Our experience with pre-operative haemostatic assessment of paediatric patients undergoing adenotonsillectomy at Federal Medical Centre, Makurdi

Abstract

Background:In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, pre-operative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. However, because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in paediatric patients undergoing adenoidectomy, tonsillectomy or both in our centre.Patients and Methods:This is a 3½-year analysis of the data of 165 paediatric patients who had adenoidectomy, tonsillectomy or both over the study period. The data collected included age, sex, procedure done and detailed clinical bleeding history.Results:A total of 165 children had either adenoidectomy or tonsillectomy, or both. There were 76 males and 89 females giving a male to female ratio of 1:1.2. Their ages ranged from 10 months to 18 years. Eighty-five (51.5%) patients had adenotonsillectomy, 48 (29.1%) and 32 (19.4%) had only tonsillectomies and adenoidectomies, respectively. Only 11 (6.7%) families volunteered the history of either prolonged bleeding with minor injury on the skin or occasional slight nose bleeding. Six (3.6%) patients including 3 of the children with positive family history had posttonsillectomy bleed, out of which 4 (66.7%) were moderate whereas the remaining 2 (33.3%) were severe bleeding, which was not statistically significant (P = 0.041). The two cases of severe bleeding had fresh whole blood transfused whereas the rest that had no bleeding issues were discharged home 48 h postoperatively.Conclusion:Our experience in this study suggests that detailed bleeding history is necessary as well as pre-operative haemostatic assessment, if available and affordable for paediatric patients undergoing adenotonsillectomy.

Risk Factors for Postoperative Bleeding after Adenoidectomy

“…We found that the risk of bleeding is not higher in a patient with a positive coagulation test (some pathological values) or with a positive coagulation questionnaire. Many studies consider the coagulation questionnaire to be sufficient, effective, and more cost-effective than routinely performing laboratory coagulation tests [ 20 , 21 , 22 ].…”

Screening for von Willebrand disease does not impact posttonsillectomy bleeding in a low‐risk population

“…Postoperative bleeding may uncover an undiagnosed bleeding disorder. Screening with general coagulation tests prior to the procedure have become common to assess bleeding risk in the perioperative period despite inconsistent data to support this practice 3–6 . ASH/ASPHO Choosing Wisely guidelines recommend against routine PT/PTT testing for otherwise healthy children without significant personal or family history of bleeding symptoms 7 .…”

“…Screening with general coagulation tests prior to the procedure have become common to assess bleeding risk in the perioperative period despite inconsistent data to support this practice. [3][4][5][6] ASH/ASPHO Choosing Wisely guidelines recommend against routine PT/PTT testing for otherwise healthy children without significant personal or family history of bleeding symptoms. 7 PT and PTT are not sensitive tests for the diagnosis of the most common inherited bleeding disorders, including von Willebrand disease (VWD).…”