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The Egyptian Journal of Otolaryngology
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Factors affecting secondary post-tonsillectomy hemorrhage: a case—control study

The Egyptian Journal of Otolaryngology volume 33, pages 50–55 (2017)Cite this article

Abstract

Background

Tonsillectomy is one of the commonest otolaryngological procedures performed. Multiple reports have demonstrated the safety of ambulatory (outpatient) pediatric Tonsillectomy, however Post-tonsillectomy hemorrhage remains the most serious complication of tonsillectomy.

Patients and methods

In this work, we analyzed different parameters including patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy”, technique “Cold dissection or Bipolar”, evidence of tonsillar bed infection and pre-operative hemoglobin level in two groups of patients indicated for tonsillectomy. One group of 80 patients didn’t suffer from posttonsillectomy bleeding as a control group; the other of 20 patients having secondary post-tonsillectomy bleeding.

Results

According to our statistical analysis and data, no significant difference between the two groups regarding the occurrence of secondary post-tonsillectomy in the following parameters: patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy” and preoperative hemoglobin level.

Conclusion

However there was higher incidence of secondary post tonsillectomy bleeding in patients operated by bipolar scissors. Also evidence of tonsillar bed infection raises the possibility of secondary post-tonsillectomy bleeding occurrenc.

References

  1. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005; 132:281–286.

    Article  CAS  Google Scholar 

  2. Blakley BW. Post-tonsillectomy bleeding: how much is too much. Otolaryngol Head Neck Surg 2009; 140:288–290.

    Article  Google Scholar 

  3. Liu JH, Anderson E, Willging JP, Myer CM III, Shott SR, Bratcher GO, et al. Post tonsillectomy haemorrhage. What is it and what should be recorded. Arch Otolaryngol Head Neck Surg 2001; 127:1271– 1275.

    Article  CAS  Google Scholar 

  4. Tomkinson A, de Martin S, Gilchrist CR, Temple M. Instrumentation and patient characteristics that influence postoperative hemorrhage rates following tonsil and adenoid surgery. Clin Otolaryngol 2005; 30: 338–346.

    Article  CAS  Google Scholar 

  5. Sarny S, Habermann W, Ossimitz G, Schmid C, Stammberger H. Tonsilar haemorrhage and re-admission: a questionnaire based study. Eur Arch Otorhinolaryngol 2011; 268:1803–1807.

    Article  Google Scholar 

  6. Chan YH. Biostatistics 102: quantitative data – parametric & non-parametric tests. Singapore Med J 2003; 44:391–396.

    PubMed  CAS  Google Scholar 

  7. Chan YH. Biostatistics 103: qualitative data – tests of independence. Singapore Med J 2003; 44:498–503.

    PubMed  CAS  Google Scholar 

  8. Cullen KA, Hall MJ, Golosinskiy A. National Health Statistics Reports. Number 11. 2006. Centers for Disease Control, Ambulatory Surgery in the United States.

  9. Younis RT, Lazar RH. History and current practice of tonsillectomy. Laryngoscope. 2002; 112:3–5.

    Article  Google Scholar 

  10. Wieland A, Belden L, Cunningham M. Preoperative coagulation screening for adenotonsillectomy: a review and comparison of current physician practices. Otolaryngol Head Neck Surg 2009; 140: 542–547.

    Article  Google Scholar 

  11. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 2011; 121:279–288.

    Article  Google Scholar 

  12. Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J, et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007; 117:717–724.

    Article  Google Scholar 

  13. Lowe D, van der Meulen J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004; 364:697–702.

    Article  CAS  Google Scholar 

  14. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34:1608–1616.

    Article  Google Scholar 

  15. Ahsan F, Rashid H, Eng C, Bennett DM, Ah-See KW. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort. Clin Otolaryngol 2007; 32:24–27.

    Article  CAS  Google Scholar 

  16. Stephens JC, Georgalas C, Kyi M, Ghufoor K. Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage? J Laryngol Otol 2008; 122:383–387.

    Article  CAS  Google Scholar 

  17. Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2010; 7:CD005607.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Kasr El Ainy School of Medicine, Cairo University, Cairo, 11562, Egypt

    Hesham Negm, Ahmed Atef, Hesham Lasheen, Ahmed A. Kamel (MD), Khaled Azooz & Osama Elhoussainy

Authors
  1. Hesham Negm
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  2. Ahmed Atef
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  3. Hesham Lasheen
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  4. Ahmed A. Kamel
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  5. Khaled Azooz
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  6. Osama Elhoussainy
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Corresponding author

Correspondence to Ahmed A. Kamel.

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Negm, H., Atef, A., Lasheen, H. et al. Factors affecting secondary post-tonsillectomy hemorrhage: a case—control study. Egypt J Otolaryngol 33, 50–55 (2017). https://doi.org/10.4103/1012-5574.199414

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  • DOI: https://doi.org/10.4103/1012-5574.199414

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