Bleeding of Post-Tonsillectomy
Authors:
Pavel Komínek 1; Viktor Chrobok 2; A. Pellant 3; J. Kraus 4; V. Černý 5,6; J. Betka 7
Authors‘ workplace:
ORL klinika, Fakultní nemocnice Ostrava, přednosta doc. MUDr. P. Komínek, Ph. D., MBA
Klinika otorinolaryngologie a chirurgie hlavy a krku, Fakultní nemocnice Hradec Králové
1; Lékařská fakulta v Hradci Králové, Univerzita Karlova v Praze, přednosta prof. MUDr. V. Chrobok, CSc., Ph. D.
Klinika otorinolaryngologie a chirurgie hlavy a krku Pardubické krajské nemocnice, a. s.
2; Fakulta zdravotnických studií Univerzity Pardubice, přednosta MUDr. J. Mejzlík, Ph. D.
3; Otorinolaryngologické oddělení, Nemocnice Rudolfa a Stefanie Benešov, a. s., primář MUDr. J. Kraus, MBA
Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové
4; přednosta prof. MUDr. V. Černý, Ph. D., FCCM
5; Department of Anesthesia, Pain, Management and Perioperative Medicíně Dalhousie University, Halifax, Nova Scotia, Canada
Klinika ORL a chirurgie hlavy a krku 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol
6; přednosta prof. MUDr. J. Betka, DrSc., FCMA
7
Published in:
Otorinolaryngol Foniatr, 63, 2014, No. 1, pp. 41-49.
Category:
Survey Articles
Overview
Tonsillectomy is one of the most frequent surgeries performed by otorhinolaryngologists and bleeding is the most serious post-operative complication. Primary bleeding occurs during hospitalization of the patient and the measures can be taken immediately, whereas treatment of secondary bleeding may be problematic. In the paper, the authors give a review of the risk factors of post-tonsillectomy bleeding and the factors that influence the bleeding.
There is no clear definition of post-tonsillectomy bleeding, therefore the study results vary. Postoperative bleeding occurs in 2-15%. Questionnaire-based studies show that bleeding occurs more often than is believed among health care professionals. The bleeding is more frequent when using hot tonsillectomy techniques (although some studies do not suggest so). A negative history of hemorrhagic disorders is the most important factor for prediction of non-surgical bleeding. There is a greater risk of bleeding in adult patients and males. Indication of tonsillectomy seems not to influence the bleeding frequency. First postoperative bleeding increases the risk of subsequent, more serious bleeding approximately twice. The risk is also increased when using certain medications (e.g. aspirin). The influence of surgeon’s experience is not clear.
Rarely, the post-tonsillectomy bleeding can be life-threatening. There is a lack of exact data on their incidence because there is no systematic monitoring of these events. Despite of all the measures that can be taken it is not always possible to prevent the death of the patient or severe neurological consequences (due to cardiac arrest and resuscitation).
At the conclusion of the paper, there is a summary of basic measures necessary for treatment of both nonsevere and severe post-tonsillectomy bleeding.
Keywords:
tonsillectomy, bleeding, life-threatening bleeding, incidence, factors influencing the bleeding, treatment measures for bleeding
Sources
1. American Academy of Otolaryngology-Head neck Surgery. Tonsillectomy and Adenoidectomy Inpatient Guidelines. Recommendations of the AAO-HNS Pediatric Otolaryngology Commiteee. St. Louis, MO:Mosby, 1996, s. 1-4.
2. Alexander, R. J., Kikreja, R., Ford, G. R.: Secondary posttonsillectomy haemorrhage and informed consent. J. Laryngol Otol, 118, 2004, s. 937-940.
3. Al-Shehri, A. M. S.: Post-tonsillectomy pain and bleeding in children: A comparison of traditional tonsillectomy with electrodissection tonsillectomy. Curr. Pediatr. Res., 16, 2012, č. 2, s.150-152.
4. Czarnetzki, C., Elia, N., Lysakiwski, C.: Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: A randomized trial. JAMA, 300, 2008, s. 2621-2630.
5. Evans, A. S., Khan, A. M., Zouny, D., Adamson, R.: Assessment of secondary haemorrhage rates following adult tonsillectomy – a telephone survey and literature review. Clin. Otolaryngol. Allied Sci., 28, 2003, č. 6, s. 489-491.
6. Ghufoor, K., Frosh, A., Sandhu, G., Hanif, J.: Post-tonsillectomy patient care in the community. Int. J. Clin. Pract., 54, 2000, č. 7, s. 420-423.
7. Harris, R. L., Mitchell, J. E., Jonathan, D. A.: A telephone audit in paralel with the UK national tonsillectomy audit to investigate readmission as a measure of secondary haemorrhage rate. Auris Nasus Larynx, 35, 2008, č. 2, s. 220-223.
8. Helmus, C., Grin, M., Westfall, R.: Same-day-stay adenotonsillectomy. Laryngoscope, 100, 1990, s. 593-596.
9. Chowdhury, K., Teslak, T. L., Schloss, M. D.: Post-tonsillectomy and adenoidectomy hemorrhagie. J. Otolaryngol, 17, 1988, s. 46-49
10. Chrobok, V., Pellant, A., Janouch, J., Komínek, P., Kabelka, Z., Šlapák, I.: Problematika předoperačního vyšetření před adenotomií a tonzilektomií u dětí. Otorinolaryng. a Foniat. /Prague/, 58, 2010; č. 4, s. 232-236
11. Irani, D. B., Berkowitz, R. G.: Management of secondary hemorrhagie following pediatric adenotonsillectomy. Int. J. Pediatr. Otorhinolaryngol., 40, 1997, s. 115-124.
12. Kim, M. K., Lee, J. W., Kim, M. G., Ha, S. Y., Lee, J. S., Yeo, S. G.: Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch. Otorhinolaryngol., 269, 2011, s. 977-981.
13. Klimák, P., Lischkeová, B., Astl, J., Kuchynková, Z.: Komplikace po tonzilektomii. Otorinolaryng. a Foniat./Prague/, 49, 2000, č. 1, s. 25-28.
14. Komínek, P., Chrobok, V., Astl, M. et al.: Záněty hltanu. Havlíčkův Brod,Tobiáš, 2005, s. 323.
15. Krishna, P., Lee, D.: Post-tonsillectomy bleeding: a meta-analysis. Laryngoskope, 111, 2001, s. 1358-1361.
16. Kuo, M.: Early post-tonsillectomy morbidity following hospital discharge: do patiens and GPs know what to expect? Health Trends, 27, 1995, s. 98-100.
17. Lee, M. S., Mongague, M. L., Hussain, S. S.: Post-tonsillectomy hemorrhagie: cold versus hot dissection. Otolaryngol. Head Neck Surg., 131, 2004, s. 833-836.
18. Lowe, D., van der Meulen, J.: Tonsillectomy technique as a risk factor for postoperative haemorgage. Lancet, 34, 2004, s. 697-702.
19. Lowe, D., van der Meulen, J., Cromwell, D. et al: Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope, 117, 2007, s. 717-724.
20. Mowatt, G., Cook, J. A., Fraser, C., McKerrow, W. S.,Burr, J. M.: Systematic review of the safety of electrosurgery for tonsillectomy. Clin. Otolaryngol., 31, 2006, s. 95-102.
21. Pellant, A., Eliáš, P., Náhlovský, J.: Anomálie a variace velkých tepen hlavy a krku z pohledu otorinolaryngologa. Choroby hlavy a krku. Head and Neck Diseases, 4, 1995, č. 1, s. 32-35.
22. Randall, D. A., Hober, M. E.: Complicatons of tonsillectomy and adenoidectomy. Otolaryngol. Head Neck Surg., 118, 1998, č. 1, s. 61-69.
23. Reiner, S. A., Sawyer, W. P., Clark, K. F., Wood, M. W.: Safety of outpatient tonsillectomy and adenoidectomy. Otolaryngol. Head Neck Surg., 102, 1990, s.161-168.
24. Sarny, S., Ossimitz, G., Habermann, W., Stammberger, H.: Hemorrhagie following tosil srgery: A multicenter prospective study. Laryngoskope, 121, 2011, s. 2553-2556.
25. Sarny, S., Habermann, W., Ossimitz, G., Schmidt, Ch., Stammberger, H.: Tonsilar haemorrhage and re-admission: a questionnaire based study. Eur Arch. Otorhinolaryngol., 268, 2011, s. 1803-1807.
26. Smith, I,, Wilde, A.: Secondary tonsillectomy haemorrgahe and non-steroidal antiinflammatory drugs. J. Laryngol. Otol., 113, 1999,1, s. 28-30.
27. Swoboda, H., Welleschik, B.: A severe late tonsila hemorrhagie 2 months postoperatively. Otolaryngol. Rhinol Otol. (Stuttg.), 67, 1988, s. 431-433.
28. Školoudík, L., Dufek, Z., Vokurka, J., Čelakovský, P.: Krvácení po tonzilektomii. Otorinolaryng. a Foniat./Praque/, 54, 2005, č. 1, s. 42-46.
29. Tomkinson, A., Harrison, W., Owens, D., Hartus, S., McClure, V., Temple, M.: Risk factors for postoperative hemorrhagie following tonsillectomy. Laryngoscope, 121, 2011, s. 279-288.
30. Wei, J. L., Beatty, C. W., Gustafson, R. O.: Evaluation of post tonsillectomy hemorrhagie and risk factors. Otolaryngol. Head Neck Surg., 123, 2000, č. 3, s. 229-235.
31. Windfuhr, J. P., Chen, Y. S., Remmert, S.: Haemorrhagie following tonsillectomy and adenoidectomy in 15 218 patients. Otolaryngol. Head Neck Surg., 132, 2005, č. 2, s. 281-286.
32. Windfuhr, J. P., Schloendorff, G., Baburi, D., Kremer, B.: Life-threatening posttonsillectomy hemorrhagie. Laryngoskope, 118, 2008, s.1389-1394.
33. Windfuhr, J. P.: Excessive post-tonsillectomy hemorrhagie requiring ligature of the external carotid artery. Auris Nasus Larynx, 29, 2002, s. 159-164.
34. Windfuhr, J. P., Wienke, A., Chen, Y. S.: Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhagie. Eur Arch. Otorhinolaryngol., 266, 2009, s. 111-116.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
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