Secondary tonsillar hemorrhage requiring surgical intervention: Analysis of 1429 tonsillectomy cases on single surgeon experience

Öz

Objective: Determination of risk factors affecting secondary tonsillar hemorrhage of the requiring surgical intervention.

Material and Method: 1429 tonsillectomy cases performed with three different dissection techniques (dissection and snare, bipolar and monopolar dissection) by a single surgeon were examined retrospectively.  Age, sex, surgical knowledge, indications and postoperative tonsillar hemorrhage day of the patients were recorded. Patients who were operated on for hemorrhage were evaluated statistically in terms of technique used, age, sex and indications.

Findings: A total of 25 cases of a secondary hemorrhage cases requiring surgical intervention were detected. The relationship between age and bleeding was statistically significant (p=0.003). Hemorrhage frequency requiring surgical intervention was significantly higher in patients with recurrent tonsillitis than in patients with tonsillar hypertrophy (p = 0.001). 19 of the 25 patients who were operated on for hemorrhage were in the group of tonsillectomy patients due to recurrent tonsillitis. There was no meaningful relationship in terms of sex. The hemorrhage rate in the dissection and snare technique was 1.74% (12 patients), the hemorrhage rate in bipolar dissection was 2.78% (9 patients), and the monopolar dissection- hemorrhage rate was 0.96% (4 patients). There was no statistically significant difference between the results (p = 0.170). It was determined that the hemorrhage required surgery at most was between 6th and 10th days.

Conclusion: While there was no significant relationship between the incidence of secondary tonsillar hemorrhage requiring surgery and gender and dissection techniques, it has been observed that the risk was increased in patients operated due to recurrent tonsillitis and older age group.

Anahtar Kelimeler

• Tonsillectomy,hemorrhage,risk,factors

Kaynakça

1. 1. R.F. Baugh, S.M. Archer, R.B Mitchell, R.M. Rosenfeld, R. Amin, J.J Burns, at al., Clinical practice guideline:tonsillectomy in children, Otolaryngol. Head Neck Surg. 144(Suppl 1)(2011)S1-S30.
2. 2. Bhattacharyya N, Shapiro NL. Associations between socioeconomic status and race with complications after tonsillectomy in children. Otolaryngol Head Neck Surg. 2014;151(6):1055-60.
3. 3. Duval M, Wilkes J, Korgenski K, Srivastava R, Meier J. Causes, costs and risks factors for unplanned return visits after adenoyonsillectomy in children, Int. J. Pediatr. Otorhinolaryngol. 2015;79(10):1640-1646.
4. 4. Mueller J, Boeger D, Buentzel J, et al., Population based analysis of tonsil surgery and postoperative haemorrhage. Eur. Arch. Otorhinolaryngol. 2015;272(12):3769-77.
5. 5. Schrock A, Send T, Heukamp L, Gerstner AO, Bootz F, Jakob M. The role of histology and other risk factors for post-tonsillectomy hemorrhage, Eur. Arch.Otorhinolaryngol. 2009;266(12):1983-7.
6. 6. Spektor Z, Kay DJ, Mandell DL. Prospective comperative study of pulsed-electron avalanche knife (PEAK) and bipolar radiofrequency ablation (coblation) pediatric tonsillectomy and adenoidectomy. Am J Otolaryngol. 2016;37(6):528-533
7. 7. Ozkiris M, Kapusuz Z, Saydam L. Comparison of three techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol. 2013;270(3):1143–1147.
8. 8. Lane JC, Valenti JD, Chiado L, Haupert M. Postoperative tonsillectomy bleeding complications in children: A comparison of three surgical tecniques. International Journal of Pediatric Otorhinolaryngol. 2016;88(11):184-8

9. 9. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15218 patients. Otolaryngol Head Neck Surg. 2005;132(2):281-6.
10. 10. Perkins JN, Liang C, Gao D, Shults I, Freidman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 2012;122(10):2311-5.
11. 11. Kim MK, Lee JN, Kim MG, Ha SY, Lee JS, Yeo SG. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol. 2012;269(3):977-81
12. 12. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope. 2012;269(3):977-81.
13. 13. Ali RB, Smyth D, Kane R, Donnerlly M. Post-tonsillectomy bleeding: a regional hospital experience. 2008;177(4):297-301.
14. 14. Tomkinson A, De Martin S, Gilchrist CR, Temple M. Instrumentation and patients characteristics that influence postoperative hemorrhage rates following tonsil and adenoid surgery. Clin Otolaryngol 20005;30(4):338-46.
15. 15. Arnoldner C, Grasl M, Thurnher D., et al Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr. 2008;120(11-12):336-42.
16. 16. Blakley BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg. 2009;140(3):288-90.
17. 17. Blanchford H, Lowe D. Cold versus hot tonsillectomy: state of the art and recommendations. ORL J Otorhinolaryngol Relat Spec 2013;75(3):136-41.
18. 18. Chowdhury K, Tewfik TL, Schloss MD. Post-tonsillectomy and adenoidectomy hemorrhage. J Otolaryngol. 1988;17(1):46-9.
19. 19. Windfuhr JP , Verspohl BC, Chen YS, Dahm JD, Werner JA. Post‑tonsillectomy hemorrhage—some facts will never change. Eur Arch Otorhinolaryngol. 2015;272(5):1211-8
20. 20. Pinder DK, Wilson H, Hilton MP. Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev. 2011;16(3):CD002211
21. 21. Http://Www.Rcseng.Ac.Uk/Surgeons/Research/SurgicalResearch/Docs/National%20prospective%20tonsillectomy%20audit%20final%20report%202005.Pdf/View (2005) National Prospective Tonsillectomy Audit Final Report 2005.
22. 22. Söderman ACH, Ericsson E, Hemlin C 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(11):2322–2326.
23. 23. Liu JH, Anderson KE, Willging JP et al., Post tonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg. 2001;127(10):1271-5.
24. 24. Rakover Y, Almog R, Rosen G. The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children. Int J Pediatr Otorhinolaryngol. 1997;41(1):29-36.
25. 25. Tami TA, Parker GS, Taylor RE. Post-tonsillectomy bleeding: an evaluation of risk factors. Laryngoscope. 1987;97(11):1307-11.
26. 26. Sarny SA. Multicenter prospective study on all patients undergoing tonsillectomy, tonsillotomy or adenoidectomy in Austria in 2009 and 2010. 2011 Doctoral thesis.
27. 27. Thottam PJ, Christenson JR, Cohen DS, Metz CM, Saraiya SS, Haupert MS. The utility of common surgical instruments for pediatric adenotonsillectomy. Laryngoscope. 2015;125(2):475-9
28. 28. Alexander RJ, Kukreja R, Ford GR. Secondary post-tonsillectomy hemorrhage and informed consent. J Laryngol Otol. 2004;118(12):937-40.
29. 29. Attner P, Haraldsson PO, Hemlin C, Hessen Soderman AC. A 4 year consecutive study of post-tonsillectomy haemorrhage. ORL J Otorhinolaryngol Relat Spec. 2009;71(5):273-8.
30. 30. Windfuhr J, Ulbrich T. Post-tonsillectomy hemorrhage: results of a 3-month follow-up. Ear Nose Throat J. 2001;80(11):790, 795-8.
31. 31. Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N. Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx. 2014;41(4):376-9.