Risk factors of post-tonsillectomy hemorrhage in adults

Yoshiaki Inuzuka, Kunio Mizutari, Daisuke Kamide, Michiya Sato, Akihiro Shiotani, Yoshiaki Inuzuka, Kunio Mizutari, Daisuke Kamide, Michiya Sato, Akihiro Shiotani

Abstract

Objective: Tonsillectomy is an essential surgery and is conducted on both children and adults. However, the risk factors of post-tonsillectomy hemorrhage for adult patients remain unclear. In this study, we analyzed post-tonsillectomy hemorrhage in adult patients.

Methods: We retrospectively analyzed 325 adult patients who underwent a tonsillectomy between 2014 and 2018 in our facilities.

Results: The average age of this study's population was 31.7 ± 10.5 years (range: 19-70 years), and 250 (76.9%) patients were male. Overall, post-tonsillectomy hemorrhage occurred in 71 (21.8%) patients and 5 (1.5%) patients required a second surgery for hemostasis. Post-tonsillectomy hemorrhage often occurred on postoperative day zero or six. Using multiple logistic regression analysis, current smoking status (odds ratio 3.491; 95% confidence interval 1.813-6.723), male sex (odds ratio 3.924; 95% confidence interval 1.548-9.944), and perioperative non-steroidal anti-inflammatory drug administration (odds ratio 7.930; 95% confidence interval 1.004-62.64) were revealed as overall post-tonsillectomy hemorrhage risk factors. To analyze the hemorrhage period after tonsillectomy, we categorized the post-tonsillectomy hemorrhage patients into the primary (bleeding within postoperative day one) and secondary hemorrhage (bleeding on or after postoperative day two) groups. The current smoking status and older age were risk factors for primary hemorrhage and the current smoking status and sex (male) were risk factors for secondary hemorrhage.

Conclusions: In this study, smoking status, sex, and perioperative non-steroidal anti-inflammatory drug administration were the clinical risk factors for adult post-tonsillectomy hemorrhage. Thus, smoking cessation is, at least, mandatory for patients who receive tonsillectomy to avoid post-tonsillectomy hemorrhage.

Level of evidence: 4.

Keywords: adult; adult tonsillectomy; postoperative hemorrhage; smoking.

Conflict of interest statement

The authors have no conflict of interest to disclose.

© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.

Figures

FIGURE 1
FIGURE 1
Periods and categories of PTH. Among the 71 patients, eight had primary hemorrhage, and 63 had secondary hemorrhage. There were two peaks of frequency on postoperative days 0 and 6

References

    1. Hall MJ, Schwartzman A, Zhang J, Liu X. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report. 2017;102:1‐15.
    1. 4th NDB Open Data Japan, The Ministry of Health, Labour and Welfare, 2010.
    1. Hoddeson EK, Gourin CG. Adult tonsillectomy: current indications and outcomes. Otolaryngol Head Neck Surg. 2009;140:19‐22.
    1. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160:S1‐S42.
    1. Johnson LB, Elluru RG, Myer CM 3rd. Complications of adenotonsillectomy. Laryngoscope. 2002;112:35‐36.
    1. De Luca Canto G, Pacheco‐Pereira C, Aydinoz S, et al. Adenotonsillectomy complications: a meta‐analysis. Pediatrics. 2015;136:702‐718.
    1. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative bleeding and associated utilization following tonsillectomy in children. Otolaryngol Head Neck Surg. 2017;156:442‐455.
    1. Spektor Z, Saint‐Victor S, Kay DJ, Mandell DL. Risk factors for pediatric post‐tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016;84:151‐155.
    1. Tomkinson A, Harrison W, Owens D, Fishpool S, Temple M. Postoperative hemorrhage following adenoidectomy. Laryngoscope. 2012;122:1246‐1253.
    1. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope. 2011;121:2553‐2560.
    1. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005;132:281‐286.
    1. Meng H, Ohtake H, Ishida A, Ohta N, Kakehata S, Yamakawa M. IgA production and tonsillar focal infection in IgA nephropathy. J Clin Exp Hematop. 2012;52:161‐170.
    1. Noda Y. Pre‐operative diagnosis for dermatoses due to tonsillar focal infections: recent views. Auris Nasus Larynx. 1989;16(suppl 1):S59‐S64.
    1. Windfuhr J, Seehafer M. Classification of haemorrhage following tonsillectomy. J Laryngol Otol. 2001;115:457‐461.
    1. Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post‐tonsillectomy bleeding between children and adults. Auris Nasus Larynx. 2010;37:456‐460.
    1. Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N. Risk factors for post‐tonsillectomy hemorrhage. Auris Nasus Larynx. 2014;41:376‐379.
    1. Galindo Torres BP, De Miguel Garcia F, Whyte Orozco J. Tonsillectomy in adults: analysis of indications and complications. Auris Nasus Larynx. 2018;45:517‐521.
    1. Hoshino T, Tanigawa T, Yanohara G, et al. Effect of body mass index on posttonsillectomy hemorrhage. Biomed Res Int. 2017;2017:9610267.
    1. Seyhun N, Dizdar SK, Coktur A, et al. Risk factors for post‐tonsillectomy hemorrhage in adult population: does smoking history have an impact? Am J Otolaryngol. 2020;41:102341.
    1. Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 2008;134:811‐814.
    1. Giger R, Landis BN, Dulguerov P. Hemorrhage risk after quinsy tonsillectomy. Otolaryngol Head Neck Surg. 2005;133:729‐734.
    1. Cinamon U, Goldfarb A, Marom T. The impact of tobacco smoking upon chronic/recurrent tonsillitis and post tonsillectomy bleeding. Int Arch Otorhinolaryngol. 2017;21:165‐170.
    1. Saetta M, Turato G, Baraldo S, et al. Goblet cell hyperplasia and epithelial inflammation in peripheral airways of smokers with both symptoms of chronic bronchitis and chronic airflow limitation. Am J Respir Crit Care Med. 2000;161:1016‐1021.
    1. Yamashita S, Yamaguchi H, Sakaguchi M, et al. Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients. Respir Med. 2004;98:760‐766.
    1. Hardman MJ, Waite A, Zeef L, Burow M, Nakayama T, Ashcroft GS. Macrophage migration inhibitory factor: a central regulator of wound healing. Am J Pathol. 2005;167:1561‐1574.
    1. Coordes A, Soudry J, Hofmann VM, Lenarz M. Gender‐specific risk factors in post‐tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol. 2016;273:4535‐4541.
    1. Marret E, Flahault A, Samama CM, Bonnet F. Effects of postoperative, nonsteroidal, antiinflammatory drugs on bleeding risk after tonsillectomy: meta‐analysis of randomized, controlled trials. Anesthesiology. 2003;98:1497‐1502.
    1. Moiniche S, Romsing J, Dahl JB, Tramer MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg. 2003;96:68‐77.
    1. Riggin L, Ramakrishna J, Sommer DD, Koren G. A 2013 updated systematic review & meta‐analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti‐inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol. 2013;38:115‐129.
    1. Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Postoperative hemorrhage following tonsillectomy in adults: analysis of population‐based inpatient cohort in Taiwan. Auris Nasus Larynx. 2019;46:397‐406.
    1. Kim J, Bhattacharjee R, Dayyat E, et al. Increased cellular proliferation and inflammatory cytokines in tonsils derived from children with obstructive sleep apnea. Pediatr Res. 2009;66:423‐428.
    1. Stoodley P, Debeer D, Longwell M, et al. Tonsillolith: not just a stone but a living biofilm. Otolaryngol Head Neck Surg. 2009;141:316‐321.
    1. Cooper MM, Steinberg JJ, Lastra M, Antopol S. Tonsillar calculi. Report of a case and review of the literature. Oral Surg Oral Med Oral Pathol. 1983;55:239‐243.
    1. Caldas MP, Neves EG, Manzi FR, de Almeida SM, Boscolo FN, Haiter‐Neto F. Tonsillolith—report of an unusual case. Br Dent J. 2007;202:265‐267.
    1. Mueller J, Boeger D, Buentzel J, et al. Population‐based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol. 2015;272:3769‐3777.
    1. Tolska HK, Takala A, Pitkaniemi J, Jero J. Post‐tonsillectomy haemorrhage more common than previously described—an institutional chart review. Acta Otolaryngol. 2013;133:181‐186.
    1. Perkins JN, Liang C, Gao D, Shultz L, Friedman NR. Risk of post‐tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope. 2012;122:2311‐2315.
    1. Lowe D, van der Meulen J. National Prospective Tonsillectomy A. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet. 2004;364:697‐702.
    1. Kim MK, Lee JW, Kim MG, Ha SY, Lee JS, Yeo SG. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol. 2012;269:977‐981.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren