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Risk Factors For Post-Tonsillectomy Hemorrhage

Year 2018, Volume: 8 Issue: 2, 114 - 119, 31.08.2018
https://doi.org/10.32448/entupdates.459027

Abstract


Objectives:

This research was undertaken to determine the frequency of post-tonsillectomy hemorrhage (PTH) in one particular clinical setting and to assess which risk factors exist for PTH.



Methods:

Following a retrospective case review of 892 patients who had gone through either tonsillectomy or adenotonsillectomy, a subgroup of 50 records were selected for detailed study. These 50 patients were then classified as either pediatric cases (aged under 16) or adult cases (aged over 16). Their risk factors were then assessed. Risk factors included: age, sex, surgical indication; type of surgery; time hospitalized post-operatively; timing of PTH (primary and secondary); management used to staunch bleeding and time in hospital following PTH.



Results:

The overall rate of PTH was 5.6% (3.0% pediatric, 2.6% adult). All PTH instances were secondary and no primary type occurred. In comparing the adult and pediatric cases of PTH, there was no statistically significant difference (p>0.05) in terms of age, sex, time hospitalized post-operatively, management used to staunch bleeding or time in hospital following PTH. There was, however, a statistically significant difference (p<0.05) between groups in terms of surgical indication and timing of PTH (primary or secondary).



Conclusion:

There was an increased frequency of secondary PTH in both groups. PTH typically happened between day 5 and 10 post-operatively. Patients need to be advised about this risk and show caution regarding factors that increase the risk of PTH after surgery.







References

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  • 2. Nguyen TBV, Chin RY, Paramaesvaran S, Eslick GD. Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar hemorrhage? Eur Arch Otorhinolaryngol 2014;271:3005-10.
  • 3. Walner DL, Karas A. Standardization of reporting post-tonsillectomy bleeding. Ann Otol Rhinol Laryngol 2013;122:277-82.
  • 4. Sarny S, Habermann W, Ossimitz G, Schmid C, Stammberger H. Tonsillar hemorrhage and re- admission: a questionnaire based study. Eur Arch Otorhinolaryngol 2011;268:1803-7.
  • 5. Sun GH, Harmych BM, Dickson JM, Gonzalez del Rey JA, Myer CM, Greinwald JH. Characteristics of children diagnosed as having coagulopathies following posttonsillectomy bleeding. Arch Otolaryngol Head Neck Surg 2011;137:65-8.
  • 6. Ulualp SO. Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels. Eur Arch Otorhinolaryngol 2012;269:1269-75.
  • 7. Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 2010;37:456-60.
  • 8. Kaygusuz I, Susaman N. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2003;67:737-42.
  • 9. Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2006;70:73-9.
  • 10. Belyea J, Chang Y, Rigby MH, Corsten G, Hong P. Post-tonsillectomy complications in children less than three years of age: A case-control study. Int J Pediatr Otorhinolaryngol 2014;78:871-4.
  • 11. Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: What is it and what should be recorded. Arch Otolaryngol Head Neck Surg 2001;127:1271-5.
  • 12. Evans AS, Khan AM, Young D, Adamson R. Assessment of secondary hemorrhage rates following adult tonsillectomy-a telephone survey and literature review. Clin Otolaryngol Allied Sci 2003;28:489-91.
  • 13. Windfuhr JP, Verspohl BC, Chen YS, Dahm JD, Werner JA. Post-tonsillectomy hemorrhage-some facts will never change. Eur Arch Otorhinolaryngol 2015;272:1211-18.
  • 14. Siodlak MZ, Gleeson MJ, Wengraf CL. Post-tonsillectomy secondary hemorrhage. Ann R Coll Surg Engl 1985;67:167-8.
  • 15. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005;132:281-6.
  • 16. Tolska HK, Takala A, Pitkaniemi J, Jero J. Post-tonsillectomy hemorrhage more common than previously described-an institutional chart review. Acta Otolaryngol 2013;133:181-6.
  • 17. Perkins JN, Liang C, Gao D, Shults L, Friedman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 2012;122:2311- 5.
  • 18. Kaygusuz I, Gok U, Yalcin S, Keles E, Kizirgil A, Demirbag E. Bacteremia during tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;58:69- 73.
  • 19. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflmmatory drug use after tonsillectomy. Arch Otolaryngol Head Neck Surg 2003;129:1086-9.
  • 20. Blakley BW. Post-tonsillectomy bleeding:how much is too much. Otolaryngol Head Neck Surg 2009;140:288-90.
  • 21. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2010;144:1-30.
  • 22. Lee MSW, Montague ML, Hussain SSM. Post-tonsillectomy hemorrhage: Cold versus hot dissection. Otolaryngol Head Neck Surg 2004;131:833-6.
  • 23. Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: Who needs intervention. Int J Pediatr Otorhinolaryngol 2015;79:165-9.
  • 24. Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:61-8.
  • 25. Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post-tonsillectomy hemorrhage rates in children? Int J Pediatr Otorhinolaryngol 2015;79:246-50.
  • 26. Attner P, Haraldsson PO, Hemlin C, Hessén Soderman AC. A 4-year consecutive study of post-tonsillectomy hemorrhage. ORL J Otorhinolaryngol Relat Spec 2009;71:273-8.
  • 27. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 2011;121:279-88.
  • 28. Kvaerner KJ. Benchmarking surgery: secondary post-tonsillectomy hemorrhage 1999-2005. Acta Otolaryngol 2009;129:195-8.
  • 29. Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of hemorrhage in 8388 patients after cold-steel adenoidectomies. Wien Klin Wochenschr 2008;120:336-42.
  • 30. Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001;80:544-9.
  • 31. Ozkiris M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:1497-501.
  • 32. Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy: a safe outpatient procedure. Arch Otolaryngol Head Neck Surg 1989;115:92-4.
  • 33. Weirmert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 1990;116:186-8.
  • 34. Gabalski EC, Mattucci FK, Setzen M, Moleski P. Ambulatory tonsillectomy and adenoidectomy. Laryngoscope 1996;106:77-80.
  • 35. Amir I, Belloso A, Broomfield S, Morar P. Return to theatre in secondary post-tonsillectomy hemorrhage: a comparison of coblation and dissection techniques. Eur Arch Otorhinolaryngol 2012;269:667-71.
  • 36. Mitchell RB, Pereria KD, Friedman N, Lazar RH. Outpatient adenotonsillectomy. Is ıt safe in children younger than 3 years? Arch Otolaryngol Head Neck Surg 1997;123:681-3.
Year 2018, Volume: 8 Issue: 2, 114 - 119, 31.08.2018
https://doi.org/10.32448/entupdates.459027

Abstract

References

  • 1. Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N. Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx 2014;41:376-9.
  • 2. Nguyen TBV, Chin RY, Paramaesvaran S, Eslick GD. Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar hemorrhage? Eur Arch Otorhinolaryngol 2014;271:3005-10.
  • 3. Walner DL, Karas A. Standardization of reporting post-tonsillectomy bleeding. Ann Otol Rhinol Laryngol 2013;122:277-82.
  • 4. Sarny S, Habermann W, Ossimitz G, Schmid C, Stammberger H. Tonsillar hemorrhage and re- admission: a questionnaire based study. Eur Arch Otorhinolaryngol 2011;268:1803-7.
  • 5. Sun GH, Harmych BM, Dickson JM, Gonzalez del Rey JA, Myer CM, Greinwald JH. Characteristics of children diagnosed as having coagulopathies following posttonsillectomy bleeding. Arch Otolaryngol Head Neck Surg 2011;137:65-8.
  • 6. Ulualp SO. Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels. Eur Arch Otorhinolaryngol 2012;269:1269-75.
  • 7. Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 2010;37:456-60.
  • 8. Kaygusuz I, Susaman N. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2003;67:737-42.
  • 9. Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 2006;70:73-9.
  • 10. Belyea J, Chang Y, Rigby MH, Corsten G, Hong P. Post-tonsillectomy complications in children less than three years of age: A case-control study. Int J Pediatr Otorhinolaryngol 2014;78:871-4.
  • 11. Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: What is it and what should be recorded. Arch Otolaryngol Head Neck Surg 2001;127:1271-5.
  • 12. Evans AS, Khan AM, Young D, Adamson R. Assessment of secondary hemorrhage rates following adult tonsillectomy-a telephone survey and literature review. Clin Otolaryngol Allied Sci 2003;28:489-91.
  • 13. Windfuhr JP, Verspohl BC, Chen YS, Dahm JD, Werner JA. Post-tonsillectomy hemorrhage-some facts will never change. Eur Arch Otorhinolaryngol 2015;272:1211-18.
  • 14. Siodlak MZ, Gleeson MJ, Wengraf CL. Post-tonsillectomy secondary hemorrhage. Ann R Coll Surg Engl 1985;67:167-8.
  • 15. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005;132:281-6.
  • 16. Tolska HK, Takala A, Pitkaniemi J, Jero J. Post-tonsillectomy hemorrhage more common than previously described-an institutional chart review. Acta Otolaryngol 2013;133:181-6.
  • 17. Perkins JN, Liang C, Gao D, Shults L, Friedman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 2012;122:2311- 5.
  • 18. Kaygusuz I, Gok U, Yalcin S, Keles E, Kizirgil A, Demirbag E. Bacteremia during tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;58:69- 73.
  • 19. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflmmatory drug use after tonsillectomy. Arch Otolaryngol Head Neck Surg 2003;129:1086-9.
  • 20. Blakley BW. Post-tonsillectomy bleeding:how much is too much. Otolaryngol Head Neck Surg 2009;140:288-90.
  • 21. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2010;144:1-30.
  • 22. Lee MSW, Montague ML, Hussain SSM. Post-tonsillectomy hemorrhage: Cold versus hot dissection. Otolaryngol Head Neck Surg 2004;131:833-6.
  • 23. Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: Who needs intervention. Int J Pediatr Otorhinolaryngol 2015;79:165-9.
  • 24. Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:61-8.
  • 25. Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post-tonsillectomy hemorrhage rates in children? Int J Pediatr Otorhinolaryngol 2015;79:246-50.
  • 26. Attner P, Haraldsson PO, Hemlin C, Hessén Soderman AC. A 4-year consecutive study of post-tonsillectomy hemorrhage. ORL J Otorhinolaryngol Relat Spec 2009;71:273-8.
  • 27. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 2011;121:279-88.
  • 28. Kvaerner KJ. Benchmarking surgery: secondary post-tonsillectomy hemorrhage 1999-2005. Acta Otolaryngol 2009;129:195-8.
  • 29. Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of hemorrhage in 8388 patients after cold-steel adenoidectomies. Wien Klin Wochenschr 2008;120:336-42.
  • 30. Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001;80:544-9.
  • 31. Ozkiris M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:1497-501.
  • 32. Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy: a safe outpatient procedure. Arch Otolaryngol Head Neck Surg 1989;115:92-4.
  • 33. Weirmert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 1990;116:186-8.
  • 34. Gabalski EC, Mattucci FK, Setzen M, Moleski P. Ambulatory tonsillectomy and adenoidectomy. Laryngoscope 1996;106:77-80.
  • 35. Amir I, Belloso A, Broomfield S, Morar P. Return to theatre in secondary post-tonsillectomy hemorrhage: a comparison of coblation and dissection techniques. Eur Arch Otorhinolaryngol 2012;269:667-71.
  • 36. Mitchell RB, Pereria KD, Friedman N, Lazar RH. Outpatient adenotonsillectomy. Is ıt safe in children younger than 3 years? Arch Otolaryngol Head Neck Surg 1997;123:681-3.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Nihat Susaman

İrfan Kaygusuz This is me

Turgut Karlıdag This is me

Erol Keles This is me

Sinasi Yalcın This is me

Rabia Efe Cilibas This is me

Publication Date August 31, 2018
Submission Date May 29, 2018
Acceptance Date June 20, 2018
Published in Issue Year 2018 Volume: 8 Issue: 2

Cite

APA Susaman, N., Kaygusuz, İ., Karlıdag, T., Keles, E., et al. (2018). Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates, 8(2), 114-119. https://doi.org/10.32448/entupdates.459027
AMA Susaman N, Kaygusuz İ, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates. August 2018;8(2):114-119. doi:10.32448/entupdates.459027
Chicago Susaman, Nihat, İrfan Kaygusuz, Turgut Karlıdag, Erol Keles, Sinasi Yalcın, and Rabia Efe Cilibas. “Risk Factors For Post-Tonsillectomy Hemorrhage”. ENT Updates 8, no. 2 (August 2018): 114-19. https://doi.org/10.32448/entupdates.459027.
EndNote Susaman N, Kaygusuz İ, Karlıdag T, Keles E, Yalcın S, Cilibas RE (August 1, 2018) Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates 8 2 114–119.
IEEE N. Susaman, İ. Kaygusuz, T. Karlıdag, E. Keles, S. Yalcın, and R. E. Cilibas, “Risk Factors For Post-Tonsillectomy Hemorrhage”, ENT Updates, vol. 8, no. 2, pp. 114–119, 2018, doi: 10.32448/entupdates.459027.
ISNAD Susaman, Nihat et al. “Risk Factors For Post-Tonsillectomy Hemorrhage”. ENT Updates 8/2 (August 2018), 114-119. https://doi.org/10.32448/entupdates.459027.
JAMA Susaman N, Kaygusuz İ, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates. 2018;8:114–119.
MLA Susaman, Nihat et al. “Risk Factors For Post-Tonsillectomy Hemorrhage”. ENT Updates, vol. 8, no. 2, 2018, pp. 114-9, doi:10.32448/entupdates.459027.
Vancouver Susaman N, Kaygusuz İ, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates. 2018;8(2):114-9.