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Post-tonsillectomy bleeding: Our 10-year experience

Year 2017, Volume: 27 Issue: 1, 1 - 9, 05.03.2017

Abstract

Objectives: This study aims to evaluate the characteristics of the patients who were admitted due to the post-tonsillectomy bleeding and treated and to investigate related risk factors. Patients and Methods: A total of 40 patients 19 males, 21 females; mean age: 18.2 years; range, 2 to 48 years who were admitted to our clinic with the complaint of bleeding in the tonsil region following tonsillectomy/adenotonsillectomy and treated between January 2005 and December 2015 were included. Post-tonsillectomy bleeding was evaluated in terms of age, gender, indication and method of tonsillectomy, amount and time of bleeding, hemoglobin level, bleeding etiology, interventions applied, blood transfusion requirement, comorbidities, and recurrences. Results: Five patients were admitted with primary bleeding, while the remaining patients were admitted with secondary bleeding. Five patients experienced recurrent bleeding. The incidence of bleeding was found to be higher in the age group of 5-16 years and adults. The gender, the method of tonsillectomy, and the expertise degree of the surgeon had no effect on the bleeding complication. Bleeding was more commonly seen in case of tonsillectomies with an infectious indication, while infectious causes were the most common causes of bleeding etiology. Eighteen patients were treated conservatively, eight received silver nitrate cauterization, 10 received suturing, and four received suturing + bipolar cauterization. Five patients required blood transfusion. There was no mortality. Conclusion: Post-tonsillectomy bleeding is one of the most serious complications of the tonsillectomy. Preventative strategies and careful management are of utmost importance to avoid additional comorbidities and mortality.

References

  • Østvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, et al. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol 2015;272:737-43.
  • Tuchtan L, Torrents J, Lebreton-Chakour C, Niort F, Christia-Lotter MA, Delmarre E, et al. Liability under post-tonsillectomy lethal bleeding of the tonsillar artery: a report of two cases. Int J Pediatr Otorhinolaryngol 2015;79:83-7.
  • Bellis JR, Pirmohamed M, Nunn AJ, Loke YK, De S, Golder S, et al. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2014;113:23-42.
  • Hessén Söderman AC, Ericsson E, Hemlin C, Hultcrantz E, Månsson I, Roos K, et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 2011;121:2322-6.
  • Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005;132:281-6.
  • Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: who needs intervention? Int J Pediatr Otorhinolaryngol 2015;79:165-9.
  • Goldman JL, Baugh RF, Davies L, Skinner ML, Stachler RJ, Brereton J, et al. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope 2013;123:2544-53.
  • 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.
  • Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011;121:2553-60.
  • Bajaj Y, Atkinson H, Sagoo R, Bhatti I, Newbegin C. Paediatric day-case tonsillectomy: a three-year prospective audit spiral in a district hospital. J Laryngol Otol 2012;126:159-62.
  • Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J, et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717-24.
  • Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144:1-30.
  • Windfuhr JP, Verspohl BC, Chen YS, Dahm JD, Werner JA. Post-tonsillectomy hemorrhage--some facts will never change. Eur Arch Otorhinolaryngol 2015;272:1211-8.
  • Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth 2010;20:982-6.
  • Ahmad Z, de Silva N, Morton RP, Wood AB. Safety of day-stay tonsillectomy. Indian J Otolaryngol Head Neck Surg 2010;62:158-61.
  • Akin RC, Holst R, Schousboe LP. Risk factors for post-tonsillectomy haemorrhage. Acta Otolaryngol 2012;132:773-7.
  • Nguyen TB, Chin RY, Paramaesvaran S, Eslick GD. Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar haemorrhage? Eur Arch Otorhinolaryngol 2014;271:3005-10.
  • Ozkırış M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:1497-501.
  • Ozkiriş M, Kapusuz Z, Saydam L. Comparison of three techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol 2013;270:1143-7.
  • Söderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, et al. 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.
  • Kurtoğlu G, Erdağ TK. Outpatient surgical practices in otorhinolaryngology. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2016;26:123-8.
  • Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post- tonsillectomy haemorrhage rates in children? Int J Pediatr Otorhinolaryngol 2015;79:246-50.
  • Windfuhr JP. Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx 2003;30:391-6.
  • Gratacap M, Couloigner V, Boulouis G, Meder JF, Brunelle F, Naggara O. Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children. Eur Radiol 2015;25:239-45.
  • Kontorinis G, Schwab B. Significance of advanced haemostasis investigation in recurrent, severe post-tonsillectomy bleeding. J Laryngol Otol 2011;125:952-7.
  • Bhattacharyya N. Rapid communication: The risk of additional post-tonsillectomy bleeding after the first bleeding episode. Laryngoscope 2015;125:354-5.
  • Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 2013;38:115-29.
  • Plante J, Turgeon AF, Zarychanski R, Lauzier F, Vigneault L, Moore L, et al. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;345:5389.
  • Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2012;12:005607.

Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz

Year 2017, Volume: 27 Issue: 1, 1 - 9, 05.03.2017

Abstract

Amaç: Bu çalışmada, tonsillektomi sonrası kanama ile başvurup tedavileri yapılmış hastaların özellikleri değerlendirildi ve ilişkili risk faktörleri araştırıldı.Hastalar ve Yöntemler: Ocak 2005 - Aralık 2015 tarihleri arasında tonsillektomi/adenotonsillektomi sonrası tonsil lojundan kanama yakınmasıyla kliniğimize başvuran ve tedavi edilen toplam 40 hasta 19 erkek, 21 kadın; ort. yaş 18.2 yıl; dağılım 2-48 yıl çalışmaya alındı. Tonsillektomi sonrası kanama yaş, cinsiyet, tonsillektomi endikasyonu ve yöntemi, kanama zamanı ve miktarı, hemoglobin düzeyi, kanama etyolojisi, uygulanan girişimler, kan transfüzyonu gereksinimi, eşlik eden hastalıklar ve nüksler açısından değerlendirildi.Bulgular: Beş hasta primer kanama ile başvururken, diğer hastalar sekonder kanama ile başvurdu. Beş hastada nüks kanama yaşandı. Kanama sıklığı 5-16 yaş grubu ve erişkin hastalarda daha fazla bulundu. Cinsiyet, tonsillektomi yöntemi ve cerrahın uzman olmasının kanama komplikasyonu üzerine etkisi gösterilemedi. Enfeksiyöz endikasyonlu tonsillektomilerde daha sık kanama komplikasyonu görülürken, kanama etyolojisinde de en sık enfeksiyöz nedenler saptandı. Hastalardan 18’i konservatif olarak tedavi edilirken, sekizine gümüş nitrat koterizasyon, 10’una sütürasyon ve dördüne sütürasyon + bipolar koterizasyon uygulandı. Beş hastada kan transfüzyou gerekti. Mortalite yaşanmadı.Sonuç: Tonsillektomi sonrası kanama, en ciddi tonsillektomi komplikasyonlarından biridir. İlave komorbiditeler ve mortaliteyi önlemek için önleyici stratejiler ve dikkatli tedavi büyük önem arz etmektedir

References

  • Østvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, et al. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol 2015;272:737-43.
  • Tuchtan L, Torrents J, Lebreton-Chakour C, Niort F, Christia-Lotter MA, Delmarre E, et al. Liability under post-tonsillectomy lethal bleeding of the tonsillar artery: a report of two cases. Int J Pediatr Otorhinolaryngol 2015;79:83-7.
  • Bellis JR, Pirmohamed M, Nunn AJ, Loke YK, De S, Golder S, et al. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2014;113:23-42.
  • Hessén Söderman AC, Ericsson E, Hemlin C, Hultcrantz E, Månsson I, Roos K, et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 2011;121:2322-6.
  • Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005;132:281-6.
  • Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: who needs intervention? Int J Pediatr Otorhinolaryngol 2015;79:165-9.
  • Goldman JL, Baugh RF, Davies L, Skinner ML, Stachler RJ, Brereton J, et al. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope 2013;123:2544-53.
  • 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.
  • Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011;121:2553-60.
  • Bajaj Y, Atkinson H, Sagoo R, Bhatti I, Newbegin C. Paediatric day-case tonsillectomy: a three-year prospective audit spiral in a district hospital. J Laryngol Otol 2012;126:159-62.
  • Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J, et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717-24.
  • Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144:1-30.
  • Windfuhr JP, Verspohl BC, Chen YS, Dahm JD, Werner JA. Post-tonsillectomy hemorrhage--some facts will never change. Eur Arch Otorhinolaryngol 2015;272:1211-8.
  • Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth 2010;20:982-6.
  • Ahmad Z, de Silva N, Morton RP, Wood AB. Safety of day-stay tonsillectomy. Indian J Otolaryngol Head Neck Surg 2010;62:158-61.
  • Akin RC, Holst R, Schousboe LP. Risk factors for post-tonsillectomy haemorrhage. Acta Otolaryngol 2012;132:773-7.
  • Nguyen TB, Chin RY, Paramaesvaran S, Eslick GD. Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar haemorrhage? Eur Arch Otorhinolaryngol 2014;271:3005-10.
  • Ozkırış M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:1497-501.
  • Ozkiriş M, Kapusuz Z, Saydam L. Comparison of three techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol 2013;270:1143-7.
  • Söderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, et al. 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.
  • Kurtoğlu G, Erdağ TK. Outpatient surgical practices in otorhinolaryngology. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2016;26:123-8.
  • Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post- tonsillectomy haemorrhage rates in children? Int J Pediatr Otorhinolaryngol 2015;79:246-50.
  • Windfuhr JP. Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx 2003;30:391-6.
  • Gratacap M, Couloigner V, Boulouis G, Meder JF, Brunelle F, Naggara O. Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children. Eur Radiol 2015;25:239-45.
  • Kontorinis G, Schwab B. Significance of advanced haemostasis investigation in recurrent, severe post-tonsillectomy bleeding. J Laryngol Otol 2011;125:952-7.
  • Bhattacharyya N. Rapid communication: The risk of additional post-tonsillectomy bleeding after the first bleeding episode. Laryngoscope 2015;125:354-5.
  • Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 2013;38:115-29.
  • Plante J, Turgeon AF, Zarychanski R, Lauzier F, Vigneault L, Moore L, et al. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;345:5389.
  • Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2012;12:005607.
There are 29 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Aslı Çakır This is me

Cafer Boran This is me

Yüksel Olgun This is me

Taner Kemal Erdağ This is me

Publication Date March 5, 2017
Published in Issue Year 2017 Volume: 27 Issue: 1

Cite

APA Çakır, A., Boran, C., Olgun, Y., Erdağ, T. K. (2017). Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz. The Turkish Journal of Ear Nose and Throat, 27(1), 1-9.
AMA Çakır A, Boran C, Olgun Y, Erdağ TK. Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz. Tr-ENT. March 2017;27(1):1-9.
Chicago Çakır, Aslı, Cafer Boran, Yüksel Olgun, and Taner Kemal Erdağ. “Tonsillektomi Sonrası Kanama: 10 yıllık Deneyimimiz”. The Turkish Journal of Ear Nose and Throat 27, no. 1 (March 2017): 1-9.
EndNote Çakır A, Boran C, Olgun Y, Erdağ TK (March 1, 2017) Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz. The Turkish Journal of Ear Nose and Throat 27 1 1–9.
IEEE A. Çakır, C. Boran, Y. Olgun, and T. K. Erdağ, “Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz”, Tr-ENT, vol. 27, no. 1, pp. 1–9, 2017.
ISNAD Çakır, Aslı et al. “Tonsillektomi Sonrası Kanama: 10 yıllık Deneyimimiz”. The Turkish Journal of Ear Nose and Throat 27/1 (March 2017), 1-9.
JAMA Çakır A, Boran C, Olgun Y, Erdağ TK. Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz. Tr-ENT. 2017;27:1–9.
MLA Çakır, Aslı et al. “Tonsillektomi Sonrası Kanama: 10 yıllık Deneyimimiz”. The Turkish Journal of Ear Nose and Throat, vol. 27, no. 1, 2017, pp. 1-9.
Vancouver Çakır A, Boran C, Olgun Y, Erdağ TK. Tonsillektomi sonrası kanama: 10 yıllık deneyimimiz. Tr-ENT. 2017;27(1):1-9.