.2019.02.026] [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: 11/04/2018] [Revised: 01/26/2019] [Accepted: 02/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Tertiary hospitals see a wide array of complex paediatric patients requiring the procedure of tonsillectomy to alleviate airway symptoms. To investigate the implications of patient-specific factors on postoperative morbidities and hospital stay length, including the role of BMI and AH as predictors for airway complications following surgery. METHODS A retrospective chart review was performed for all patients presenting at The Children's Hospital at Westmead for routine tonsillectomy between July 2010 and July 2014. RESULTS Of 500 charts, 420 patients met inclusion criteria. 155 (37%) patients had a pre-existing comorbidity. Polysomnogram (PSG) was conducted prior to surgery (n = 129). BMI results showed a mean BMI of 20.0, n = 25 were overweight, n = 70 were obese and n = 11 underweight. 84 patients (20%) experienced a postoperative complication/unexpected morbidity. There were no returns to theatre and no mortality. 24 patients had more than one complication. Complication rate was highest in the patients <2 years of age. There was a statistically significant difference in the number of desaturation related complications between obese and non-obese groups p = 0.00480. There was statistically significant difference in length of hospital stay between the two groups. 16% of children with co-morbidities stayed for >2 nights in hospital (25/155) compared to 7.5% of children without co-morbidities p = 0.00607. 9% of children with co-morbidities stayed for 3 nights in hospital (14/155) compared to patients without co-morbidities (6/256), p = 0.00167. CONCLUSIONS This audit confirms the impact of age, obesity and certain co-morbidities on the potential costs to the hospital in managing complications and length of stay after surgery.
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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.
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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.
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Tranexamic acid and post-tonsillectomy hemorrhage: propensity score and instrumental variable analyses. Eur Arch Otorhinolaryngol 2018; 276:249-254. [DOI: 10.1007/s00405-018-5192-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
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Lejus C, Orliaguet G, Servin F, Dadure C, Michel F, Brasher C, Dahmani S. Peri-operative management of overweight and obese children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 1:311-322. [PMID: 30169186 DOI: 10.1016/s2352-4642(17)30090-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
Abstract
Obesity has become endemic, even in children. Systemic complications associated with obesity include metabolic syndrome, cardiovascular disease, and respiratory compromise. These comorbidities require adequate investigation, targeted optimisation, and, if surgery is required, specific management during the peri-operative period. Specific peri-operative strategies should be used for paediatric patients who are overweight or obese to prevent postoperative complications, and optimising the respiratory function during surgery is particularly crucial. This Review aims to provide up-to-date information on peri-operative management for physicians who are caring for children and adolescents (usually younger than 18 years) who are overweight or obese undergoing surgery, including bariatric surgery. We have particularly focussed on the physiological consequences of obesity-namely, obstructive sleep apnoea, respiratory compromise, and pharmacological considerations.
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Affiliation(s)
- Corinne Lejus
- Department of Anaesthesia and Intensive care, Hôtel Dieu Hospital, Nantes, France
| | - Gilles Orliaguet
- Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France; EA08 Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris-Descartes and Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, Paris, France
| | - Frederique Servin
- Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive care, Lapeyronie University Hospital, Montpellier, France; Institut de Neuroscience de Montpellier, Unité INSERM, Montpellier, France
| | - Fabrice Michel
- Department of Anaesthesia and Intensive Care, La Timone Hospital, Marseille, France; Espace Ethique Méditerranéen, Aix-Marseille Université, Hôpital Timone Adulte, Marseille, France
| | - Christopher Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, VIC, Australia; Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, VIC, Australia
| | - Souhayl Dahmani
- DHU PROTECT, INSERM U1141, Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, PRES Paris Sorbonne Cité, Paris, France.
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Ordemann AG, Hartzog AJ, Seals SR, Spankovich C, Stringer SP. Is weight a predictive risk factor of postoperative tonsillectomy bleed? Laryngoscope Investig Otolaryngol 2018; 3:238-243. [PMID: 30062141 PMCID: PMC6057213 DOI: 10.1002/lio2.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/16/2017] [Accepted: 03/13/2018] [Indexed: 12/27/2022] Open
Abstract
Objective To determine if a correlation exists between weight-for-age percentile and post-tonsillectomy hemorrhage in the pediatric population. Study Design Retrospective study. Methods 1418 patients under the age of 15 who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital between June 2012 and March 2015 were included in this retrospective study. Patient demographic information, operative and postoperative variables, as well as category and day of postoperative tonsillectomy bleed, if one occurred, were recorded. Fisher's exact and ordinal logistic regression analyses were performed on the full cohort. Results The overall post-tonsillectomy hemorrhage prevalence was found to be 2.2%, with primary and secondary rates of 0.78% and 1.34%, respectively. Weight-for-age percentile, sex, indication for or method of tonsillectomy, or postoperative use of NSAIDs, antibiotics or narcotics were not significantly associated with post-tonsillectomy hemorrhage. There was a significant relationship between postoperative use of dexamethasone and higher rate of Category 3 post-tonsillectomy hemorrhage (P = .028). Conclusion The post-tonsillectomy hemorrhage rate in our study is consistent with that cited in the literature. No correlation was demonstrated between weight-for-age percentile and occurrence of post-tonsillectomy hemorrhage. Postoperative administration of dexamethasone was associated with a significant increased rate of post-tonsillectomy hemorrhage requiring surgical intervention, a novel finding. Level of Evidence 4.
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Affiliation(s)
- Allison G Ordemann
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
| | - Anna Jade Hartzog
- Department of Anesthesiology Vanderbilt University Medical Center Nashville Tennessee U.S.A
| | - Samantha R Seals
- Department of Mathematics and Statistics University of West Florida Pensacola Florida U.S.A
| | - Christopher Spankovich
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
| | - Scott P Stringer
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
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Lechner M, Chandrasekharan D, Vithlani R, Sutton L, Grandidge C, Elmiyeh B. Evaluation of a newly introduced tonsillectomy operation record for the analysis of regional post-tonsillectomy bleed data: a quality improvement project at the London North West Healthcare NHS Trust. BMJ Open Qual 2017; 6:e000055. [PMID: 29450272 PMCID: PMC5699122 DOI: 10.1136/bmjoq-2017-000055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/30/2017] [Accepted: 07/16/2017] [Indexed: 01/29/2023] Open
Abstract
The primary objective of this audit and quality improvement project was to retrospectively analyse regional post-tonsillectomy haemorrhage data as per national recommendations. However, this process highlighted the need for high-quality routinely collected data; something that was not always available via retrospective audit and thus does not enable formal aetiological factor analyses. We therefore created further secondary objectives to facilitate our primary audit objective. These secondary objectives were (1) to introduce a standardised tonsillectomy operation proforma to improve completeness and quality of routinely collected data and (2) to evaluate and validate proforma use and usefulness in improving using routine data collection to help with a repeated audit of post-tonsillectomy haemorrhages with the eventual aim to help improve operative outcomes by identifying potential associated factors. The retrospective audit component, the prospective audit and the quality improvement component were all carried out at the Northwick Park Hospital and Central Middlesex Hospital (London North West Healthcare NHS Trust). First, 642 tonsillectomy records (2012–2014) were retrospectively reviewed. Free-text operative documentation and, where possible, potential factors associated with post-tonsillectomy haemorrhages were analysed. In addition, completeness of data available before and after the introduction of (A) a new paper-based and (B) electronic surgical record proforma was reviewed (2014–2015). Over a 2-year period, 62 of the 642 (9.7%) audited tonsillectomy patients had a post-tonsillectomy haemorrhage, and 19 of these (2.9%) had to return to theatre for surgical arrest of the haemorrhage. Bipolar diathermy was the most commonly used technique. During this period, data available from routine operative documentation in the surgical operation notes were variable and thus did not allow identification of potential factors associated with post-tonsillectomy haemorrhage. The completeness and quality of data significantly improved after the introduction of a standardised paper-based proforma with sections for required details based on known risk factors for post-tonsillectomy haemorrhage and required operative details. Quality and completeness of data was further improved after the introduction of an electronic version. This electronic proforma will allow prospective spiral auditing results, early identification of raised bleeding rate, and provide individual surgeon audit results.
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Affiliation(s)
- Matt Lechner
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.,Royal National Throat, Nose and Ear Hospital/University College London Hospital, London, UK.,University College London, London, UK
| | - Deepak Chandrasekharan
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.,Royal National Throat, Nose and Ear Hospital/University College London Hospital, London, UK.,University College London, London, UK
| | - Rohan Vithlani
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Liam Sutton
- Royal National Throat, Nose and Ear Hospital/University College London Hospital, London, UK
| | - Carly Grandidge
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Behrad Elmiyeh
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, Harrow, London, UK
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Effect of Body Mass Index on Posttonsillectomy Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9610267. [PMID: 28555197 PMCID: PMC5438846 DOI: 10.1155/2017/9610267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Obesity affects adverse outcomes in patients undergoing various surgeries. Tonsillectomy is one of the most common surgical procedures and posttonsillectomy hemorrhage (PTH) is the major complication in patients with tonsillectomy. However, the effect of body mass index (BMI) on posttonsillectomy bleeding episodes is not well known. This study aimed to assess the clinical association between obesity and PTH. METHODS A total of 98 tonsillectomies were retrospectively reviewed. Patient charts were analyzed regarding demographic data and the indication for surgery. Patients with PTH were compared with uneventful cases. Patients were divided into three groups based on BMI: normal weight (BMI < 25 kg/m2), overweight (BMI ≥ 25 and <30 kg/m2), and obese (≥30 kg/m2). RESULTS PTH occurred in 13% of patients with normal weight, in 23.5% of patients with overweight, and in 50% patients with obesity. The occurrence of PTH was significantly higher in patients with obesity than in those with normal weight and overweight (p = 0.008). Multivariate analysis showed that obesity was a significant factor affecting the incidence of PTH after adjusting for confounding factors. CONCLUSIONS Our findings suggest that the obese condition is independently associated with the incidence of PTH.
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Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy. Int J Pediatr Otorhinolaryngol 2016; 84:119-23. [PMID: 27063766 DOI: 10.1016/j.ijporl.2016.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate post-operative setting. METHODS The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. The records of patients aged less than 18 years undergoing tonsillectomy (T) or adenotonsillectomy (AT) were extracted using relevant ICD-9 diagnosis codes. The association between hemorrhage and obesity, OSA, AH, CT, PTA, and patients' demographics among surgeries performed in the outpatient setting was evaluated. RESULTS A total of 138,998 procedures, 22,478 Ts and 116,520 ATs, were performed during 2005-2011, of which 3.0% were performed on obese children. Hemorrhage occurred in 156 cases (0.1%), and was associated with an age from 9 to 18 years (p=0.01), and obesity (p=0.02). There was no association between hemorrhage and gender (p=0.8), OSA (p=0.6), ATH (p=0.5), CT (p=0.35), PTA (p=0.47), or T versus AT (p=0.3). Multivariate analysis revealed that hemorrhage was about 2.3 times more likely to occur in obese children (odds ratio [OR]=2.3; 95% Confidence Interval: 1.1-5.1; p=0.03). CONCLUSIONS Obesity and older age are associated with an increased risk of immediate post-operative hemorrhage following tonsillectomy with or without adenoidectomy in the outpatient setting. Gender, OSA, ATH, CT, PTA, and T versus AT did not alter the risk of post-operative hemorrhage.
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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.
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Brant JA, Bur AM, Chai R, Hatten K, Nicolli EA, Fischer JP, Cannady SB. Reoperation following Adult Tonsillectomy. Otolaryngol Head Neck Surg 2016; 154:779-84. [DOI: 10.1177/0194599816630239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
Objective Tonsillectomy remains a common procedure in adults; however, there are few population-level data evaluating risk factors for reoperation. Study Design Retrospective review of national database. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2013. Subjects and Methods The ACS-NSQIP was queried for patients undergoing tonsillectomy ± adenoidectomy as their primary procedure ( CPT 42821 or 42826). Demographic information and indications were reviewed along with complications and reoperation rates. Results In total, 12,542 cases met inclusion criteria. Patients were predominantly female (66.4%) and white (70.8%), with mean age of 30 ± 12 years (range: 16-90+). Thirty-day mortality was 0.03%, and 4.8% of patients experienced at least 1 complication, including reoperation (3.6%). Risk of complications was associated with male sex ( P < .0001; odds ratio [OR], 1.7), diabetes ( P = .0002; OR, 2.1), and presence of a bleeding disorder ( P = .002; OR, 3.2). Risk factors for reoperation were similar, in addition to older age ( P = .002; OR, 0.986). Complications other than reoperation were correlated with older age ( P = .001; OR, 1.02) and diabetes ( P = .001; OR, 2.59). Procedures were done mostly for infectious/inflammatory (70.4%) versus hypertrophic (16.4%) indications. Indication had no significant effect on the rate of reoperation. Most reoperations occurred after postoperative day 1 (86%; mean, 6.4 ± 4.2 days). Conclusion This review of a large validated surgical database provides an overview of the rates of, and risk factors for, complications and reoperations following tonsillectomy in the adult population.
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Affiliation(s)
- Jason A. Brant
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Pennsylvania, USA
| | - Andrés M. Bur
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Pennsylvania, USA
| | - Raymond Chai
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Kyle Hatten
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Pennsylvania, USA
| | - Elizabeth A. Nicolli
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, South Carolina, USA
| | - John P. Fischer
- Department of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, Pennsylvania, USA
| | - Steven B. Cannady
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Pennsylvania, USA
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