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Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy?
Peggy Leung1, Elliana Kirsh DeVore2, Kosuke Kawai1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Pediatric posttonsillectomy hemorrhage (PTH) risk increased from 2010-2015, particularly with ibuprofen use. Older age, male sex, comorbidities, and certain medications were associated with higher PTH risk.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes Research
- Health Informatics
Background:
- Posttonsillectomy hemorrhage (PTH) is a significant complication in pediatric patients.
- Identifying risk factors for PTH and transfusion is crucial for improving patient safety and outcomes.
Purpose of the Study:
- To identify risk factors associated with pediatric posttonsillectomy hemorrhage (PTH).
- To evaluate the need for blood transfusion in pediatric patients experiencing PTH.
- To analyze trends in PTH incidence over time.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) database (2004-2015).
- Inclusion of children aged 18 years or younger undergoing tonsillectomy with or without adenoidectomy (T±A).
- Evaluation of risk factors including demographics, comorbidities, surgical indications, medications, and year of surgery.
Main Results:
- A total of 551,137 patients underwent T±A, with 1.58% experiencing PTH.
- PTH incidence increased from 1.33% in 2010 to 1.91% in 2015 (P < .001).
- Risk factors for PTH included older age, male sex, medical comorbidities, recurrent tonsillitis, intensive care unit admission, and use of ibuprofen, ketorolac, anticonvulsants, and antidepressants. Blood transfusion was required in 2.1% of PTH cases.
Conclusions:
- The incidence of pediatric PTH significantly increased between 2011 and 2015.
- Ibuprofen use was identified as a potential contributing factor to the rising PTH rates.
- Further evaluation is needed to determine if the observed increase in risk associated with ibuprofen warrants changes in clinical practice.
Objective:
To evaluate risk factors for pediatric posttonsillectomy hemorrhage (PTH) and the need for transfusion using a national database.
Study Design:
Retrospective cohort study.
Setting:
The study was conducted using the Pediatric Health Information System (PHIS) database.
Methods:
Children ≤18 years who underwent tonsillectomy with or without adenoidectomy (T±A) between 2004 and 2015 were included. We evaluated the risk of PTH requiring cauterization according to patient demographics, comorbidities, indication for surgery, medications, year of surgery, and geographic region.
Results:
Of the 551,137 PHIS patients who underwent T±A, 8735 patients (1.58%) experienced a PTH. The risk of PTH increased from 1.33% (95% confidence interval [CI]: 1.15%, 1.53%) in 2010 to 1.91% (95% CI: 1.64%, 2.24%) in 2015 (P < .001). Older age (≥12 vs <5 years old: adjusted odds ratio [aOR] 3.17; 95% CI: 2.86, 3.52), male sex (aOR 1.11; 95% CI: 1.05, 1.17), medical comorbidities (aOR 1.18; 95% CI: 1.08, 1.29), recurrent tonsillitis (aOR 1.15; 95% CI: 1.07, 1.24), and intensive care unit admission (aOR 1.74; 95% CI: 1.55, 1.95) were significantly associated with an increased risk of PTH. Use of ibuprofen (aOR 1.36; 95% CI: 1.22, 1.52), ketorolac (aOR 1.39; 95% CI: 1.14, 1.69), anticonvulsant (aOR 1.23; 95% CI: 1.03, 1.76), and antidepressants (aOR 1.35; 95% CI: 1.03, 1.76) were also associated with an increased risk of PTH. The need for blood transfusion was 2.1% (181/8735).
Conclusion:
The incidence of PTH increased significantly between 2011 and 2015, and ibuprofen appears to be one contributing factor. Given the benefits of ibuprofen, it is unclear whether this increased risk warrants a change in practice.
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