Assessment of Operative Blood Loss and the Factors Affecting it in Tonsillectomy and Adenotonsillectomy

Abstract

To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the various factors affecting it. A prospective study of estimation of blood loss in 100 patients who underwent tonsillectomy and adenotonsillectomy. Data collected included the age, sex, operative indication, clotting time, Hb levels and usage of pre-operative antibiotics. Cold knife dissection method for tonsillectomy and curettage method for adenoidectomy were used. Measurement by calorimetric method of estimation being simple and accurate was used for estimation. Study undertaken at a tertiary referral hospital catering to an urban, semi-urban and rural populace. Blood loss was more in males and increases as age advances both in adenotonsillectomy and tonsillectomy. Blood loss was more in fibrosed tonsils, at lower hemoglobin levels and at higher clotting times. It was less in cases who received pre-operative antibiotics. The average blood losses in males and females during tonsillectomy were 106.91 and 96.26 ml respectively. In adenotonsillectomy, the average blood losses in males and females were 81.44 and 76.82 ml respectively. In our series we found that blood loss in tonsillectomy and adenotonsillectomy depended on various factors like age, sex, the type of tonsillitis, method of dissection, hemoglobin concentration, clotting time and the use of antibiotics. All these factors must be taken into consideration while taking up patients especially those who cannot tolerate blood loss, for surgery.

Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It

“…So, even a moderate blood loss will lead to hemodynamic instability and complications [1]. Thus the estimation of blood loss for nearly all pediatric surgeries and a more widespread appreciation of the equivalent quantities for adults and children would do much to reduce dangerous imbalance of blood volume [12].…”

“…This finding correlates with Holden and Maher's [2] and Shalom's [13] study on blood loss measurement. In a study conducted by KC Prasad and SC Prasad [1], it was shown that the older the child is, the greater the blood loss is. Though the difference in mean blood loss between males and females was 10.03 ml, it was not statistically significant (P > 0.05).…”

“…There are many studies which show bleeding as the most common complication of adenotonsillectomy and various methods to reduce blood loss [1]- [7], but only very few studies have dealt with measurement of adenotonsillectomy blood loss [1] [3]- [7]. It is difficult to accurately measure the operative blood loss in adenotonsillectomy [1].…”

“…It is difficult to accurately measure the operative blood loss in adenotonsillectomy [1]. Various methods of blood loss measurement have been suggested.…”

Predicting early and delayed bleedings in children who undergo adeno‐tonsillectomy surgery. Is it really possible?

“…Different AT-surgery techniques and antibiotic prophylaxis have widely reduced the risk of bleeding [9] but it is still uncertain if a latent MBD could be responsible of some surgery-related bleeds. The aim of our study was to evaluate the efficacy of PBQ, standard laboratory tests (PLT, PT and APTT) and bleeding time (BT) in predicting the bleeding risk in a population of children undergoing AT surgery.…”