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Khoury S, Zabihi-Pour D, Davidson J, Poolacherla R, Nair G, Biswas A, You P, Strychowsky JE. The Safety of the Laryngeal Mask Airway in Adenotonsillectomy: A Systematic Review and Meta-Analysis. J Otolaryngol Head Neck Surg 2024; 53:19160216241263851. [PMID: 38899617 PMCID: PMC11191617 DOI: 10.1177/19160216241263851] [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: 01/08/2024] [Accepted: 05/04/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy. METHOD Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed. RESULTS Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67). CONCLUSION For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.
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Affiliation(s)
- Sami Khoury
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Dorsa Zabihi-Pour
- Department of Otolaryngology—Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Raju Poolacherla
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Gopakumar Nair
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Abhijit Biswas
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Peng You
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Shah R, Shah HP, Rohrbaugh T, Reeder A, Kohli N, Maurrasse SE. Comparing nationally reported adverse events associated with coblation vs. PlasmaBlade for tonsillectomy. Am J Otolaryngol 2023; 44:103894. [PMID: 37178539 DOI: 10.1016/j.amjoto.2023.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE(S) Coblation, or radiofrequency ablation, and pulsed-electron avalanche knife (PEAK) plasmablade are newer approaches for tonsillectomy that reduce exposure to thermal heat. This study aims to describe and compare adverse events related to these devices for tonsillectomy. STUDY DESIGN Retrospective cross-sectional study. SETTING The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database. METHODS The MAUDE database was queried for reports involving coblation devices and the PEAK plasmablade from 2011 to 2021. Data were extracted from reports pertaining to tonsillectomy with and without adenoidectomy. RESULTS There were 331 reported adverse events for coblation and 207 for the plasmablade. For coblation, 53 (16.0 %) of these involved patients and 278 (84.0 %) were device malfunctions. Similarly for the plasmablade, 22 (10.6 %) involved patients and 185 (89.4 %) were device malfunctions. The most frequent patient-related adverse event was burn injury, which was significantly more common with the plasmablade compared to coblation (77.3 % vs. 50.9 %, respectively, p = 0.042). For both the coblator and plasmablade, the most common device malfunction was intraoperative tip or wire damage (16.9 % vs. 27.0 %, respectively, p = 0.010). The Plasmablade tip caught fire in five reports (2.7 %) with one causing burn injury. CONCLUSIONS While coblation devices and the plasmablade have demonstrated utility in tonsillectomy with or without adenoidectomy, they are associated with adverse events. Plasmablade use may require greater caution for intraoperative fires and patient burn injuries compared to coblation use. Interventions to improve physician comfort with these devices may help reduce adverse events and inform preoperative discussions with patients.
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Affiliation(s)
- Rema Shah
- Yale University School of Medicine, New Haven, CT, USA.
| | - Hemali P Shah
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Allison Reeder
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nikita Kohli
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Maurrasse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Knubb JC, Kaislavuo JM, Jegoroff HS, Piitulainen JM, Routila J. Comparison of three common tonsil surgery techniques: cold steel with hot hemostasis, monopolar and bipolar diathermy. Eur Arch Otorhinolaryngol 2023; 280:2975-2984. [PMID: 36813861 PMCID: PMC10175435 DOI: 10.1007/s00405-023-07892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared to bipolar diathermy was of particular interest. METHODS The data from tonsil surgery patients were retrospectively collected between 2012 and 2018 in the Hospital District of Southwest Finland. The surgical method, instruments, indication, sex and age and their association with a postoperative hemorrhage were analyzed. RESULTS A total of 4434 patients were included. The postoperative hemorrhage rate for tonsillectomy was 6.3% and for tonsillotomy 2.2%. The most frequently used surgical instruments were monopolar diathermy (58.4%) cold steel with hot hemostasis (25.1%) and bipolar diathermy (6.4%) with the overall postoperative hemorrhage rates 6.1%, 5.9% and 8.1%, respectively. In tonsillectomy patients, the risk for a secondary hemorrhage was higher with bipolar diathermy compared to both monopolar diathermy (p = 0.039) and the cold steel with hot hemostasis technique (p = 0.029). However, between the monopolar and the cold steel with hot hemostasis groups, the difference was statistically non-significant (p = 0.646). Patients aged > 15 years had 2.6 times higher risk for postoperative hemorrhage. The risk of a secondary hemorrhage increased with tonsillitis as the indication, primary hemorrhage, tonsillectomy or tonsillotomy without adenoidectomy, and male sex in patients aged ≤ 15 years. CONCLUSION Bipolar diathermy increased the risk for secondary bleedings compared to both monopolar diathermy and the cold steel with hot hemostasis technique in tonsillectomy patients. Monopolar diathermy did not significantly differ from the cold steel with hot hemostasis group regarding the bleeding rates.
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Affiliation(s)
- Jenny Christina Knubb
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
- Department of Otorhinolaryngology, Satakunta Hospital District, Satasairaala Central Hospital, Pori, Finland.
| | - Jasmin Maria Kaislavuo
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Henri Sebastian Jegoroff
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Jaakko Matias Piitulainen
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Johannes Routila
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital, Turku, Finland
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A retrospective observational cohort study evaluating the postoperative outcomes of intracapsular coblation tonsillectomy in children. Sci Rep 2022; 12:21134. [PMID: 36477138 PMCID: PMC9729299 DOI: 10.1038/s41598-022-25768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Coblation intracapsular tonsillectomy (ICT) is becoming popular due to its decreased postoperative complications. However, a concern exists about the need for revision surgery. We conducted a retrospective observational cohort study, with a null hypothesis that Coblation ICT is not associated with recurrence of the preoperative symptoms, obstructive tonsillar regrowth, or the need for revision tonsillar surgery. We reviewed 345 patients (median age of 4.5 years; IQR 3.2-6.3), operated by the senior author between Feb 2017 and Sep 2020, for a median follow-up of 395.0 days (IQR 221.5-654.5). Most patients had snoring (94.2%), mouth breathing (92.8%), restless sleep (62.6%), and sleep disorder breathing (52.8%); 12.5% had recurrent tonsillitis. The mean initial total symptoms score (TSS) was 5.2 (SD 1.4, range 1-8); 87.5% had three or more symptoms; 86.7% underwent ICT; TSS decreased postoperatively to a mean of 0.2, SD 0.8, range 0-7. The mean hospital stay was 0.96 day (SD 0.36, range 0-3). Secondary bleeding occurred in 0.7% of ICT patients. No patient required admission or intervention. There was no documented tonsillar regrowth resulting in upper airway obstruction. No one needed tonsillar revision surgery. Intracapsular tonsillectomy was shown to be an effective procedure with long-lasting results.
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Liu Y, Yan Z, Guo H, Xu Q, Li Z, Lin J. Rare and fatal complications of tonsillectomy: sudden pneumothorax and extensive subcutaneous emphysema. J Int Med Res 2022; 50:3000605221112369. [PMID: 35891577 PMCID: PMC9340339 DOI: 10.1177/03000605221112369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Tonsillectomy is a common, minimally invasive, and relatively safe surgical operation.
Although the surgical technology for such minor operations is mature and widely available
in most countries worldwide, postoperative adverse complications occur and may be
hazardous and fatal. Our article presents the details of a 4-year-old boy who suddenly
developed pneumothorax and systemic extensive subcutaneous emphysema after tonsillectomy.
He received professional treatment from a multi-disciplinary team (MDT) and timely rescue
in our hospital; however, he died tragically. To this end, there is an urgent need to
raise clinicians’ awareness of the potentially fatal and rare complications that can occur
after tonsillectomy.
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Affiliation(s)
- Yanquan Liu
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Zhimin Yan
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Huidong Guo
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qinglin Xu
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Zuotao Li
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
| | - Jie Lin
- Department of Intensive Medicine of The First Affiliated Hospital of Gannan Medical University, Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine, Ganzhou, Jiangxi, China
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Čampara AJ, Brkić S, Cerovac A, Kovačević M. Hemorrhage after adenotonsillectomy in children: tertiary center experiences. Wien Med Wochenschr 2022; 172:317-321. [PMID: 35759051 DOI: 10.1007/s10354-022-00945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively, is one of the most serious complications. OBJECTIVE To determine the frequency of hemorrhage in children after adenotonsillectomy and to compare postoperative hemorrhage with regard to age and sex. METHODS A cross-sectional longitudinal study was conducted at the Ear, Nose, and Throat Clinic, University Clinical Center Tuzla, and included all children of both sexes, aged 3 to 15 years, who underwent adenotonsillectomy during a 1.5-year period. RESULTS A total of 201 children aged 3-15 years underwent adenotonsillectomy, 113 males and 88 females, which corresponds to a ratio of 1.28: 1. Adenotonsillectomy was performed in 147 (73.1%) patients and adenoidectomy in 54 (27%). In the overall sample, there were 19 (9.5%) subjects with postoperative hemorrhage. Primary hemorrhage occurred in 9 subjects (47%) and secondary hemorrhage in 10 subjects (53%). Significantly more female subjects had postoperative hemorrhage. In the group of subjects with hemorrhage, the mean age (standard deviation) was 8.45 (3.3) years. Tonsillar lodges are common sites of hemorrhage. CONCLUSION The frequency and causes of hemorrhage after adenotonsillectomy in our study are partially comparable to the world data.
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Affiliation(s)
- Alma Jahić Čampara
- Clinic for Anesthesiology and Reanimatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.,Department of Pathophysiology, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Selmira Brkić
- Department of Pathophysiology, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Braće Pobrić 17, 74260, Tešanj, Bosnia and Herzegovina. .,Department of Anatomy, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Mirza Kovačević
- Department of Anaesthesiology and Intensive Care Unit, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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Shaikh N, Tumlin P, Morrow V, Bulbul MG, Coutras S. Does length of time between cases affect resident operative time for tonsillectomy and adenoidectomy? Int J Pediatr Otorhinolaryngol 2022; 154:111045. [PMID: 35038673 DOI: 10.1016/j.ijporl.2022.111045] [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: 08/04/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of prolonged time intervals between tonsillectomy and adenoidectomy (TA) on resident operative time and complications. STUDY DESIGN Retrospective cohort. SETTING Tertiary academic hospital. METHODS This retrospective study covers a five-year period from 2015 to 2020. Time intervals between isolated pediatric TA cases performed by eight otolaryngology residents were reviewed to assess effect on operative time (defined as prolonged if ≥ 30 min and non-prolonged if < 30 min). Intervals including a procedure involving either a tonsillectomy or adenoidectomy that was a non-isolated TA were excluded. RESULTS A total of 309 isolated TAs were identified with 67.3% of procedures performed under 30 min. The mean surgical time interval between procedures was 5.83 ± 10.02 days (range 0.02-69.82). Most TAs were performed on patients aged 7 years or younger. Surgical time interval between TA was not a significant factor in determining prolonged operative time on univariable logistic regression, OR 1.01 (CI: 0.98 to 1.03) (p = 0.63). Patient age at surgery, adenoid grade, tonsil size and total number of TAs performed to date were significant factors in determining prolonged operative time in both univariable and multivariable logistic regression models. Prolonged operative time did not have a significant effect on readmission, reoperation, or post-operative bleeding. CONCLUSION Extended time interval (up to 3 months) between routine TA does not affect operative time. Expansion of our methodology to more complex cases would be beneficial in designing resident training curriculum.
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Affiliation(s)
- Noah Shaikh
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA.
| | - Parker Tumlin
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Vincent Morrow
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Mustafa G Bulbul
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Steven Coutras
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
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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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James TW, Thomson BJ, Naumann DN, Stevenson DS. Platelet function testing in patients with post-operative tonsillectomy bleeding may be a useful early identifier of inherited platelet function disorders. J Laryngol Otol 2020; 134:1-5. [PMID: 33016256 DOI: 10.1017/s0022215120002030] [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: 11/07/2022]
Abstract
BACKGROUND Post-tonsillectomy bleeding is the most frequent complication of tonsillectomy. Inherited platelet function disorders have an estimated prevalence of 1 per cent. Any association between post-tonsillectomy bleeds and undiagnosed inherited platelet function disorders has not been investigated before. OBJECTIVES To assess the prevalence of inherited platelet function disorders in a cohort of post-tonsillectomy bleed patients. METHODS An observational cohort study was conducted using hospital digital records. Platelet function analyser 100 ('PFA-100') closure time was tested on post-tonsillectomy bleed patients who presented to hospital. RESULTS Between 2013 and 2017, 9 of 91 post-tonsillectomy bleed patients who underwent platelet function analyser 100 testing (9.89 per cent) had positive results. Five patients (5.49 per cent) had undiagnosed inherited platelet function disorders. Four patients had false positive results secondary to a non-steroidal anti-inflammatory drug effect (specificity of 95.3 per cent) proven by repeat testing six weeks later, off medication. The false negative rate was 0 per cent. CONCLUSION The prevalence of inherited platelet function disorders in our post-tonsillectomy bleed cohort is five-fold higher than in the general population. Platelet function analyser 100 testing when patients present with a post-tonsillectomy bleed allows management of their inherited platelet function disorder.
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Affiliation(s)
- T W James
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - B J Thomson
- Department of Otolaryngology - Head and Neck Surgery, Christchurch Hospital, New Zealand
| | - D N Naumann
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - D S Stevenson
- Department of Otolaryngology - Head and Neck Surgery, Christchurch Hospital, New Zealand
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Abstract
The number of operations for tonsillectomy have been significantly decreasing for many years in Germany. In children the number of adenotonsillectomies has decreased by two thirds within a decade. This phenomenon is mirrored by a significant increase in the number of annually performed tonsillotomies, a surgical procedure which is preferably performed for volume reduction in cases of tonsillar hypertrophy. The aim of this article is to elucidate the different interventional procedures, their typical indications and risks.
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Affiliation(s)
- Jochen P Windfuhr
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Deutschland.
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Gonçalves AI, Rato C, de Vilhena D, Duarte D, Lopes G, Trigueiros N. Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors. Eur Arch Otorhinolaryngol 2020; 277:3095-3102. [PMID: 32451667 DOI: 10.1007/s00405-020-06060-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a potentially fatal complication. We aim to assess the incidence of hemorrhage after tonsillectomy in our institution, and to evaluate and identify the possible associated risk factors. METHODS This retrospective study included 897 patients who underwent tonsillectomy between January 2015 and December 2018, 50.7% women and 49.3% men, aged between 2 and 83 years. No coagulopathies were identified. Comparison of age, gender, surgical indication, coagulation profile, concomitant adenoidectomy, surgical technique, surgeon's experience and hemostasis method between groups with and without post-operative bleeding was made. RESULTS Our incidence of post-tonsillectomy hemorrhage was 6%. Most patients (83.3%) had secondary bleeding (> 24 h after surgery). In 22.2% of the bleeding cases, it was necessary to revise the hemostasis in the operating room. Adulthood (age ≥ 18 years) (p < 0.001), INR values ≥ 1.2 (p = 0.014), aPTT values ≥ 35 s (p = 0.001), as well as concomitant adenoidectomy (p < 0.001) were the predictors of post-tonsillectomy bleeding. CONCLUSION Recognition of adult age, INR ≥ 1.2, aPTT ≥ 35 s and concomitant adenoidectomy as risk factors can be useful in identifying the patients at higher risk for bleeding complications.
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Affiliation(s)
- Ana Isabel Gonçalves
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal.
| | - Catarina Rato
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Ditza de Vilhena
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Delfim Duarte
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Gustavo Lopes
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
| | - Nuno Trigueiros
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Oporto, Portugal
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12
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Windfuhr JP, Alizoti P, Hendricks C. Regional variability of hemorrhage following tonsil surgery in 1,520,234 cases. Eur Arch Otorhinolaryngol 2020; 277:3169-3177. [PMID: 32451670 DOI: 10.1007/s00405-020-06080-x] [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] [Received: 04/19/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate, whether the regional variability of tonsil surgery in terms of the 16 Federal States of Germany was mirrored by a comparable variability of bleeding complications in male and female patients. METHODS A longitudinal population-based inpatient cohort study was performed including all patients who had undergone tonsil surgery between 2005 and 2018. The database was provided by the Federal Statistical Office of Germany and included all inpatient cases after tonsillectomy (with or without adenoidectomy), tonsillotomy, abscess-tonsillectomy and secondary tonsillectomy. The population was stratified by region (16 Federal States) and gender. Operation rates were calculated in relation to the end-year population number of each region. Bleeding percentages were calculated for each calendar year and region as the number of procedures to achieve hemostasis divided by the total number of operations. RESULTS The surgical rates varied significantly between the 16 Federal States in male, female and all patients (p = 0.001). Revision surgery to achieve hemostasis was predominantly performed in male patients (5.2-11.4% male vs. 3.7-7.6% female patients). Bleeding percentages did not differ significantly from national values in male and female patients in 5 Federal States, but were significantly higher than the national average in 3 Federal States and significantly lower in 7 Federal States for both genders (p < 0.05), while in 1 Federal State it was significantly lower only for the male patients. Pearson's correlation coefficient for surgical and bleeding rates was positive and statistically significant (p < 0.05) for all Federal States, except for two. This phenomenon was emphasized by female gender. CONCLUSIONS Gender had an impact not only on surgical rates but also on bleeding percentages and this was independent from the decrease in the total number of operations. Surprisingly, there was a clear correlation between the rates of both variables in the majority of the Federal States of Germany. It needs further studies to clarify, why a higher prevalence of surgical practice, thus surgical experience, was not followed by lower bleeding complications.
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Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany.
| | | | - Christina Hendricks
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany
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13
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Tonsillektomie und Tonsillotomie. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00856-5] [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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14
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Manimaran V, Mohanty S, Jayagandhi SK, Umamaheshwaran P, Jeyabalakrishnan S. A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital. Int Arch Otorhinolaryngol 2019; 23:e403-e407. [PMID: 31649759 PMCID: PMC6805177 DOI: 10.1055/s-0039-1696702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/03/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction
Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage.
Objective
The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage.
Methods
A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate.
Results
A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (
p
= 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (
p
< 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases.
Conclusion
The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Sanjeev Mohanty
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Satish Kumar Jayagandhi
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Preethi Umamaheshwaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Shivapriya Jeyabalakrishnan
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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15
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Screening for undiagnosed bleeding disorders in post-tonsillectomy bleed patients: Retrospective review and systematic review of the literature. Int J Pediatr Otorhinolaryngol 2019; 124:210-214. [PMID: 31229837 DOI: 10.1016/j.ijporl.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/01/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES There is currently no standard for screening children with post-tonsillectomy bleeds (PTB) for coagulopathy disorders. This study aims to identify children with occult coagulopathy diagnosed at PTB and to identify factors associated with diagnosis. A systematic review of the literature further identified trends in this topic. METHODS A retrospective chart review of patients returning to the operating room for PTB at a tertiary children's hospital was undertaken from 2012 to 2016. A systematic review using Medline OVID was subsequently performed. RESULTS Of 12,503 tonsillectomies, 311 children (52% male, mean age 8 years) required surgery for PTB (2.5% rate). Twenty-one patients (7%) had multiple episodes. Only two patients (0.6%) (both with known coagulopathy) underwent pre-tonsillectomy labs and 260 (84%) had labs at PTB. Six patients (2%) were diagnosed with a new coagulopathy, most commonly von Willebrand's Disease (vWD) in five (2%). Three patients (1%) were diagnosed at first PTB and three (1%) at second PTB. Of the three diagnosed at second PTB, two had normal partial thromboplastin time (PTT). In systematic review, 1243 manuscripts were reviewed and 8 papers discussing this topic are presented. CONCLUSION Occult coagulopathy was rarely diagnosed at PTB, but this may be limited by inconsistent screening. PT and PTT are not sensitive tests for vWD, and normal coagulation labs may lead to delayed diagnosis. The literature reveals occult coagulopathy is rare but often diagnosed after severe or recurrent hemorrhage. In order to provide efficient care and medical management, a standardized algorithm and sensitive labs for screening PTB patients are needed.
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16
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De Coninck L, Goderis J, Herregods N, Vanspeybroeck S, Vermassen F, Dhont E. Massive pneumomediastinum with subcutaneous emphysema after elective adenotonsillectomy in children: Involvement of the Boyle-Davis mouth gag. Int J Pediatr Otorhinolaryngol 2019; 122:152-154. [PMID: 31029949 DOI: 10.1016/j.ijporl.2019.04.023] [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: 12/24/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/26/2022]
Abstract
Adenotonsillectomy, a very common surgical procedure in otorhinolaryngology, is considered easy and safe surgery. However, clinicians should be aware of some less common but potentially life-threatening complications. This report discusses subcutaneous emphysema with pneumomediastinum following elective adenotonsillar surgery in children. The Boyle-Davis mouth gag seemed to play a part in the pathogenic mechanism of this rare complication in this case. Better insights in the mechanism of this severe complication of adenotonsillectomy may contribute to the prevention of this complication.
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Affiliation(s)
- L De Coninck
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - J Goderis
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - N Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - F Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Dhont
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
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17
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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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18
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Paediatric Posttonsillectomy Haemorrhage Rates in Auckland: A Retrospective Case Series. Int J Otolaryngol 2019; 2019:4101034. [PMID: 30956663 PMCID: PMC6431364 DOI: 10.1155/2019/4101034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/11/2019] [Indexed: 01/05/2023] Open
Abstract
Background Tonsillectomy is one of the most commonly performed surgical procedures in children. It is performed for sleep-disordered breathing and infective symptoms. Despite advances in instrumentation and perioperative care, posttonsillectomy haemorrhage (PTH) remains a significant complication, which should be audited regularly. Methods A retrospective case series of all tonsillectomies performed in patients <15 years old in the Auckland region during 2017 was performed. Demographic, clinical, and surgical data were extracted and analysed. Univariate analysis was performed to compare patients with and without PTH. Results A total of 2177 tonsillectomies were performed during the study period, 64% in a public hospital and 36% in a private hospital. The overall PTH rate was 3.6% (0.23% occurring within the first 24 hours (primary) and 3.4% after 24 hours (secondary)). Mean time to PTH was 6.6 ± 3 days (range: 1-16 days). 90% of PTH occurred within the first 10 days and 99% by 14 days. Return to theatre was required in 28% of these cases, representing 1% of all tonsillectomies. There were no deaths or major complications in this cohort. The only differences observed between patients with PTH and those without were that children with PTH had smaller tonsils (p=0.004) and were less likely to have associated OME (p<0.001). Conclusion It is important to report institutional tonsillectomy outcomes and associated complications. These results show that PTH rates in Auckland remain within acceptable limits according to the literature.
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19
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Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK. The Journal of Laryngology & Otology 2019; 132:1119-1127. [DOI: 10.1017/s0022215118002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractObjectiveThis study aimed to estimate the cost-effectiveness of Coblation compared with cold steel tonsillectomy in adult and paediatric patients in the UK.MethodDecision analysis was undertaken by combining published clinical outcomes with resource utilisation estimates derived from a panel of clinicians.ResultsUsing a cold steel procedure instead of Coblation is expected to generate an incremental cost of more than £2000 for each additional avoided haemorrhage, and the probability of cold steel being cost-effective was approximately 0.50. Therefore, the cost-effectiveness of the two techniques was comparable. When the published clinical outcomes were replaced with clinicians’ estimates of current practice, Coblation was found to improve outcome for less cost, and the probability of Coblation being cost-effective was at least 0.70.ConclusionA best-case scenario suggests Coblation affords the National Health Service a cost-effective intervention for tonsillectomy in adult and paediatric patients compared with cold steel procedures. A worst-case scenario suggests Coblation affords the National Health Service an equivalent cost-effective intervention for adult and paediatric patients.
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20
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McKeon M, Kirsh E, Kawai K, Roberson D, Watters K. Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children. Laryngoscope 2018; 129:2765-2770. [PMID: 30536682 DOI: 10.1002/lary.27719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. STUDY DESIGN Retrospective chart review. METHODS A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary-care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. RESULTS Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47-6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06-4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. CONCLUSIONS Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2765-2770, 2019.
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Affiliation(s)
- Mallory McKeon
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Elliana Kirsh
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Roberson
- Global Tracheostomy Collaborative, Raleigh, North, Carolina, U.S.A
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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21
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Viard T, Lavigne M, Dadone B. Hémorragie postamygdalectomie compliquée d’arrêt cardiorespiratoire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Powell J, Powell S. Obstructive Sleep Apnea in the Very Young. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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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.
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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
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Eriksson M, Nilsson U, Bramhagen AC, Idvall E, Ericsson E. Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy. Int J Pediatr Otorhinolaryngol 2017; 96:47-54. [PMID: 28390613 DOI: 10.1016/j.ijporl.2017.02.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/20/2017] [Accepted: 02/25/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect. METHODS In total, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items. RESULTS Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period. The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness. Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states. Postoperative recovery improved from day 1-10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01-0.001) in most items. CONCLUSION The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.
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Affiliation(s)
- Mats Eriksson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden
| | - Ulrica Nilsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden
| | - Ann-Cathrine Bramhagen
- Faculty of Health and Society, Department of Care Sciences, Malmö University, S-205 06 Malmö, Sweden
| | - Ewa Idvall
- Faculty of Health and Society, Department of Care Sciences, Malmö University, S-205 06 Malmö, Sweden
| | - Elisabeth Ericsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden.
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25
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Hoey A, Foden N, Hadjisymeou Andreou S, Noonan F, Chowdhury A, Greig S, Sproson E, Allin D, Amin N, Wouters K, Jonas N, Tweedie D. Coblation®
intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up. Clin Otolaryngol 2017; 42:1211-1217. [DOI: 10.1111/coa.12849] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- A.W. Hoey
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - N.M. Foden
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - S. Hadjisymeou Andreou
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - F. Noonan
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - A.K. Chowdhury
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - S.R. Greig
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - E.L. Sproson
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - D. Allin
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - N. Amin
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - K.M. Wouters
- Department of Paediatric Anaesthesia; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - N.E. Jonas
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - D.J. Tweedie
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
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26
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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.
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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.
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Choi HG, Park B, Sim S, Ahn SH. Tonsillectomy Does Not Reduce Upper Respiratory Infections: A National Cohort Study. PLoS One 2016; 11:e0169264. [PMID: 28036375 PMCID: PMC5201261 DOI: 10.1371/journal.pone.0169264] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/14/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives The objective of this study was to compare post-operative visits for upper respiratory infections (URIs) between tonsillectomy and non-tonsillectomy participants (controls). Methods Using the national cohort study from the Korean Health Insurance Review and Assessment Service, 1:4 matched (age, sex, income, region, and pre-operative URI visit) tonsillectomy participants (5,831) and control participants (23,324) were selected. Post-operative visits for URI were measured from 1 to 9 years post-op. The equivalence test was used. The margin of equivalence of the difference (Tonsillectomy—Control group group) was set to -0.5 to 0.5. Results There was no difference between the tonsillectomy and control group in 1- to 9-year post-op visits (-0.5 < 95% CI of difference < 0.5). URI visits gradually decreased from 5.5/2 years (pre-op) to 2.1/year (at 1 year post-op) and 1.4/year (at 9 years post-op) in both tonsillectomy and control groups. In the subgroup analysis (children Vs adolescent and adults; rare Vs frequent pre-operative URI), there was no difference in the number of post-op visits for URI between the tonsillectomy and control groups (-0.5 < 95% CI of difference < 0.5). Conclusion Tonsillectomy does not provide a decrease in the number of post-operative visits for URI, and URI decreased over time whether or not a tonsillectomy was performed.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Songyong Sim
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University College of Medicine, Bundang, Korea
- * E-mail:
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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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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]
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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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Betancourt AR, López C, Zerpa V, Carrasco M, Dalmau J. ¿Influye la técnica quirúrgica en las hemorragias postamigdalectomía? Nuestra experiencia. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:218-23. [DOI: 10.1016/j.otorri.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/10/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
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Betancourt AR, López C, Zerpa V, Carrasco M, Dalmau J. Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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[Ischemic stroke in childhood. A complication of tonsillectomy]. ACTA ACUST UNITED AC 2015; 63:108-11. [PMID: 26025286 DOI: 10.1016/j.redar.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/18/2015] [Accepted: 03/26/2015] [Indexed: 11/21/2022]
Abstract
Tonsillectomy is one of the most frequently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis.
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Söderman ACH, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol 2015; 40:248-54. [DOI: 10.1111/coa.12361] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A.-C. Hessén Söderman
- Department of Otorhinolaryngology; Aleris Sabbatsberg; Stockholm Sweden
- Division of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - E. Odhagen
- Department of Otorhinolaryngology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - E. Ericsson
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - C. Hemlin
- Sollentuna Specialist Clinic; Stockholm Sweden
| | - E. Hultcrantz
- Department of Otorhinolaryngology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - O. Sunnergren
- Department of Otorhinolaryngology; Ryhov County Hospital and Futurum; the Academy for Health and Care; County Council; Jönköping Sweden
| | - J. Stalfors
- Department of Otorhinolaryngology; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
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Becke K. Anesthesia for ORL surgery in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 13:Doc04. [PMID: 25587364 PMCID: PMC4273165 DOI: 10.3205/cto000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
ORL procedures are the most common operations in children – an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Children at risk must already be identified preoperatively: the combination of ORL surgery, airway susceptibility and age below 3 years can increase the risk of perioperative respiratory adverse events. Postoperatively, it is important to prevent complications such as pain and PONV by dedicated prevention and treatment strategies, as well as to recognize and treat respiratory or circulatory complications competently. Interdisciplinary guidelines and agreements as well as the overall competence of the team have the potential to improve patient safety and outcome in children.
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Affiliation(s)
- Karin Becke
- Abteilung für Anästhesie und Intensivmedizin, Klinik Hallerwiese/Cnopf'sche Kinderklinik, Diakonie Neuendettelsau, Nürnberg, Germany
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Hadjisymeou S, Modayil P, Dean H, Jonas N, Tweedie D. Our experience. Coblation®intracapsular tonsillectomy (tonsillotomy) in children: a prospective study of 100 consecutive cases. Clin Otolaryngol 2014; 39:301-7. [DOI: 10.1111/coa.12278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S. Hadjisymeou
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - P.C. Modayil
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - H. Dean
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - N.E. Jonas
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - D.J. Tweedie
- Department of Paediatric Otolaryngology; Evelina London Children's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
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Soleymanifard F, Khademolhoseyni SM, Nouri JM. Nursing process in post tonsillectomy pain diagnosis: a systematic review. Glob J Health Sci 2014; 7:180-7. [PMID: 25560345 PMCID: PMC4796453 DOI: 10.5539/gjhs.v7n1p180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
Objective: Tonsillectomy is the most common surgery in the field of ENT. Pain is the most common post tonsillectomy complaint. Considering the importance of nursing cares in relieving post-surgery pain in general and post-tonsillectomy pain in particular, this study is conducted with the aim of presenting nursing process in post tonsillectomy pain diagnosis for decreasing loss of appropriate opportunities in nursing cares and achieving appropriate results in taking care of the patients. Methods: This study is a targeted systematic review focusing on “effective nursing measures in relieving children’s post tonsillectomy pain”. The main stages of searching strategy included searching in electronic sources of Latin databases; Pub Med, Science Direct, and EMBASE and Persian databases; SID, Iran medex, ISC to find published articles from 2009 to 2014. In the end, final synthesis was done on eight articles in English. Findings: Effective nursing measurements for relieving post tonsillectomy pain include: decreasing children’s anxiety through children and their families’ psychological preparation by nurses and other caregivers, using cold compress to reduce neck and jaw pain, presenting distraction techniques, offering fluids and cold foods immediately in the period after surgery, creating a comfortable environment for the children, avoiding too much of talking and adequate sleep. Conclusion: It is recommended to the nursing managers and nurses to perform cares achieved from this systematic review to achieve appropriate results in relieving post tonsillectomy pain.
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Post-tonsillectomy hemorrhage—some facts will never change. Eur Arch Otorhinolaryngol 2014; 272:1211-8. [DOI: 10.1007/s00405-014-3025-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/24/2014] [Indexed: 12/31/2022]
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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