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Assessing the Relationship Between Infection Frequency and Risk of Post-Tonsillectomy Hemorrhage
Austin Schafer1, Noah Worobetz2, Jordan Lukens2
1The Ohio State University College of Medicine, Columbus, OH, USA.
Insights
Recurrent tonsillitis frequency did not significantly increase post-tonsillectomy hemorrhage (PTH) risk in children. Patients with neuromuscular conditions had higher odds of PTH, warranting further investigation into infection frequency and hemorrhage risk.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Recurrent tonsillitis is a common condition in children, often treated with tonsillectomy.
- Post-tonsillectomy hemorrhage (PTH) is a known complication, and factors influencing its risk are crucial for patient management.
Purpose of the Study:
- To investigate the association between the frequency of tonsillitis episodes and the risk of post-tonsillectomy hemorrhage (PTH) in pediatric patients.
- To identify risk factors for PTH in children undergoing tonsillectomy for recurrent tonsillitis.
Main Methods:
- Retrospective chart review of 424 pediatric patients who underwent tonsillectomy in 2017.
- Patients were stratified into two cohorts based on tonsillitis frequency (≥7 infections/year vs. <7 infections/year).
- Bivariate analyses, Kaplan-Meier curves, and regression models were used to assess PTH risk and timing.
Main Results:
- Overall PTH incidence was 8.73%. Patients meeting the 7+ infections/year criteria showed a non-significant trend towards higher PTH odds (OR: 1.42).
- Secondary hemorrhage was more common (94.59% of PTH cases), with a median onset of 6 days post-surgery.
- Pediatric patients with neuromuscular conditions exhibited significantly higher odds of PTH (OR: 4.75, P=.0276).
Conclusions:
- The frequency of tonsillitis, defined by the 1-year criteria, was not a significant predictor of post-tonsillectomy hemorrhage in this cohort.
- Neuromuscular conditions represent a significant risk factor for PTH in pediatric tonsillectomy patients.
- Further research is warranted to elucidate the relationship between infection frequency and PTH risk.
Objective:
To determine the relationship between frequency of tonsillitis and the risk of post-tonsillectomy hemorrhage (PTH) in pediatric patients undergoing tonsillectomy for recurrent tonsillitis.
Methods:
After obtaining IRB approval from Nationwide Children's Hospital, charts for all patients who underwent a total tonsillectomy in 2017 for recurrent or chronic tonsillitis were retrospectively reviewed (n = 424). Patients were divided into 2 cohorts based on the frequency of tonsillitis prior to surgery: those meeting the 1-year criteria with 7 or more infections in the past year (n = 100), and those who did not meet criteria defined as those with fewer than 7 infections in the past year (n = 324). The primary outcome of interest was PTH. Comparison of cohorts and frequency of PTH were assessed using bivariate analyses. Kaplan-Meier curves were used to compare time to onset of hemorrhage between primary vs. secondary PTH. Generalized mixed and logistic regression models were used to evaluate risk of hemorrhage following tonsillectomy.
Results:
Among a total cohort of 424 patients undergoing tonsillectomy, 23.58% (n = 100) met criteria while 76.42% (n = 324) did not. A total of 8.73% (n = 37) patients experienced PTH. Compared to those who did not meet criteria, those who met criteria had a higher odds of developing PTH; however, this was not significant (OR: 1.42 [95% CI: 0.67, 2.98], P = .3582). Estimated probability of developing PTH for those who met criteria was 11% [95% CI: 6.19, 18.81] compared to 8.03% [95% CI: 5.52, 11.54] for those who did not meet criteria. Among all PTH cases, 5.41% (n = 2) were primary hemorrhage while 94.59% (n = 35) were secondary hemorrhage with 50% of those with secondary PTH having experienced hemorrhage within 6 days [95% CI: 5, 7] of tonsillectomy. Patients with neuromuscular conditions had significantly higher odds of PTH (OR: 4.75 [95% CI: 1.19, 18.97], P = .0276).
Conclusion:
Patients who met the 1-year criteria for tonsillectomy did not have a significantly higher odds of PTH. Further research is needed to better evaluate the relationship between infection frequency and risk of PTH.
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