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Effect of post-operative oral steroids on bleeding rate after pediatric tonsillectomy
Benjamin P Stevens1, Oishika Paul1, Matthew C Donald1
1University of Mississippi Medical Center, Department of Otolaryngology and Communicative Sciences, 2500 North State Street, Jackson, MS 39216, United States of America.
Insights
Post-operative oral steroids do not increase hemorrhage risk in pediatric tonsillectomy patients. This study found no significant difference in bleeding rates between groups receiving and not receiving oral steroids after surgery.
Area of Science:
- Pediatric Otolaryngology
- Pharmacology
- Surgical Outcomes
Background:
- Opioid use post-pediatric adenotonsillectomy carries risks, prompting searches for alternatives.
- Oral steroids are considered for post-operative pain management, drawing from intraoperative IV steroid efficacy.
- Evidence on post-operative oral steroid safety and efficacy in pediatric tonsillectomy is limited.
Purpose of the Study:
- To investigate the association between post-operative oral steroid use and hemorrhage rates in pediatric tonsillectomy patients.
- To evaluate the safety of oral steroids as an alternative pain management strategy.
Main Methods:
- Retrospective case-control chart review.
- Inclusion of 1416 pediatric patients undergoing tonsillectomy (with or without adenoidectomy).
- Comparison of hemorrhage rates between patients receiving and not receiving post-operative oral steroids.
Main Results:
- A total of 1416 patients were analyzed (704 no steroids, 712 steroids).
- Hemorrhage rates were 3.1% in the steroid group vs. 1.8% in the no-steroid group.
- The observed difference in hemorrhage rates was not statistically significant (P = 0.132).
Conclusions:
- Post-operative oral steroids appear safe for pediatric tonsillectomy.
- Oral steroid use does not significantly elevate the risk of post-tonsillectomy hemorrhage.
- Further research may explore optimal pain management strategies post-tonsillectomy.
Purpose:
In 2013, the FDA placed a black box warning on the usage of opioid pain medications in the post-operative setting after pediatric adenotonsillectomy. Since then, alternative pain management regimens have been employed. Some have advocated for post-operative oral steroids, in part due to the effectiveness of intraoperative intravenous steroids in reducing post-operative pain and nausea. The evidence regarding the efficacy and safety of post-operative oral steroids is not as clear. The purpose of this study was to examine whether post-tonsillectomy hemorrhage rates in pediatric patients were affected by post-operative oral steroid usage.
Materials And Methods:
Case-control retrospective chart review using a deidentified data set of patients undergoing tonsillectomy with or without adenoidectomy at a single academic medical center between June 2012 and November 2015.
Results:
A total of 1416 patients were included in the study, with 704 in the no post-operative oral steroids group and 712 in the group who did receive post-operative oral steroids. The rate of post-tonsillectomy hemorrhage in the post-operative oral steroid group was 3.1 % compared to 1.8 % in the group who did not receive post-operative oral steroids, however, this was not a statistically significant difference (P = .132).
Conclusions:
Our study suggests that post-operative oral steroids are safe and do not increase the risk of post-operative hemorrhage after pediatric tonsillectomy.
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