Preoperative plasma fibrinogen as a predictive factor for post‐tonsillectomy haemorrhage

Abstract

Objectives To assess whether preoperative plasma fibrinogen is able to predict severe post‐tonsillectomy haemorrhage. Study design Retrospective chart review. Methods We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. Results 414 (90.8%) had no severe post‐tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (P = .023) in patients with a severe bleeding. Univariate Cox‐regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (P = .003; HR 2.66; 95% CI 1.38‐5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post‐tonsillectomy haemorrhage (P = .016; HR 15.4; 95% CI 0.01‐0.6). High preoperative PFL was associated with significantly higher risk for post‐tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. Conclusions Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.

A novel electrosurgical divider: performance in a self-controlled tonsillectomy study

“…In the present study, 2 type III events (4.2%) occurred on the control side (none on the device side). This percentage was lower than the rates reported in two larger studies, which showed 5.6% and 9.2% RTT events [4,20]. Currently, the use of this device has increased in the ENT community, which will generate larger data sets.…”

Is it possible to predict post-adenotonsillectomy hemorrhage in children with preoperative blood tests? Single-center retrospective study

“…14,15 Other authors consider elevated preoperative levels of plasma fibrinogen to be a significantly worse prognostic factor for post-tonsillectomy hemorrhage. 9…”

“…Lately, the lymphocyte count (absolute, relative, neutrophile to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)) has been studied in relation to different types of bleeding (GI tract bleeding, intracranial, cardiothoracic hemorrhage, post-tonsillectomy hemorrhage) 7,8 ; fibrinogen levels 9 and C-reactive protein levels 10,11 have been associated with the risk of post-tonsillar or upper or lower GI tract bleeding.…”

Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis

“…However, wound infection, early intake of solid/hot food, and frequent coughing can induce pseudo-membrane instability and hemorrhage. 34 Some patients in this study underwent intraoperative suturing to close the wound in the tonsillar fossa with the aim of reducing wound exposure to food, infection risk, and postoperative pain. Previously published data in this cohort showed that intraoperative suture reduced secondary PTH incidence and PTH severity, with no patients in the suture group experiencing primary PTH.…”