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Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study
Jennifer H Gross1, Miranda Lindburg2, Dorina Kallogjeri2
1Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Pediatric post-tonsillectomy hemorrhage (PTH) is linked to specific surgical techniques and tonsillectomy alone. Patients experiencing respiratory events may face higher PTH risks, necessitating careful monitoring and counseling. Four hours of post-anesthesia care unit (PACU) monitoring is adequate.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Post-tonsillectomy hemorrhage (PTH) is a significant complication in pediatric patients.
- Understanding the timing, predictors, and optimal monitoring for PTH is crucial for patient safety and resource allocation.
Purpose of the Study:
- To characterize the incidence and timing of pediatric PTH.
- To identify factors predicting PTH development.
- To determine the appropriate duration for post-anesthesia care unit (PACU) monitoring.
Main Methods:
- A matched case-control study utilized data from the Pediatric Health Information System (PHIS) database and electronic medical records.
- The study included 124 pediatric PTH cases and 479 tonsillectomy controls from a single tertiary-care institution between 2005 and 2015.
- Conditional logistic regression was employed for matched pair analysis.
Main Results:
- The institutional PTH rate was 1.9%, with 15% of cases being primary (within 24 hours) and 85% secondary.
- Cold steel and Coblation techniques, along with tonsillectomy alone, were associated with increased odds of PTH.
- Patients with PTH had four times the odds of a preceding postoperative respiratory event.
Conclusions:
- PTH is associated with specific surgical methods (cold steel, Coblation) and tonsillectomy alone.
- Postoperative respiratory events may indicate a higher risk for PTH, warranting patient counseling.
- A 4-hour PACU monitoring period is deemed sufficient for outpatient tonsillectomy.
Objective:
To describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time.
Study Design:
Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed.
Setting:
A single, tertiary-care institution.
Subjects And Methods:
Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression.
Results:
Our institutional PTH rate of 1.9% (130 of 6949) included 124 patients; 15% (19) were primary (≤24 hours), with 50% (9) occurring within 5 hours. Twenty-one percent (4 of 19) of primary PTH patients received operative intervention. Eighty-five percent (105 of 124) of all cases were secondary PTH, and 47% (49) of those patients received operative intervention. Cold steel (OR 1.9, 95% CI 1.1-3.3) and Coblation (OR 1.9, 95% CI 1.2-3.1) techniques and tonsillectomy alone (OR 3.7, 95% CI 1.9-7.2) increased odds of PTH. Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0, 95% CI 1.6-10.0).
Conclusion:
We conducted a rigorous case-control study for PTH, finding that PTH was associated with use of cold steel and Coblation techniques and with tonsillectomy alone. Patients with a postoperative respiratory event may be more likely to develop a PTH and should be counseled accordingly. A PACU monitoring time of 4 hours is sufficient for outpatient tonsillectomy.
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