Post-tonsillectomy bleeding: The effect of surgical experience

Year 2023, Volume: 6 Issue: 2, 199 - 203, 31.08.2023

Talih Özdaş , Nuray Bayar Muluk , Vedat Delibaş , Mustafa Çağrı Derici , Sanem Okşan Erkan , Birgül Tuhanioğlu , Orhan Görgülü , Osman Kürşat Arıkan

https://doi.org/10.36516/jocass.1240290

Abstract

Aim: We aimed to discuss and investigate the relationship between the surgeon's experience and post-tonsillectomy bleeding (PTB) in the light of the literature.

Methods: The retrospective data was obtained from 280 patients who underwent tonsillectomy (32 PTB and 248 no-PTB) operated by residents or consultant surgeons.

Results: The overall bleeding rate after tonsillectomy was 11.43% (32/280). The bleeding rate was 14.3% in the <16 age group and 9.7% in the ≥16 age group (p=0.246). While the rate of bleeding after tonsillectomy operation was 6.16% in the resident group; it was 27.53% in the consultant group (p<0.001). In patients who bled after tonsillectomy operation, the operation time was significantly shorter in the consultant group (p=0.032). Binary Logistic Regression analysis revealed that being a consultant surgeon is a risk factor for bleeding after tonsillectomy operation (p<0.001). Short operation time was a weak risk factor (p=0.048).

Conclusions: More experience in surgery does not decrease the risk for PTB, quite the reverse, it increases the PTB risk. The effort to finish surgery in a short time, and possibility of performing a less careful and more traumatic surgery might have caused this result.

Keywords

Tonsillectomy, post-tonsillectomy bleeding, resident, consultant, surgeon’s experience

Supporting Institution

yok

Project Number

yok

Thanks

.

Tonsillektomi sonrası kanama: Cerrahi deneyimin etkisi

Abstract

Amaç: Çalışmamızda cerrahın deneyimi ile tonsillektomi operasyonu sonrası kanama (TOSK) arasındaki ilişkiyi literatür eşliğinde tartışmayı ve araştırmayı amaçladık.

Materyal ve Metot: Retrospektif veriler, asistan veya uzman cerrahlar tarafından tonsillektomi operasyonu uygulanan (32 TOSK olan ve 248 TOSK olmayan) 280 hastadan elde edildi.

Bulgular: Tonsillektomi operasyonu sonrası genel kanama oranı %11.43 (32/280) idi. Kanama oranı <16 yaş grubunda %14.3 , ≥16 yaş grubunda %9.7 idi (p=0.246). Asistan doktor grubunda tonsillektomi operasyonu sonrası kanama oranı %6.16 iken; uzman doktor grubunda %27.53 idi (p<0.001). Tonsillektomi operasyonu sonrası kanayan hastalarda ameliyat süresi uzman doktor grubunda anlamlı olarak daha kısaydı (p=0.032). Binary Lojistik Regresyon analizi, uzman cerrah olmanın tonsillektomi operasyonu sonrası kanama için bir risk faktörü olduğunu ortaya koydu (p<0.001). Kısa operasyon süresi ise zayıf bir risk faktörüydü (p=0.048).

Sonuç: Ameliyatta daha fazla deneyim, tonsillektomi operasyonu sonrası kanama riskini azaltmaz, tam tersine; bu riski artırır. Uzman cerrahlardaki ameliyatı kısa sürede bitirme çabası, daha az dikkatli ve daha travmatik bir ameliyat yapma olasılığı bu sonuca neden olmuş olabilir.

Keywords

Tonsillektomi, tonsillektomi sonrası kanama, asistan, uzman, cerrahın deneyimi

Project Number

yok

References

• 1.Ahsan F, Rashid H, Eng C, et al. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort. Clin Otolaryngol. 2007; 32: 24-7. https://doi.org/10.1111/j.1365-2273.2007.01381.x
• 2.Evans AS, Khan AM, Young D, et al. Assessment of secondary haemorrhage rates following adult tonsillectomy a telephone surveyand literature review. Clin Otolaryngol Allied Sci. 2003; 28: 489-91. https://doi.org/10.1046/j.1365-2273.2003.00763.x
• 3.Mora R, Jankowska B, Mora F, et al. Effects of tonsillectomy on speech and voice. J Voice. 2009; 23: 614-8. https://doi.org/10.1016/j.jvoice.2008.01.008
• 4.Lee WT, Witsell DL, Parham K, et al. Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg. 2016; 155: 28-32. https://doi.org/10.1177/0194599816630523
• 5.Witsell DL, Orvidas LJ, Stewart MG, et al. Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis. Otolaryngol. Head Neck Surg 2008; 138: 1-8. https://doi.org/10.1016/j.otohns.2007.08.015
• 6.Wieland A, Belden L, Cunningham M. Preoperative coagulation screening for adenotonsillectomy: A review and comparison of current physician practices. Otolaryngology-Head and Neck Surgery. 2009; 140: 542-7. https://doi.org/10.1016/j.otohns.2008.12.016
• 7.Windfuhr JP, Schloendorff G, Baburi D, et al. Life-threatening posttonsillectomy hemorrhage. Laryngoscope. 2008; 118: 1389-94. https://doi.org/10.1097/MLG.0b013e3181734f7e
• 8.Spektor Z, Saint-Victor S, Kay DJ, et al. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016; 84: 151-5. https://doi.org/10.1016/j.ijporl.2016.03.005
• 9.Schrock A, Send T, Heukamp L, et al. The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol. 2009; 266: 1983-7. https://doi.org/10.1007/s00405-009-0958-z
• 10.Mueller J, Boeger D, Buentzel J, et al. Population based analysis of tonsil surgery and postoperative hemorrhage, Eur. Arch Otorhinolaryngol. 2015; 272: 3769-77. https://doi.org/10.1007/s00405-014-3431-6
• 11.Bhattacharyya N, Shapiro NL. Associations between socioeconomic status and race with complications after tonsillectomy in children, Otolaryngol Head Neck Surg. 2014; 151: 1055-60. https://doi.org/10.1177/0194599814552647
• 12.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. https://doi.org/10.1001/archotol.127.10.1271
• 13.Kristensen S, Tveterås K. Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol. Allied Sci. 1984; 9: 347-50. https://doi.org/10.1111/j.1365-2273.1984.tb01519.x
• 14.Rasmussen N. Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am. 1987; 20: 383-90. https://doi.org/10.1016/S0030-6665(20)31657-1
• 15.Conley SF, Ellison MD. Avoidance of primary post-tonsillectomy hemorrhage in a teaching program. Arch Otolaryngol Head Neck Surg. 1999; 125: 330-3. https://doi.org/10.1001/archotol.125.3.330
• 16.Peterson J, Losek JD. Post-tonsillectomy hemorrhage and pediatric emergency care. Clin Pediatr (Phila). 2004; 43: 445-8. https://doi.org/10.1177/000992280404300505
• 17.Ali RB, Smyth D, Kane R, et al. PTB: a regional hospital experience. Ir J Med Sci. 2008; 177: 297-301. https://doi.org/10.1007/s11845-008-0237-9
• 18.Kim DW, Koo JW, Ahn SH, et al. Difference of delayed PTB between children and adults. Auris Nasus Larynx. 2010; 37: 456-60. https://doi.org/10.1016/j.anl.2009.11.011
• 19.Szeremeta W, Novelly NJ, Benninger M. Postoperative bleeding in tonsillectomy patients. Ear Nose Throat J. 1996; 75: 373-6. https://doi.org/10.1177/014556139607500611
• 20.Irani DB, Berkowitz RG. Management of secondary hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 1997; 40: 115-24. https://doi.org/10.1016/S0165-5876(97)00025-6
• 21.Leader BA, Wiebracht ND, Meinzen-Derr J, et al. The impact of resident involvement on tonsillectomy outcomes and surgical time. Laryngoscope 2020; 130(10): 2481-6. https://doi.org/10.1002/lary.28427
• 22.Hinton-Bayre AD, Noonan K, Ling S, et al. Experience is more important than technology in paediatric post-tonsillectomy bleeding. J Laryngol Otol. 2017; 131: 35-40. https://doi.org/10.1017/S0022215117000755
• 23.Manimaran V, Mohanty S, Jayagandhi SK, et al. A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital. Int Arch Otorhinolaryngol. 2019; 23(4): e403-e407. https://doi.org/10.1055/s-0039-1696702