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Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy
Rijul Kshirsagar1, Hossein Mahboubi1, Derek Moriyama1
1Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States.
Insights
Obese children and older children face a higher risk of bleeding after tonsil or adenotonsil surgery. Other factors like sleep apnea did not show a significant link to post-operative hemorrhage.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Public Health
Background:
- Postoperative hemorrhage is a significant complication following tonsillectomy and adenotonsillectomy.
- Identifying risk factors is crucial for improving patient safety in outpatient settings.
Purpose of the Study:
- To investigate the association between pediatric post-tonsillectomy/adenotonsillectomy hemorrhage and specific patient factors.
- Key factors examined include obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA).
Main Methods:
- Retrospective review of the California Ambulatory Surgery Data from 2005-2011.
- Analysis of pediatric patients (<18 years) undergoing tonsillectomy (T) or adenotonsillectomy (AT).
- Evaluation of hemorrhage risk associated with obesity, OSA, ATH, CT, PTA, and demographics.
Main Results:
- Hemorrhage occurred in 0.1% of 138,998 procedures.
- Obesity (p=0.02) and older age (9-18 years, p=0.01) were significantly associated with increased hemorrhage risk.
- Multivariate analysis indicated obese children were 2.3 times more likely to experience hemorrhage (OR=2.3, p=0.03).
Conclusions:
- Obesity and older age are independent risk factors for immediate post-operative hemorrhage after outpatient tonsillectomy/adenotonsillectomy.
- Factors such as gender, OSA, ATH, CT, and PTA were not found to significantly alter hemorrhage risk.
Introduction:
Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate post-operative setting.
Methods:
The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. The records of patients aged less than 18 years undergoing tonsillectomy (T) or adenotonsillectomy (AT) were extracted using relevant ICD-9 diagnosis codes. The association between hemorrhage and obesity, OSA, AH, CT, PTA, and patients' demographics among surgeries performed in the outpatient setting was evaluated.
Results:
A total of 138,998 procedures, 22,478 Ts and 116,520 ATs, were performed during 2005-2011, of which 3.0% were performed on obese children. Hemorrhage occurred in 156 cases (0.1%), and was associated with an age from 9 to 18 years (p=0.01), and obesity (p=0.02). There was no association between hemorrhage and gender (p=0.8), OSA (p=0.6), ATH (p=0.5), CT (p=0.35), PTA (p=0.47), or T versus AT (p=0.3). Multivariate analysis revealed that hemorrhage was about 2.3 times more likely to occur in obese children (odds ratio [OR]=2.3; 95% Confidence Interval: 1.1-5.1; p=0.03).
Conclusions:
Obesity and older age are associated with an increased risk of immediate post-operative hemorrhage following tonsillectomy with or without adenoidectomy in the outpatient setting. Gender, OSA, ATH, CT, PTA, and T versus AT did not alter the risk of post-operative hemorrhage.
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