Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient

Abstract

Intraoperative or postoperative hemorrhage in the patient who has undergone an adenotonsillectomy because of an unrecognized hemostatic defect may increase morbidity and can be potentially life-threatening to the patient in what should be a "routine" procedure. Preoperative identification of occult hemostatic abnormalities, coupled with perioperative management directed at correcting the effects of the defects, should serve to reduce the incidence of this distressful complication. Routine use of preoperative laboratory screening tests for this purpose has been discouraged recently as a result of concerns over cost-effectiveness and the low predictiveness of the tests for bleeding. Our experience with the routine use of a comprehensive hemostatic laboratory screening panel--which includes a bleeding time test--in the adenotonsillectomy patient population demonstrated that 11.5% of our patients had abnormal initial screening laboratory tests; these results were ultimately attributable to occult hemostatic defects. Clinical history, the universally recommended method of preoperative hemostatic assessment, failed to detect any previously unrecognized coagulation disorder. Laboratory screening improved preoperative detection of occult hemostatic defects and allowed for appropriate alterations in perioperative care. Our results with this approach are presented, along with illustrative case histories and a discussion of the current recommendations for preoperative laboratory screening of the hemostatic system, as found in a review of the literature.

Occurrence of coagulation factor deficiency in post-tonsillectomy hemorrhage

“…Including such analysis in Introduction Tonsillectomy remains one of the most commonly performed surgical procedures in the fi eld of Otorhinolaryngology. Th e most serious complication is postoperative hemorrhaging accompanied by a 2-4% risk of substantial bleeding [1]. A similar incidence could be observed in a previous retrospective study performed at the Department of Otorhinolaryngology, University Hospital of Vienna.…”

Hemostasis during cold dissection tonsillectomy: Comparing the use of adrenaline and normal saline

“…Controversies exist in the preoperative evaluation of patients for tonsillectomy especially regarding hemorrhage and its control (Bolger et al, 1990;Gabriel et al, 2000;Asaf et al, 2001) but this paper would not dwell on these issues.…”

The Usefulness of Preoperative Screening for Bleeding Disorders

“…Studies in the otolaryngology literature have shown that there is no significant increase in the risk of post-tonsillectomy bleeding in patients with abnormal coagulation studies compared to those with normal studies.1-3 However, some studies have shown that an abnormal preoperative coagulation profile may identify those patients at increased risk for perioperative bleeding. [4][5][6] While most of these studies have used perioperative bleeding as the endpoint to assess the usefulness of preoperative screening, only a few have performed detailed coagulopathy evaluations to define the bleeding disorder. 4,7 To determine if preoperative screening is useful in identifying a bleeding disorder, we retrospectively reviewed the coagulopathy evaluations of 131 children referred for a prolonged preoperative aPTT.…”