Recurrent post tonsillectomy bleeds: Presentation and characteristics in the paediatric population

Meer, Graeme van der; Gruber, Maayan; Mahadevan, Murali

doi:10.1016/j.ijporl.2017.04.046

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…1 Bhattacharyya reported that the risk of a second episode of hemorrhage is 17.5% in patients with any bleed and 0.36% in 79,520 pediatric patients 34 ; van der Meer et al found that the risk of a second episode of bleedings is 3.8% in patients with any bleed and 0.17% in 5,400 patients who underwent tonsillectomy. 35 Similar to our findings, van der Meer reported that abnormal coagulation, NSAID usage, or severity of the first bleed did not predict the risk of multiple hemorrhages. 35 Variability in the reported incidence and risk of multiple hemorrhages is likely attributable to inherent differences in study sample characteristics, as well as alternative management of postoperative bleeding.…”

Section: Discussionsupporting

confidence: 90%

“…35 Similar to our findings, van der Meer reported that abnormal coagulation, NSAID usage, or severity of the first bleed did not predict the risk of multiple hemorrhages. 35 Variability in the reported incidence and risk of multiple hemorrhages is likely attributable to inherent differences in study sample characteristics, as well as alternative management of postoperative bleeding. To our knowledge, our study is the largest single-site study investigating risks of subsequent hemorrhage following a single PTH.…”

Section: Discussionsupporting

confidence: 90%

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Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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Objectives/Hypothesis Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. Study Design Retrospective chart review. Methods A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary‐care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. Results Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47‐6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06‐4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. Conclusions Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. Level of Evidence 4 Laryngoscope, 129:2765–2770, 2019

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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“…2 The overall re-admission rate of 15.5% and the return to theatre rate of 3.1% also represent some of the highest rates in the literature. [3][4][5][6][7][8][9][10] Furthermore, across the major Health Boards in Scotland, the tonsillar haemorrhage and return to theatre rates are of a similar pattern. patients with an infective indication for their tonsillectomy, and older patients, are at increased risk of post-tonsillectomy haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study

Milner

Hilmi

Marshall

et al. 2020

Clinical Otolaryngology

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Post-tonsillectomy haemorrhage is the principal complication that can occur following tonsillectomy. The consequences for the patient can include hospital admission, blood transfusion, return to theatre for arrest of haemorrhage and rarely mortality. 1 It is therefore of vital importance to accurately determine the rate of post-tonsillectomy haemorrhage and to identify factors that would decrease its incidence. The National Prospective Tonsillectomy Audit (NPTA), published in 2005, was conducted with the aim of addressing these issues. 2 It

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“…This is consistent with previous studies in the literature which report a rebleeding rate of between 4% and 17.5% for children following their initial PTAH. [10][11][12] Total number of paƟents admiƩed with PTAH In our cohort, children with recurrent PTAH were 4 times more likely to require surgical management and 8 times more likely to undergo a blood transfusion compared to those who present only once. This may reflect the lower threshold for operative intervention for children with recurrent PTAH, as well as the lower hemoglobin concentrations following recurrent PTAH, with children in our cohort having a mean hemoglobin drop of 16.6 g/L between presentations.…”

Section: Discussionmentioning

confidence: 99%

Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children

et al. 2021

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Objective: To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14. Methods: A retrospective chart review was performed for all pediatric patients admitted to The Children’s Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis. Results: Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage. Conclusions: Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.

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Recurrent post tonsillectomy bleeds: Presentation and characteristics in the paediatric population

Cited by 11 publications

References 9 publications

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study

Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children

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