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Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis
J R Bellis1, M Pirmohamed2, A J Nunn3
1Research and Development, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK jennifer.bellis@alderhey.nhs.uk.
Insights
Dexamethasone and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in pediatric tonsillectomies. This review found no significant increase in hemorrhage risk with their use, though more research is needed.
Area of Science:
- Pediatric Surgery
- Pharmacology
- Clinical Research
Background:
- Dexamethasone is recommended for managing postoperative nausea and vomiting after tonsillectomy in children.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for pain management in this population.
Purpose of the Study:
- To evaluate the association between dexamethasone (with or without NSAIDs) and the risk of post-tonsillectomy hemorrhage in children.
- To synthesize evidence from existing studies on this specific complication.
Main Methods:
- A systematic review and meta-analysis of randomized and non-randomized studies involving children undergoing tonsillectomy who received dexamethasone or dexamethasone plus NSAIDs.
- Risk of bias and data quality were assessed using the Cochrane Risk of Bias Tool and McHarm tool.
- Pooled estimates of hemorrhage rates were calculated using the Peto odds ratio method.
Main Results:
- The pooled hemorrhage rate in children receiving dexamethasone was 6.2%.
- The overall odds ratio for hemorrhage was 1.41 (95% CI 0.89-2.25, P=0.15), indicating no statistically significant increase in risk.
- Significant risk of bias and inconsistent data collection were noted across studies, along with clinical heterogeneity.
Conclusions:
- Current evidence does not demonstrate a statistically significant increased risk of post-tonsillectomy hemorrhage associated with dexamethasone use, with or without NSAIDs, in children.
- However, many included studies were not specifically designed to assess hemorrhage, highlighting the need for large, dedicated studies to definitively evaluate this risk.
Abstract:
Summary In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexamethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed.
