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Relationship between clinical history, coagulation tests, and perioperative bleeding during tonsillectomies in
P Gabriel1, X Mazoit, C Ecoffey
1Departments of Anesthesiology and Surgical Intensive Care, Centre Hospitalier de Lonjumeau, Centre Hospitalier Universitaire du Kremlin-Bicêtre, Université Paris Sud, and Centre Hospitalier Universitaire de Rennes, France.
Insights
Clinical history and preoperative coagulation tests are unreliable predictors of bleeding in children undergoing tonsillectomy. Neither method accurately identifies patients at risk for intraoperative or postoperative bleeding events.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesiology
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Bleeding complications can occur during or after tonsillectomy.
- Accurate prediction of bleeding risk is crucial for patient safety.
Purpose of the Study:
- To evaluate the predictive value of clinical bleeding history and preoperative coagulation tests for identifying children at risk of bleeding during tonsillectomy.
- To determine if these assessments can predict abnormal coagulation test results.
Main Methods:
- Prospective, multicenter investigation involving 1,706 children (9 months to 15 years) undergoing tonsillectomy.
- Data collected included clinical bleeding history, preoperative coagulation tests, and intraoperative/postoperative bleeding events.
- Surgical techniques (dissection vs. Sluder) and indications (infection, sleep apnea) were recorded.
Main Results:
- Clinical bleeding history was positive in 13 patients but did not predict abnormal coagulation tests.
- Coagulation tests were abnormal in 4% of children; only 8 had disease-induced bleeding.
- Intraoperative bleeding (7%) and postoperative bleeding (3%) were assessed.
- Univariate analysis linked intraoperative bleeding to age, Sluder technique, and abnormal tests.
- Multivariate analysis identified surgical center, Sluder technique, and older age as predictors of bleeding.
Conclusions:
- Clinical history of bleeding and preoperative coagulation tests are insufficient to predict abnormal laboratory findings.
- Neither patient history nor laboratory tests reliably predict postoperative bleeding risk.
- Current preoperative assessments have limited value in identifying children at risk for bleeding complications after tonsillectomy.
Study Objective:
To determine the value of clinical history and preoperative coagulation tests.
Design:
Prospective, multicenter clinical investigation.
Setting:
Twenty-four centers over a one-year period.
Patients:
1,706 children scheduled for tonsillectomy. In 1, 479 out of 1,706 children, studied age was ranged from 9 months to 15 years. Indications for surgery were tonsillar infection 54%, sleep apnea 33%, or both 13%. Surgical dissection was performed in 1, 284 cases (88%) and sluder technique in 172 cases (12%).
Measurements And Main Results:
Clinical history of bleeding, preoperative coagulation tests, and perioperative bleeding were recorded. Clinical history of bleeding was positive in 13 patients; clinical history cannot predict abnormal coagulation tests. Coagulation tests were abnormal in 57 children (4%). Only 8 patients had disease-induced bleeding; five children had a preoperative correction of the deficiency in factor of coagulation or received desmopressin acetate prior to surgery in the case of von Willebrand's disease. Bleeding that occurred during the intraoperative period was assessed as abnormal by the surgeon in 101 children (7%) and during the postoperative period in 50 children (3%). Univariate analysis showed a relationship between intraoperative bleeding and age (p < 0.001), sluder technique (p < 0. 001), and abnormal preoperative coagulation tests (p < 0.05). Multivariate analysis showed the probability that bleeding was linked to the center where the surgery took place, the technique used, i.e., sluder technique, and the child's age, i.e., the older children.
Conclusions:
Preoperative assessment based on the history of bleeding cannot predict abnormal laboratory tests. Neither the history of bleeding or laboratory tests can predict postoperative bleeding.