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Post-tonsillectomy bleeding in children with von Willebrand disease: a single-institution experience
Kenneth D Rodriguez1, Gordon H Sun, Francis Pike
1Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Pediatric tonsillectomy bleeding rates were similar in children with and without von Willebrand disease (vWD). Preoperative desmopressin acetate (DDAVP) showed no increased bleeding risk in vWD patients.
Area of Science:
- Pediatric Otolaryngology
- Hematology
- Pediatric Surgery
Background:
- Post-tonsillectomy bleeding is a significant concern in pediatric surgery.
- Von Willebrand disease (vWD) is a common inherited bleeding disorder that may affect surgical outcomes.
Purpose of the Study:
- To compare post-tonsillectomy bleeding rates in pediatric patients with and without von Willebrand disease (vWD).
- To identify risk factors for post-tonsillectomy bleeding in children, both with and without vWD.
Main Methods:
- A historical cohort study was conducted at a tertiary care pediatric hospital.
- Medical records of 99 pediatric patients with vWD and 99 matched controls without vWD who underwent tonsillectomy were reviewed.
- Matching criteria included age, surgical year, surgical type, and indication for surgery.
Main Results:
- The post-tonsillectomy hemorrhage rate was 8% in vWD patients and 6% in non-vWD patients (P=0.58).
- Four vWD patients and two non-vWD patients required surgical intervention for bleeding control.
- Preoperative desmopressin acetate (DDAVP) was administered to 93% of vWD patients, and response to DDAVP was not associated with increased bleeding risk.
Conclusions:
- Pediatric patients with vWD undergoing tonsillectomy exhibit a postoperative bleeding rate comparable to matched controls.
- The study's sample size was insufficient to definitively rule out a clinically significant difference in bleeding rates.
- Further research with larger cohorts may be warranted to fully elucidate bleeding risks in this population.
Objectives:
1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD.
Study Design:
Historical cohort study.
Setting:
Tertiary care, university-based pediatric hospital.
Subjects And Methods:
Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery.
Results:
Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid.
Conclusion:
Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.
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