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[Retrospective analysis of risk factors for postoperative bleeding undergoing adenotonsillectomy]

Stephan Knipping1,2, Franziska Michaelis3

  • 1Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen (Chefarzt: Prof. Dr. St. Knipping), Städtisches Klinikum Dessau.

Laryngo- Rhino- Otologie
|December 21, 2018
PubMed

Insights

Children undergoing adenotonsillectomy face a significant risk of postoperative hemorrhage. Frequent nosebleeds and abnormal hemoglobin levels are key indicators of increased bleeding risk, especially in those with von Willebrand Disease (VWD).

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Hematology

Background:

  • Adenotonsillectomy is a common pediatric surgical procedure.
  • Postoperative hemorrhage is a critical complication following adenotonsillectomy.
  • Medical history is traditionally favored over laboratory tests for predicting hemorrhage risk.

Purpose of the Study:

  • To identify risk factors for postoperative hemorrhage after adenotonsillectomy in children and adolescents.
  • To investigate the association between preoperative findings and the occurrence of postoperative bleeding.
  • To evaluate the role of von Willebrand Disease (VWD) in postoperative hemorrhage.

Main Methods:

  • Retrospective analysis of data from 308 pediatric patients undergoing surgery of Waldeyer's tonsillar ring over a 4-year period.
  • Assessment of preoperative questionnaires focusing on blood coagulation history.
  • Laboratory chemical screening, including hemoglobin values and VWD diagnostics.

Main Results:

  • Postoperative hemorrhage occurred in 14% of patients, with 4.2% within 24 hours and 10.4% after 24 hours.
  • Children with a history of frequent epistaxis had a significantly higher risk of hemorrhage.
  • Preoperative pathological hemoglobin values and diagnosed VWD (especially in males) were associated with increased bleeding risk.

Conclusions:

  • A conspicuous family bleeding history, particularly maternal, suggests an increased risk for VWD.
  • Preoperative screening, including PTT and PFA-100, is advisable for suspected VWD.
  • Abnormal preoperative laboratory findings, notably hemoglobin levels, correlate with a higher risk of postoperative hemorrhage.
Abstract

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