[Significance of blood tests prior to adenoidectomy]

Hörmann recently published a joint statement of the German Societies of Oto-Rhino-Laryngology, Head and Neck surgery, of pediatrics and of anesthesiology regarding the necessity of coagulation tests prior to adenoidectomy or tonsillectomy in children. According to many studies, these societies agreed that coagulation tests should be performed only in children with an unusual bleeding history. We analyzed our adenoidectomy-database to investigate the need for preoperative blood tests to prevent bleeding events during and following an adenoidectomy.

Data of 1137 children were collected, undergoing adenoidectomy during a period of 18 months (2005/2006) at the Bochum department of Oto-Rhino-Laryngology, retrospectively. Information on sex, age, hemoglobin concentration, platelet count, INR, thromboplastin time and prothrombin time and clinical bleeding history were collected.

3 % of the laboratory investigations showed pathological parameters. Only 0.12 % of the tests resulted in the cancellation of the operation (7 cases). The reasons for cancellation were: platelet count less than 100 000/microl (3 patients), anemia (Hb < 10 g/dl) (3 patients) and prolongated thromboplastin time (1 patient). 3 of these 7 patients were operated later on. Postoperative hemorrhage was noticed in 11 patients following adenoidectomy. In these 11 patients with bleeding complications all laboratory parameters were found to be normal.

In accordance with the current literature our data show that bleeding after adenoidectomy is a rare complication. In contrast to many other studies, we also report weak bleedings from the epipharynx. Blood tests were routinely performed prior to every operation with little benefit. Only 4 patients were definitely not scheduled for surgery as a consequence of the preoperative blood test. Patients with bleeding complications were not suspicious regarding laboratory workup. We therefore conclude that blood tests prior to adenoidectomy have no relevance for the course of the operation and postoperative bleeding event. Blood tests should only be performed on patients with an unusual bleeding history, family bleeding history or indications for anemia. The documentation of a standardized bleeding history prior to surgery is strongly recommended.