Risk Factors for Postoperative Bleeding After Adenoidectomy

Overview

Journal Children (Basel)

Specialty Health Services

Date 2021 Apr 3

PMID 33801025

Authors

Milan Urik

Michal Bartos

Sona Sikolova

Jana Jancikova

Klara Perceova

Jiri Jarkovsky

Eva Klabusayova

Petr Stourac

Petr Jabandziev

Affiliations

Soon will be listed here.

Abstract

Importance: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable.

Objective: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children.

Design: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding.

Setting: Tertiary pediatric otorhinolaryngology center.

Participants: A total of 288 children aged 0-18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome.

Main Outcomes And Measures: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy.

Results: Elevated systolic ( = 0.046), diastolic ( = 0.012), and mean arterial blood pressure ( = 0.007) (Mann-Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery ( < 0.001) (Fisher's exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon's level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy.

Conclusions And Relevance: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

Citing Articles

[Prediction of hemorrhage rate after tonsil surgery in children based on random forest model].

Xu H, Qiu S, Wang J, Han F, Xia Z, Ni L Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024; 38(10):883-890.

PMID: 39390924 PMC: 11839569. DOI: 10.13201/j.issn.2096-7993.2024.10.001.

References

Arnoldner C, Grasl M, Thurnher D, Hamzavi J, Kaider A, Brunner M . Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr. 2008; 120(11-12):336-42. DOI: 10.1007/s00508-008-0982-9. View

Licameli G, Jones D, Santosuosso J, Lapp C, Brugnara C, Kenna M . Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy. Otolaryngol Head Neck Surg. 2008; 139(4):546-550. DOI: 10.1016/j.otohns.2008.06.021. View

Scheckenbach K, Bier H, Hoffmann T, Windfuhr J, Bas M, Laws H . [Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count]. HNO. 2007; 56(3):312-20. DOI: 10.1007/s00106-007-1585-x. View

Manning S, Beste D, McBride T, GOLDBERG A . An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol. 1987; 13(3):237-44. DOI: 10.1016/0165-5876(87)90104-2. View

Singh J, Bhardwaj B . The Comparison between Microdebrider Assisted Adenoidectomy and Coblation Adenoidectomy: Analyzing the Intraoperative Parameters and Post-operative Recovery. Indian J Otolaryngol Head Neck Surg. 2020; 72(1):59-65. PMC: 7040151. DOI: 10.1007/s12070-019-01736-5. View

Mutz I, Simon H . [Hemorrhagic complications after tonsillectomy and adenoidectomy. Experiences with 7,743 operations in 14 years]. Wien Klin Wochenschr. 1993; 105(18):520-2. View

Simpson P . Perioperative blood loss and its reduction: the role of the anaesthetist. Br J Anaesth. 1992; 69(5):498-507. DOI: 10.1093/bja/69.5.498. View

Liao R, Li J, Liu G . Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol-remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children. Eur J Anaesthesiol. 2010; 27(11):930-4. DOI: 10.1097/EJA.0b013e32833d69ad. View

Lowe D, Brown P, Yung M . Adenoidectomy technique in the United Kingdom and postoperative hemorrhage. Otolaryngol Head Neck Surg. 2011; 145(2):314-8. DOI: 10.1177/0194599811403119. View

10.

Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A . The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol. 2001; 61(3):217-22. DOI: 10.1016/s0165-5876(01)00574-2. View

11.

. Bispectral index monitor: an evidence-based analysis. Ont Health Technol Assess Ser. 2012; 4(9):1-70. PMC: 3387745. View

12.

Kim J, Kim H, Lee W, Kim D, Kim S, Kim Y . Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study. PLoS One. 2015; 10(8):e0135304. PMC: 4534417. DOI: 10.1371/journal.pone.0135304. View

13.

Wang K, Yang K, Su F, Chen Y, Hsieh Y, Huang S . Association between blood pressure and postoperative hematomas in the patients undergoing head and neck cancer reconstruction. Head Neck. 2019; 41(9):3241-3246. DOI: 10.1002/hed.25831. View

14.

Sivarajan M, AMORY D, Everett G, Buffington C . Blood pressure, not cardiac output, determines blood loss during induced hypotension. Anesth Analg. 1980; 59(3):203-6. View

15.

Windfuhr J, Chen Y, Remmert S . Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005; 132(2):281-6. DOI: 10.1016/j.otohns.2004.09.007. View

16.

. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(2 Suppl 4th Report):555-76. View

17.

Chorney S, Dailey J, Zur K . Pediatric adenoidectomy in the very young child and indications for postoperative inpatient admission. Int J Pediatr Otorhinolaryngol. 2019; 130:109796. DOI: 10.1016/j.ijporl.2019.109796. View

18.

Kaminski M, Cieslik-Guerra U, Kotas R, Mazur P, Maranda W, Piotrowicz M . Evaluation of the impact of atmospheric pressure in different seasons on blood pressure in patients with arterial hypertension. Int J Occup Med Environ Health. 2016; 29(5):783-92. DOI: 10.13075/ijomeh.1896.00546. View

19.

Araz O, Yilmazel Ucar E, Akgun M, Aydin Y, Meral M, Saglam L . Is atmospheric pressure change an Independent risk factor for hemoptysis?. Pak J Med Sci. 2014; 30(3):596-600. PMC: 4048514. DOI: 10.12669/pjms.303.5063. View

20.

Tomkinson A, Harrison W, Owens D, Fishpool S, Temple M . Postoperative hemorrhage following adenoidectomy. Laryngoscope. 2012; 122(6):1246-53. DOI: 10.1002/lary.23279. View