Gender-specific risk factors in post-tonsillectomy hemorrhage

Abstract

There are gender-specific differences in the frequency and course of different diseases. Specifically, some studies have shown an increased risk of post-tonsillectomy hemorrhage (PTH). The aim of the study was to investigate gender-specific risk factors for hemorrhage after tonsillectomy (TE)/abscess-TE. We anonymously reviewed and recorded the relevant data of all patients (≥14 years) who underwent a TE/abscess-TE between 2011 and 2013 in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin. A patient survey was used to complete missing data. We analyzed gender-specific risk factors for PTH. During the study period, 460 operations were performed and the data of 250 patients were analyzed (213 TE and 37 abscess-TE). The median patient age was 27 years (ranging from 14 to 83 years). The rate of primary PTH (<24 h after TE/abscess-TE) was 3 %, and the rate of secondary PTH (>24 h) was 23 %. A significantly higher PTH rate was associated with males (p = 0.037), which was still apparent in ages 21-30 after sub-classification. Multivariate analysis calculated diagnosis, regular alcohol consumption and administration of glucocorticoids to be independent risk factors associated with gender. In conclusion, the PTH rate is gender-specific, and male patients are at higher risk, especially in young adulthood. Therefore, doctors should advise male patients of the increased risk of bleeding and stress the importance of compliance. Also, close postoperative follow-up is desirable.

Post-tonsillectomy haemorrhage in Australia—a multivariable analysis of risk factors

“…Whilst numerous studies have been conducted on PTH, there is still significant variation in the reported rates of secondary PTH (5,8,10,14,28,29). The secondary PTH rate in this study is 6.9%, which is consistent with reported rates in literature, with Australian studies reporting PTH rates ranging from 2.0% to 7.7% (18,21,22).…”

“…Several studies have found an association between surgical experience and PTH rates, thought to be due to the use of excessive diathermy for haemostasis in the tonsillar fossa, resulting in a higher likelihood of clot sloughing (8,10,14). However, this study as well as multiple previous studies did not demonstrate any significant association between PTH rates and the surgeon's experience, from house medical officers to consultant surgeons (17,28,33). It is of note that all tonsillectomies performed at our centre were performed or supervised by consultant otolaryngologists which may limit the significance of this finding.…”

“…Previous studies have reported conflicting results with regards to the role of gender as a risk factor for PTH, with some studies showing males being associated with significantly greater risk of PTH (5,8,10,28,32), Coordes et al found a significantly greater rate of PTH in males and postulated the possibility of sex hormone differences as well as lower rates of medication compliance as possible causes (28). However, other factors are likely contributing to these gender differences in PTH as Coordes et al also reported a greater proportion of male patients with surgical indications of peritonsillar abscess.…”

Risk factors of post‐tonsillectomy hemorrhage in adults

“…Another research group reported a retrospective study, which found that men had significantly more regular alcohol consumption than women, resulting in an increased risk of complications from bacterial infections, including peritonsillar abscess, thereby increasing the incidence of PTH (hazard ratio 2, confidence interval 1.1-3.8). 26 Furthermore, there was a higher proportion of current smokers in male than in female patients (24.8% vs 18.7%). Smoking might be influenced significantly in male patients, but both male patients and smoking status were independent risk factors for PTH in multivariate analysis.…”

Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

“…[1] Die Nachblutung ist eine gefürchtete Komplikation. Neben der chirurgischen Technik [2], [3], der Durchführung einer TE wegen rezidivierender Tonsillitiden sowie bei Kindern mit Aufmerksamkeits-Defizit-Hyperaktivitäts-Störung (ADHS) oder höherem Alter [4] und zahlreichen anderen Risikofaktoren [5], [6], werden auch postoperative Schmerzen mit einem erhöhten Nachblutungsrisiko in Verbindung gebracht [7].…”