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Paediatric Posttonsillectomy Haemorrhage Rates in Auckland: A Retrospective Case Series
Andrés Alvo1, Andrew Hall1, James Johnston2
1Department of Paediatric Otorhinolaryngology, Starship Children's Hospital, Auckland, New Zealand.
Insights
Post-tonsillectomy hemorrhage (PTH) occurred in 3.6% of pediatric patients in Auckland. Smaller tonsils and less associated otitis media with effusion were linked to PTH, with rates remaining within acceptable limits.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Complications
Background:
- Tonsillectomy is a common pediatric surgical procedure for sleep-disordered breathing and infections.
- Post-tonsillectomy hemorrhage (PTH) is a significant complication despite surgical advancements.
- Regular auditing of PTH is crucial for monitoring surgical outcomes.
Purpose of the Study:
- To audit the incidence and characteristics of post-tonsillectomy hemorrhage (PTH) in pediatric patients.
- To identify risk factors associated with PTH in children undergoing tonsillectomy.
- To compare institutional outcomes with established literature benchmarks.
Main Methods:
- Retrospective case series of pediatric tonsillectomies (<15 years) in Auckland during 2017.
- Extraction and analysis of demographic, clinical, and surgical data.
- Univariate analysis to compare patients with and without PTH.
Main Results:
- Overall PTH rate was 3.6% (0.23% primary, 3.4% secondary), with a mean onset of 6.6 days.
- 28% of PTH cases required return to theatre (1% of all tonsillectomies); no deaths or major complications occurred.
- Children with PTH had smaller tonsils (p=0.004) and were less likely to have otitis media with effusion (p<0.001).
Conclusions:
- Reporting institutional tonsillectomy outcomes and complications is essential.
- The PTH rates observed in Auckland are within acceptable limits based on current literature.
- Smaller tonsil size and absence of otitis media with effusion may be associated with PTH risk.
Background:
Tonsillectomy is one of the most commonly performed surgical procedures in children. It is performed for sleep-disordered breathing and infective symptoms. Despite advances in instrumentation and perioperative care, posttonsillectomy haemorrhage (PTH) remains a significant complication, which should be audited regularly.
Methods:
A retrospective case series of all tonsillectomies performed in patients <15 years old in the Auckland region during 2017 was performed. Demographic, clinical, and surgical data were extracted and analysed. Univariate analysis was performed to compare patients with and without PTH.
Results:
A total of 2177 tonsillectomies were performed during the study period, 64% in a public hospital and 36% in a private hospital. The overall PTH rate was 3.6% (0.23% occurring within the first 24 hours (primary) and 3.4% after 24 hours (secondary)). Mean time to PTH was 6.6 ± 3 days (range: 1-16 days). 90% of PTH occurred within the first 10 days and 99% by 14 days. Return to theatre was required in 28% of these cases, representing 1% of all tonsillectomies. There were no deaths or major complications in this cohort. The only differences observed between patients with PTH and those without were that children with PTH had smaller tonsils (p=0.004) and were less likely to have associated OME (p<0.001).
Conclusion:
It is important to report institutional tonsillectomy outcomes and associated complications. These results show that PTH rates in Auckland remain within acceptable limits according to the literature.
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