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Published on: January 17, 2011
[Tonsillectomy by electrical dissection: risk factors of postoperative hemorrhage in children]
A Fernández1, I Sánchez Canet, M Gómez Fiñana
1Departamento de ORL, Area de Cirugía, Hospital de Poniente, El Ejido, Almería.
Insights
Children over 15 undergoing tonsillectomy by electrodissection face a higher risk of post-tonsillectomy hemorrhage (PTH). Using ligatures for hemostasis also increases bleeding risk in pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Context:
- Post-tonsillectomy hemorrhage (PTH) is a significant complication in pediatric patients.
- Electrocautery dissection is a common method for tonsillectomy.
Purpose:
- To identify pre- or intraoperative risk factors for post-tonsillectomy hemorrhage (PTH) in children undergoing electrocautery dissection.
- To assess the impact of patient age, hemostasis type, and coagulation parameters on PTH risk.
Summary:
- A retrospective study of 163 pediatric patients found a 4.29% PTH prevalence.
- Increased PTH risk was associated with age over 15 years (OR=8.46, p=0.04) and use of ligatures for hemostasis (OR=8.62, p=0.02).
- Activated partial thromboplastin time (APTT) > or = 32 seconds showed marginal significance (OR=7.82, p=0.05).
Impact:
- Identifies specific risk factors (older age, ligature use) for PTH in pediatric electrocautery tonsillectomy.
- Informs surgical decision-making and patient counseling to mitigate bleeding risks.
- Highlights the importance of coagulation status assessment in pediatric tonsillectomy patients.
Objective:
To identify pre or intraoperative risk factors that could indicate a higher risk for post-tonsillectomy hemorrhage (PTH) in children undergoing electrocautery dissection. SET-UP: Primary referral hospital.
Design:
A retrospective study of 163 post-tonsillectomy children comparing 7 cases of PTH with 156 cases with no PTH.
Sample:
This study includes children under the age of 18 that underwent tonsillectomy by dissection between 1997 and 2000.
Outcome Parameters:
Age, sex, height, weight, body mass index, hemoglobin level, hematocrit, platelet count activated partial thromboplastin time (APTT), fibrinogen, ASA index (physical state classification of the American Society of Anesthesiology) and type of hemostasis.
Results:
Prevalence of PTH was 4.29% in the cohort sample. The risk of PTH in children following tonsillectomy by electrodissection is significantly increased in patients over 15 years of age (OR = 8.46, p = 0.04) and when ligatures are used for hemostasis (OR = 8.62, p = 0.02). Activated partial thromboplastin time > or = 32 seconds is marginally significant (OR = 7.82, p = 0.05).
Conclusions:
Our findings show that tonsillectomy by electrodissection has an increased risk of bleeding in older children and when ligatures are used for hemostasis.
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