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Zloczower E, Netanely K, Shapira-Galitz Y, Pinhas S, Aharonovich N, Lahav Y, Allon R. Outcomes of abscess tonsillectomy in patients awaiting tonsillectomy: A comparison with interval tonsillectomy. Am J Otolaryngol 2024; 45:104198. [PMID: 38104468 DOI: 10.1016/j.amjoto.2023.104198] [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: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Peritonsillar abscesses (PTA) occasionally occur in patients who have a concurrent history of recurrent tonsillitis or prior PTA episodes. These patients sometimes meet the indications for elective tonsillectomy even prior to the current PTA event. Abscess ("Quinsy") tonsillectomy (QT) could serve as definitive treatment in this specific subgroup, though it is not performed often. The purpose of this study was to compare the perioperative outcomes between immediate QT and tonsillectomy performed several days (delayed QT) or weeks (Interval tonsillectomy, IT) after incision and drainage (I&D) of the PTA in this specific subgroup. MATERIALS AND METHODS A retrospective perioperative outcomes analysis of patients undergoing tonsillectomy (2002-2022) compared QT to delayed QT and IT in patients with PTA meeting AAO-HNS elective tonsillectomy criteria. RESULTS 110 patients were included: 55 underwent IT, 36 underwent delayed QT, and 19 underwent immediate QT. Postoperative hemorrhage rates were 14.5 %, 11.1 %, and 5.3 % for IT, delayed QT, and immediate QT, respectively (P = 0.08). Mean hospitalization durations were 7.98, 6.92, and 5.37 days for IT, delayed QT, and immediate QT, respectively (P < 0.01). IT had a higher readmission rate due to pain compared to QT (14.5 % vs. 1.9 %, p = 0.032). CONCLUSION Immediate QT in PTA patients eligible for elective tonsillectomy is associated with lower postoperative hemorrhage, shorter admission time, and potentially reduced postoperative pain compared to I&D and delayed or interval tonsillectomy. These findings suggest that immediate QT should be considered as a primary treatment in this subgroup of eligible patients.
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Affiliation(s)
- Elchanan Zloczower
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katya Netanely
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Pinhas
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noy Aharonovich
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raviv Allon
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Prevalence of Post-Tonsillectomy Hemorrhage in Adults and Children. JOURNAL OF CLINICAL AND BASIC RESEARCH 2020. [DOI: 10.52547/jcbr.4.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Day-case tonsillectomy in children: Experience from a Teaching Hospital in Jordan. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention. The Journal of Laryngology & Otology 2017; 132:46-52. [PMID: 29103384 DOI: 10.1017/s0022215117002171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention. METHOD Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014. RESULTS Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less (p < 0.01), tonsillectomy indicated for neoplasm (p < 0.01) and quinsy (p < 0.05). CONCLUSION The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.
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Negm H, Atef A, Lasheen H, Kamel AA, Azooz K, Elhoussainy O. Factors affecting secondary post-tonsillectomy hemorrhage: a case—control study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017. [DOI: 10.4103/1012-5574.199414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Risk factors for secondary post-tonsillectomy haemorrhage following tonsillectomy with bipolar scissors: four-year retrospective cohort study. The Journal of Laryngology & Otology 2016; 131:155-161. [DOI: 10.1017/s0022215116009518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractObjective:To analyse risk factors associated with secondary post-operative bleeding when only one technique, namely bipolar scissors, is used.Methods:The medical records of all consecutive patients aged six years or older who underwent tonsillectomy or adenotonsillectomy between 1 December 2010 and 30 November 2014 were retrospectively analysed.Results:A total of 1734 patients were included in the study. A secondary haemorrhage occurred in 208 patients (12 per cent). Patients aged 15 years or older were 4.5 times (95 per cent confidence interval = 2.6–7.9;p< 0.001) more likely to experience secondary haemorrhage. In cases of acute quinsy, patients aged 15 years or older had an 8.1-fold (95 per cent confidence interval = 1.1–59.6;p= 0.02) increased likelihood of experiencing secondary haemorrhage.Conclusion:Patients aged 15 years or older have a higher risk for bleeding regardless of the primary indication for the tonsillectomy. The risk for secondary haemorrhage does not seem to depend on the primary indication itself.
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Vallamkondu V, Ah-See K, Rocke J, Bannister M. Tranexamic acid for the prevention and treatment of tonsillectomy-related haemorrhage in adults. Hippokratia 2016. [DOI: 10.1002/14651858.cd010740.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vamsidhar Vallamkondu
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - Kim Ah-See
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - John Rocke
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
| | - Miles Bannister
- Aberdeen Royal Infirmary; Department of Otolaryngology, Head and Neck Surgery; Aberdeen UK
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Sproat R, Radford P, Hunt A. Hemostatic glues in tonsillectomy: A systematic review. Laryngoscope 2015; 126:236-42. [PMID: 25946391 DOI: 10.1002/lary.25256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to compare use of hemostatic glues to conventional techniques of intraoperative hemostasis for tonsillectomy. STUDY DESIGN A systematic review of the literature and meta-analysis. METHODS All published prospective controlled trials that compared hemostatic glues to conventional techniques of hemostasis were identified. We performed a meta-analysis of articles comparing fibrin sealant to electrocautery, and of those comparing electrocautery to electrocautery plus fibrin hemostasis. RESULTS Seven studies were identified that made qualifications for review, with a total of 748 patients. Outcome measures were postoperative hemorrhage recorded by investigators, and visual analogue scores of pain for day 1, day 3, and day 10 postoperatively. Use of fibrin sealant was not associated with a reduction in hemorrhage rates following tonsillectomy when compared to electrocautery (pooled relative risk [RR] 0.315; 95% confidence intervals [CI]: 0.047-2.093, 224 patients). No statistical difference in bleeding rate was seen between electrocautery hemostasis alone, compared to electrocautery with fibrin sealant (pooled RR 1.742; 95% CI: 0.433-7.005, 108 patients). No statistically significant difference in pain was identified. CONCLUSIONS Pain and bleeding are significant causes of morbidity post-tonsillectomy. We conclude that there is no significant evidence to support hemostatic glues over current techniques for reducing severity of these outcomes. Consequently, we do not recommended hemostatic glues for routine use in current clinical practice. Studies were generally of low quality and inadequately powered to detect a statistical difference, even when pooled. We advocate further research to facilitate future meta-analysis.
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Affiliation(s)
- Rhona Sproat
- Ear, Nose, and Throat Department, Royal National Throat Nose and Ear, London
| | - Peter Radford
- Ear, Nose, and Throat Department, Wexham Park Hospital, Slough
| | - Alison Hunt
- Ear, Nose, and Throat Department, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, United Kingdom
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Salturk Z, Kumral TL, Arslanoglu A, Aydogdu I, Yildirim G, Berkiten G, Uyar Y. Role of Laryngopharyngeal Reflux in Complications of Tonsillectomy in Pediatric Patients. Indian J Otolaryngol Head Neck Surg 2015; 69:392-396. [PMID: 28929074 DOI: 10.1007/s12070-015-0841-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/06/2015] [Indexed: 12/14/2022] Open
Abstract
Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice. Gastroesophageal reflux was identified as a risk factor for complications in tonsillectomy. This prospective study was designed to assess the role of reflux in the development of complications following tonsillectomy in pediatric patients. Children (n = 60) who underwent tonsillectomy with adenoidectomy were divided into two groups, i.e., the laryngopharyngeal reflux (LPR) group and control group. Patients with LPR were identified by reflux symptom index and reflux finding score. Pain, hemorrhage, fever, nausea, vomiting, fever, dehydration, infection, and pulmonary problems were evaluated post operatively. The mean lengths of hospital stay were 2.11 days in the reflux group and 1.05 days in the control group. The difference was statistically significant. Visual analogue scores of both groups were similar on day 1 but it was significantly higher on day 7 and 14 in LPR group. Nausea and vomiting rates were 11.1 and 9.5 % for the patients in the LPR group and the controls, respectively. The difference between the two groups was not significant. The mean fever was 37.6 °C in the reflux group and 37.3 °C in the controls, which were not significantly different. 19 % of the controls and 22 % of the LPR group patients were readmitted. This difference was not statistically significant. There were two cases of bleeding in the reflux group, while no bleeding occurred in the control group. This difference was significant statistically. LPR is a risk factor for complications following tonsillectomy.
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Affiliation(s)
- Ziya Salturk
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Tolgar Lutfi Kumral
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Ahmet Arslanoglu
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Imran Aydogdu
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Guven Yildirim
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Guler Berkiten
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
| | - Yavuz Uyar
- Okmeydanı Eğitim ve Araştırma Hastanesi KBB Kliniği Darulaceze cad. Şişli/İstanbul, Istanbul, Turkey
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Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children? Int J Pediatr Otorhinolaryngol 2015; 79:246-50. [PMID: 25575427 DOI: 10.1016/j.ijporl.2014.12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION A significant risk in tonsillectomy that causes concern to surgeon and patient is post-tonsillectomy bleed. Secondary haemorrhage is mainly post-operative bleed presenting at or 24h after surgery. Classical teaching indicates infection as the cause. There are not enough published data to evaluate the post-tonsillectomy bleed rates in patients operated for obstructive sleep apnoea versus recurrent tonsillitis. We suspected secondary bleed rates to be higher in patients with recurrent tonsillitis. METHODS A retrospective review of case-notes of patients presenting to Accident & Emergency department within 4 weeks of tonsillectomy or adeno-tonsillectomy was performed. 568 patients presented with post-operative complications over the 5-year period 2008-2013. Of these, 222 presented with post-operative secondary bleed. Electronic case records were used to identify indication of operation and matched with coding data. These coded data were also used to identify number of operations and primary indications over the 5-year period. RESULTS The proportion of OSA patients receiving tonsillectomy or adenotonsillectomy surgery increased over the 5-year period. Secondary haemorrhage rate for recurrent tonsillitis surgery was around 4.9% and for OSA surgery was around 15.6%. Comparison of recurrent tonsillitis against OSA for post-operative bleed showed a relative risk of 0.31 (CI 0.24-0.41). The incidence of bleeding mirrored primary indication for each year. CONCLUSION The bleed rate for OSA was unexpectedly higher than for recurrent tonsillitis. The primary indication for tonsillectomy affects secondary bleeding rate.
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Affiliation(s)
- P Achar
- Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.
| | - R K Sharma
- Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom
| | - S De
- Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom
| | - A J Donne
- Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom
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Fox R, Varadharajan K, Patel B, Beegun I. Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage. BMJ Case Rep 2014; 2014:bcr-2014-207111. [PMID: 25398921 DOI: 10.1136/bcr-2014-207111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy.
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Affiliation(s)
- Richard Fox
- Department of ENT, West Middlesex University Hospital, London, Middlesex, UK
| | - Kiran Varadharajan
- Department of ENT, West Middlesex University Hospital, London, Middlesex, UK
| | - Bhavesh Patel
- Department of ENT, West Middlesex University Hospital, London, Middlesex, UK
| | - Issa Beegun
- Department of ENT, West Middlesex University Hospital, London, Middlesex, UK
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Biggs T, Bird J, Frampton S, Harries P, Salib R. C-reactive protein and coagulation studies in secondary post-tonsillectomy haemorrhage - need for routine testing? Our experience in 93 patients. Clin Otolaryngol 2014; 39:238-40. [DOI: 10.1111/coa.12261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 02/06/2023]
Affiliation(s)
- T.C. Biggs
- ENT Department; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - J.H. Bird
- ENT Department; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - S.J. Frampton
- ENT Department; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - P.G. Harries
- ENT Department; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - R.J. Salib
- ENT Department; University Hospital Southampton NHS Foundation Trust; Southampton UK
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Walner DL, Karas A. Standardization of Reporting Post-Tonsillectomy Bleeding. Ann Otol Rhinol Laryngol 2013; 122:277-82. [DOI: 10.1177/000348941312200411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fu B, Padgham N. 'Raised leucocyte levels as a marker for post-tonsillectomy haemorrhage - a useful tool?' More questions than answers. Clin Otolaryngol 2010; 35:338-9; author reply 339-40. [PMID: 20738349 DOI: 10.1111/j.1749-4486.2010.02146.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joseph J, Stephens J. CORRESPONDENCE: LETTERS: Response to Fu and Padgham. Clin Otolaryngol 2010. [DOI: 10.1111/j.1749-4486.2010.02165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hemorragia postamigdalectomía: ¿tienen las pruebas de coagulación y el historial de coagulopatía un valor predictivo? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:287-92. [DOI: 10.1016/j.otorri.2010.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 01/14/2010] [Indexed: 12/29/2022]
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Joseph J, Stephens J, Scott D. Raised leucocyte levels as a marker for post-tonsillectomy haemorrhage - a useful tool? Clin Otolaryngol 2010; 35:77-8. [PMID: 20447181 DOI: 10.1111/j.1749-4486.2009.02074.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Zagólski O. Post-tonsillectomy haemorrhage—Do coagulation tests and coagulopathy history have predictive value? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pain versus bleeding risk following tonsillectomy: do patients and doctors agree? The Journal of Laryngology & Otology 2009; 123:1015-20. [DOI: 10.1017/s0022215109004514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractObjective:To investigate the differing opinions of patients and medical practitioners regarding the relative priorities of pain relief versus bleeding prevention following tonsillectomy.Methods:Questionnaires were mailed out to adult patients, paediatric patients' parents, general practitioners and ENT surgeons.Results:A total of 72/112 (64.3 per cent) questionnaires were returned. Adult patients, paediatric patients' parents, general practitioners and ENT surgeons all ranked bleeding as the most important factor when assessing risks related to tonsillectomy. Most adult patients indicated that they would accept a bleeding risk of 2 per cent; however, parents indicated that they would accept a higher bleeding risk (3 per cent) for their children in exchange for better pain control.Conclusions:Adult patients, paediatric patients' parents and doctors were slightly more inclined to ‘trade-off’ an increased post-tonsillectomy bleeding risk in exchange for better post-tonsillectomy pain control, although concerns about post-operative haemorrhage remained the main priority for all groups.
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Browning G. Choosing the relevant primary outcome for tonsillectomy. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01828.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Scale invariance is a property of scientific laws or objects that change in a prescribed fashion if measurements are scaled, and is often represented by a power-law relationship. Power laws suggest that events of a large magnitude will be rare, while small events will be much more common, and that a simple mathematical law relates "severity" with frequency. Scale invariance has been demonstrated in scientific fields including physics, social science, and economics. The authors use the complication of a posttonsillectomy hemorrhage to test whether this property is a feature of surgical complications. METHODS Non-identifiable data were obtained regarding posttonsillectomy hemorrhage and subcategorized by calendar month, and the percentage rate of posttonsillectomy hemorrhage was calculated. The data were then transformed using a logarithmic function. This transformed data were plotted and a linear regression analysis was performed. RESULTS The 13-year period studied included 6,381 tonsillectomy procedures. The logarithm of the frequency of a given rate range of posttonsillectomy hemorrhage (y) was linearly related to the logarithm of the geometric mean of the rate range (x). The best-fit straight line was y = -1.3996x + 2.0624 with R2 = 0.851, n = 10, r = 0.922, and P < .001. CONCLUSIONS The authors found that the incidence of posttonsillectomy hemorrhage is scale invariant. The practical implication is that the observation of rare incidences of large hemorrhage rates may not be due to a unique circumstance or a particular operative fault. To reduce the incidence of extreme rates of postoperative hemorrhage, a review of the entire process of tonsillectomy would be required. Scale-invariance analysis may represent a novel tool that should be considered when reviewing surgical complications.
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Gerlinger I, Török L, Nagy Á, Patzkó Á, Losonczy H, Pytel J. Frequency of coagulopathies in cases with post-tonsillectomy bleeding. Orv Hetil 2008; 149:441-6. [DOI: 10.1556/oh.2008.28249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A tonsillectomiát követő legsúlyosabb komplikáció az utóvérzés. Primer post-tonsillectomiás vérzésről akkor beszélünk, ha az a műtétet követően a nem megfelelően ellátott artériák vérzése miatt 24 órán belül fordul elő. Szekunder post-tonsillectomiás vérzés esetében a komplikáció az 1–10. posztoperatív nap egyikén, legnagyobb gyakorisággal az 5–8. napon jelentkezik. A szekunder vérzések rizikófaktorait illetően az irodalom rendkívül ellentmondásos.
Célkitűzés:
A szerzők azt a kérdést vizsgálták, hogy a rejtett coagulopathiáknak van-e oki szerepe a post-tonsillectomiás vérzésekben, valamint hogy a műtét előtti általános hematológiai szűrésnek van-e létjogosultsága.
Módszer:
Vizsgálataik során a 2002 és 2004 között a PTE Fül-orr-gégészeti és Fej-nyaksebészeti Klinikájára utóvérzés miatt felvett 115 beteg közül 107 esetben (59 nő, 48 férfi, átlagéletkor 29 év ± 10,9 év) kezdeményeztek utánvizsgálatot a thrombocytaszám, a vérzési idő, a trombinidő (TI), az aktivált parciális tromboplasztinidő (aPTI), a protrombin/INR ráta és a fibrinogénszint meghatározásával.
Eredmények:
Az utánvizsgálaton 58 beteg vett részt, közülük 28 esetben (49%) észleltünk kóros értékeket. A kóros értékeket mutatók számára javasolt izolált faktormeghatározáson 19 beteg (68%) vett részt, végül 2 betegben, az utánvizsgálaton megjelentek 3,4%-ában igazolták a korábban nem ismeretes, rejtett coagulopathiát (egy esetben izolált VII. faktorszintcsökkenést, egy esetben kombinált VII. és XII. faktorszintcsökkenést). Meglepő, hogy 3, anticoncipienst szedő nőbetegben trombózisra hajlamosító IX. faktorszint-emelkedést diagnosztizáltak.
Következtetések:
Vizsgálataikból számos gyakorlati következtetés vonható le: 1. a mindenkire kiterjedő szűrés nem tűnik költséghatékonynak; 2. elsősorban gyermekkorban és pozitív családi anamnézis esetében, valamint pozitív fizikális vizsgálat és gyanút keltő preoperatív anamnesztikus adatok (ismételt orrvérzések!) ismeretében a coagulopathia oka lehet az utóvérzésnek; 3. a legérzékenyebb haemostaseologiai paraméter beteganyagukban az aktivált parciális tromboplasztinidő (aPTI) volt (15/28 kóros érték); 4. a coagulopathia az esetek többségében öröklődő betegség, ezért egy beteg diagnosztizálása segíthet a családtagok vérzékenységének felderítésében is; 5. a szekunder utóvérzések döntő többsége bipoláris olló és bipoláris csipesz használata mellett fordult elő; 6. ugyancsak fontos tanulság, hogy a vérzési idő korrekt vizsgálatára csakis az Ivy-módszer a megbízható technika.
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Affiliation(s)
- Imre Gerlinger
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Fül-orr-gégészeti és Fej-nyaksebészeti Klinika Pécs Munkácsy Mihály utca 2. 7621
| | - László Török
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Fül-orr-gégészeti és Fej-nyaksebészeti Klinika Pécs Munkácsy Mihály utca 2. 7621
| | - Ágnes Nagy
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Hematológiai Osztály Pécs
| | - Ágnes Patzkó
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Fül-orr-gégészeti és Fej-nyaksebészeti Klinika Pécs Munkácsy Mihály utca 2. 7621
| | - Hajna Losonczy
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Hematológiai Osztály Pécs
| | - József Pytel
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Fül-orr-gégészeti és Fej-nyaksebészeti Klinika Pécs Munkácsy Mihály utca 2. 7621
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Flook E. Re: is secondary haemorrhage after tonsillectomy in adults an infective condition? Clin Otolaryngol 2007; 32:308-9; author reply 309. [PMID: 17651291 DOI: 10.1111/j.1365-2273.2007.01497.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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