Dexamethasone and postoperative bleeding after tonsillectomy and adenotonsillectomy in children: A meta-analysis of prospective studies
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Published on: November 6, 2019
Josef Shargorodsky1, Christopher J Hartnick, Gi Soo Lee
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. josef_shargorodsky@meei.harvard.edu
Insights
Perioperative dexamethasone did not increase bleeding risk after pediatric tonsillectomy overall. However, specific doses may elevate hemorrhage risk, warranting further study in this common surgery.
Area of Science:
- Pediatric Surgery
- Pharmacology
- Clinical Outcomes Research
Background:
- Tonsillectomy and adenotonsillectomy are frequent pediatric surgical procedures.
- Perioperative dexamethasone is commonly administered to reduce inflammation and pain.
- Emerging evidence suggests a potential link between dexamethasone use and increased postoperative hemorrhage risk.
Purpose of the Study:
- To conduct a meta-analysis of prospective studies to evaluate the association between perioperative dexamethasone and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy.
- To investigate the dose-response relationship between dexamethasone and bleeding risk.
Main Methods:
- Meta-analysis of 12 placebo-controlled prospective studies involving 1,180 pediatric patients.
- Studies included children under 18 undergoing tonsillectomy or adenotonsillectomy.
- Dose-specific analyses were performed using meta-regression and stratified models.
Main Results:
- No significant overall association was found between dexamethasone and increased odds of bleeding (OR = 1.07; P = .82).
- No significant dose-dependent increase in bleeding risk was observed (regression slope = -1.47, P = .10).
- A specific dexamethasone dose range (0.4-0.6 mg/kg) was associated with significantly increased odds of bleeding (OR = 3.14; P = .03).
Conclusions:
- Overall, perioperative dexamethasone does not appear to increase postoperative bleeding risk in pediatric tonsillectomy or adenotonsillectomy.
- A potential association between specific dexamethasone doses and increased bleeding risk cannot be ruled out.
- Further dedicated prospective studies are recommended to clarify the safety of specific dexamethasone dosing regimens.
Objectives/Hypothesis:
Tonsillectomy and adenotonsillectomy are common pediatric surgical procedures. Although perioperative administration of dexamethasone is common, recent data indicate a possible association between dexamethasone and increased risk of postoperative hemorrhage.
Study Design:
Meta-analysis of prospective studies.
Methods:
Meta-analysis using MEDLINE and EMBASE, including all placebo-controlled prospective studies with perioperative dexamethasone as the intervention and postoperative bleeding as the outcome, in children age <18 years undergoing tonsillectomy or adenotonsillectomy. The association between any dexamethasone dose and bleeding outcomes was quantified. Dexamethasone dose analyses were performed using meta-regression and stratified dose analysis models. Individuals were pooled using the random effects model, and Mantel Haenszel odds ratios (OR) were used to assess the associations. All P values were two-sided.
Results:
Twelve studies with 1,180 total participants were included in the meta-analysis. There was no significant association between dexamethasone at any dose and odds of bleeding compared to placebo (OR = 1.07; 95% confidence interval [CI], 0.58-1.98; P = .82). There was no significant association between increasing dexamethasone dose and bleeding (regression slope = -1.47, P = .10). Stratifying by dose ranges, studies comparing dexamethasone doses in 0.4 to 0.6 mg/kg range to placebo showed significantly increased odds of bleeding (OR = 3.14; 95% CI, 1.14-8.65; P = .03). Higher or lower doses were not associated with a difference in bleeding.
Conclusions:
There was no overall association between dexamethasone administration and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy. However, this study cannot exclude the possibility of an association between specific dexamethasone doses and increased odds of bleeding. The results underscore the need for more dedicated prospective studies of this very common intervention.
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