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Published on: November 6, 2019
Utility of preoperative hematologic screening for pediatric adenotonsillectomy
Yekaterina A Koshkareva1, Michael Cohen, John P Gaughan
1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. koshkarevaye@ph.upmc.edu
Insights
Preoperative hematologic screening identifies undiagnosed bleeding disorders in children undergoing tonsillectomy. Prompt treatment of these coagulopathies, including elevated international normalized ratio (INR), can prevent postoperative bleeding.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Hematology
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative bleeding is a significant complication.
- The role of preoperative hematologic screening in preventing bleeding is debated.
Purpose of the Study:
- To evaluate the effectiveness of preoperative hematologic screening in identifying coagulopathies.
- To determine the incidence of postoperative bleeding after tonsillectomy.
- To assess the relationship between preoperative screening results and postoperative bleeding.
Main Methods:
- Retrospective study of 875 pediatric patients (ages 2-18) undergoing tonsillectomy.
- Analysis of demographic data, medical/surgical history, and bleeding history.
- Review of preoperative hematologic screening tests: prothrombin time, activated partial thromboplastin time, international normalized ratio (INR), and platelet count.
Main Results:
- 14.5% of patients had abnormal preoperative hematologic screening results.
- Postoperative bleeding occurred in 3.5% of patients overall.
- Patients with abnormal screening had a significantly higher incidence of bleeding (7.1%) compared to those with normal screening (2.9%).
- Elevated INR was a common abnormality; newly diagnosed coagulopathies were treated and did not result in postoperative bleeding.
Conclusions:
- Preoperative hematologic screening is valuable for identifying undiagnosed coagulopathies in pediatric tonsillectomy patients.
- Appropriate perioperative management based on screening results can prevent postoperative bleeding.
- Mildly elevated INR warrants further investigation due to its association with increased hemorrhage risk.
Abstract:
We conducted a 3-year retrospective study to examine the results of preoperative hematologic screening, the incidence of postoperative bleeding, and the possible relationship between the two factors in patients who had undergone tonsillectomy with or without adenoidectomy. Our study population was made up of 875 patients--441 boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)--who had been treated at our institution from January 2004 through December 2006. In addition to demographic data, we compiled information on each patient's medical and surgical history, personal and family history of abnormal bleeding, indication for tonsillectomy, and preoperative hematologic screening results. The latter included determinations of the prothrombin time, activated partial thromboplastin time, international normalized ratio (INR), and platelet count. A total of 748 patients (85.5%) had normal findings on preoperative hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively, hemorrhagic complications occurred in 31 children (3.5%)--in 22 of the 748 patients with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality (7.1%); the difference between the two groups was statistically significant (p = 0.041). The abnormalities in the latter group consisted of an elevated INR but no otherwise identifiable coagulopathy. Another 14 patients with an abnormal screening result (11.0%) were found to have at least one coagulopathy that was newly diagnosed during our preoperative evaluation; they were treated perioperatively, and none bled postoperatively. Of 21 patients who had a personal or family history of abnormal bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery. In conclusion, we found that preoperative hematologic screening identified patients with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able to prevent some bleeding events in these patients. Our finding that patients with a mildly elevated INR had a higher incidence of postoperative hemorrhage warrants further study.
