Post-tonsillectomy late haemorrhage: Is it a preferably night-time event?

Objective To assess post-tonsillectomy hemorrhage (PTH), associated non-operative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and also conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was below 4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also below 5% overall (4.2% for total tonsillectomy; 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH occurred with tonsillectomy for obstructive sleep-disordered breathing than throat infection. In meta-analysis, frequency of PTH-associated non-operative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least four deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Though studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus we cannot conclude that a given technique is superior.

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“…We identified 46 unique database or registry studies or case series with ≥1000 children (reported in multiple papers) addressing PTH. 3,4,123-176…”

Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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“…These two changes have ultimately reduced the experience and consequently the competence of junior doctors. 8 It has been reported that 71% of secondary post-tonsillectomy bleeding presents during the period between 9pm and 9am, 9 and SHOs covering ENT outof-hours must therefore be well versed in the management of this potentially life-threatening condition. Three of the doctors responding to our survey (9%), however, would not admit these potentially unstable patients and 80% were not aware of the use of hydrogen peroxide mouthwash as a treatment.…”

Section: Resultsmentioning

confidence: 99%

The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover

2013

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The implementation of the European Working Time Regulations (EWTR), coupled with the ongoing impact of Modernising Medical Careers (MMC), has necessitated a significant redevelopment of out-of-hours cover for surgical specialties in the UK. A review of the literature related to the provision of out-of-hours ENT cover gives an insight into the impact of these changes on a comparatively small surgical specialty. A 2008 survey revealed that three-quarters of junior doctors providing ENT out-of-hours care were crosscovering specialties other than ENT – a figure up from just over half of junior doctors in 2005, prior to stricter EWTR rules. Of all 'first-on-call' doctors for ENT, only 19–32% have prior ENT experience. Consequently, ENT services are provided frequently by inexperienced, non-enT doctors covering multiple other specialties, often as part of a 'hospital-at-night' team.

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“…In a literature based study by Blakley, he concluded that PTB rates of about 5 percent are typical [14]. In a recent study by D'Agostino et al on 3306 patients undergoing elective adenotonsillectomy by five senior surgeons with different surgical techniques, they found late post-operative hemorrhage rate of 1.78% which started all at home [15]. Benson and Mitchell found that 16% of children had experienced some bleeding when contacted at 2 weeks postoperatively [16].…”

Section: Discussionmentioning

confidence: 99%

“…Different tonsillectomy techniques have different impact on postoperative morbidity [6]. Generally tonsillectomy is considered simple procedure but, in comparison with other similar operations, it implies a common and sometimes serious complication [7]. There are several techniques for tonsillectomy and their relative effectiveness remains a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

2016

Int J Otorhinolaryngol

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Post-tonsillectomy late haemorrhage: Is it a preferably night-time event?

Cited by 10 publications

References 12 publications

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover

Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

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