Sains Malaysiana 48(3)(2019): 621–627

http://dx.doi.org/10.17576/jsm-2019-4803-15

Incidence and Risk Factors of Post-Tonsillectomy Haemorrhage in Patients Operated during the 2012-2016 Period at ENT Department Hospital Serdang, Malaysia

(Kejadian dan Faktor Risiko Pendarahan Selepas Tonsilektomi bagi Pesakit yang Dibedah Sepanjang Tempoh 2012-2016 di Jabatan ENT Hospital Serdang, Malaysia)

SETHU T. SUBHA*, ATIQAH FARAH, Z., CHONG, K.M., NOR ASHIKIN, A.H. & MUHAMMAD FIKRI, S.

Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia

Received: 5 October 2018/Accepted: 11 January 2019

ABSTRACT

Tonsillectomy is the most common operation performed in the field of Ear, Nose and Throat (ENT) Surgical speciality. Post-tonsillectomy haemorrhage remains a significant complication leading to morbidity and occasional mortality. The main objective of this study was to evaluate the incidence and risk factors of post-tonsillectomy haemorrhage in a cohort of patients who had been operated at our institution. This retrospective cohort study reviewed the medical records of all patients who underwent tonsillectomy from 1st January 2012 to 31st December 2016. Data on patient’s age, gender, race, smoking habit, indication for tonsillectomy, duration and technique of surgery, usage of post-operative drugs and management were recorded. Out of 315 patients included this study, 54.9% were adults (12 years and above) and majority (86.3%) of them were of Malay descent. The common indication for tonsillectomy was recurrent tonsillitis (84.4%). This study showed significant associations (p<0.05) between age, smoking and the use of steroids with post-tonsillectomy haemorrhage. However, there was no significant association between gender, race, use of post-operative drugs (non-steroidal anti-inflammatory drugs, antibiotics), duration of surgery, the technique of surgery and post-tonsillectomy haemorrhage. The incidence of post-tonsillectomy haemorrhage in our population was 10.5 % (n=33) and among them, 54.5 % (n=18) required surgical intervention. Our study demonstrated that older patients (12 years and above), smokers and the use of steroids during the post-operative period have increased the risk of post-tonsillectomy haemorrhage. An awareness of these risk factors should help to minimize the post-tonsillectomy haemorrhage and improve the patient outcomes.

Keywords: Post tonsillectomy haemorrhage (PTH); risk factors; smokers; steroids

ABSTRAK

Tonsilektomi adalah pembedahan yang paling biasa dilakukan dalam bidang kepakaran Telinga, Hidung dan Tekak (ENT). Pendarahan selepas pembedahan tonsilektomi adalah komplikasi yang ketara membawa kepada morbiditi dan mortaliti sekali sekala. Objektif utama kajian ini adalah untuk menilai kejadian dan faktor risiko untuk mendapat pendarahan selepas pembedahan tonsilektomi dalam kohort pesakit yang telah menjalani pembedahan di institusi kami. Kajian kohort retrospektif ini mengkaji rekod perubatan daripada semua pesakit yang menjalani tonsilektomi dari 1 Januari 2012 hingga 31 Disember 2016. Data pesakit seperti umur, jantina, bangsa, tabiat merokok, petunjuk untuk menjalani tonsilektomi, tempoh dan teknik pembedahan, penggunaan ubat-ubatan dan pengurusan selepas pembedahan telah direkodkan. Antara 315 pesakit termasuk kajian ini, 54.9% adalah orang dewasa (12 tahun ke atas) dan majoriti (86.3%) daripadanya adalah berbangsa Melayu. Penunjuk umum untuk pembedahan adalah tonsillitis berulang (84.4%) dalam kalangan pesakit kami. Kajian ini menunjukkan kaitan yang signifikan (p<0.05) antara umur, merokok dan penggunaan steroid dengan pendarahan selepas pembedahan tonsilektomi. Walau bagaimanapun, tidak terdapat hubungan yang signifikan antara jantina, bangsa, penggunaan ubat-ubatan selepas pembedahan (NSAIDS, antibiotik), tempoh pembedahan, teknik pembedahan dengan pendarahan selepas pembedahan tonsilektomi. Insiden pendarahan selepas tonsilektomi dalam populasi kami adalah 10.5% (n=33) dan antara mereka 54.5% (n=18) memerlukan rawatan intervensi surgeri. Kajian ini menunjukkan bahawa pesakit yang lebih tua (12 tahun ke atas), perokok dan penggunaan steroid dalam tempoh selepas pembedahan mempunyai risiko yang lebih tinggi untuk mendapat pendarahan selepas pembedahan. Kesedaran mengenai faktor risiko ini harus membantu meminimumkan pendarahan selepas pembedahan tonsilektomi dan meningkatkan penjagaan dan keadaan pesakit.

Kata kunci: Faktor risiko; pendarahan pasca-tonsilektomi (PTH); perokok; steroid

REFERENCES

Al-Ani, R.M. 2012. Post-tonsillectomy bleeding: Incidence and risk factors running title: PTB: Incidence and risk factors. Iraqi J. Comm. Med. 3: 261-264.

Al-Shehri, A.M.S. 2014. Incidence and potential risk factors of post-tonsillectomy hemorrhage. Bahrain Medical Bulletin 36: 3.

Alexander, R.J., Kukreja, R. & Ford, G.R. 2004. Secondary post-tonsillectomy haemorrhage and informed consent. Laryngol. Otol. 118(12): 937-940.

Aljabr, I.K., Hassan, F.M. & Alyahya, K.A. 2016. Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia. Alexandria Journal of Medicine 52(2): 169-172.

Arora, R., Saraiya, S., Niu, X., Thomas, R. & Kannikeswaran, N. 2015. Post-tonsillectomy haemorrhage: Who needs intervention? Int. J. Pediatr. Otorhinolaryngol. 79(2): 165- 169.

Bellis, J.R., Pirmohamed, M., Nunn, A.J., Loke, Y.K., De, S., Golder, S. & Kirkham, J.J. 2014. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: A systematic review and meta-analysis. Br. J. Anaesth. 113(1): 23-42.

Bhattacharyya, N. 2001. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J. 80(8): 544-549.

Bhattacharyya, N. & Shapiro, N.L. 2014. Associations between socioeconomic status and race with complications after tonsillectomy in children. Otolaryngol. Head Neck Surg. 151(6): 1055-1160.

Blakley, B.W. 2009. Post-tonsillectomy bleeding: How much is too much? Otolaryngol. Head Neck Surg. 140(3): 288-290.

Cohen, D. & Dor, M. 2008. Morbidity and mortality of post-tonsillectomy bleeding: Analysis of cases. J. Laryngol. Otol. 122(1): 88-92.

Collison, P.J. & Mettler, B. 2000. Factors associated with post-tonsillectomy hemorrhage. Ear Nose Throat J. 79(8): 640-648.

Cooper, L. 2016. Post-tonsillectomy management: A framework. Australian Family Physician 45(5): 289-291.

Coordes, A., Soudry, J., Hofmann, V.M. & Lenarz, M. 2016. Gender-specific risk factors in post-tonsillectomy hemorrhage. Eur. Arch. Otorhinolaryngol. 273: 4535-4541.

Curtis, J.L., Harvey, B., Willie, S., Narasimhan, E., Andrews, S., Henrichsen, J., Van Buren, N.C., Srivastava, R. & Meier, J.D. 2015. Causes as costs of ED visits after pediatric adenotonsillectomy. Otolaryngol. Head Neck Surg. 152(4): 691-696.

Demars, S.M., Harsha, W.J. & Crawford, J.V.M. 2008. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch. Otolaryngol. Head Neck Surg. 134(8): 811-814.

Dhiwakar, M., Clement, W.A., Supriya, M. & McKerrow, W. 2012. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst. Rev. 12: CD005607.

Harju, T. & Numminen, J. 2017. Risk factors for secondary post-tonsillectomy haemorrhage following tonsillectomy with bipolar scissors: Four-year retrospective cohort study. J. Laryngol. Otol. 131(2): 155-161.

Kuo, M., Hegarty, D., Johnson, A. & Stevenson, S. 1995. Early post-tonsillectomy morbidity following hospital discharge: Do patients and GPs know what to expect? Health Trends 27(3): 98-100.

Kwok, M.M., Subramaniyan, M., Rimmer, J.J. & Karahalios, A. 2018. Post-tonsillectomy haemorrhage in Australia-A multivariable analysis of risk factors. Aus. J. Otolaryngol. 1: 2.

Lee, W.C. & Sharp, J.F. 1996. Complications of paediatric tonsillectomy post-discharge. J. Laryngol. Otol. 110(2): 136-140.

Leinbach, R.F., Markwell, S.J. & Colliver, J.A. 2003. Hot versus cold tonsillectomy: A systematic review of the literature. Otolaryngol. Head Neck Surg. 129: 360-364.

Liu, J.H., Anderson, K.E., Willging, J.P., Myer, C.M., Shott, S.R., Bratcher, G.O. & Cooton, R.T. 2001. Post tonsillectomy hemorrhage. What is it and what should be recorded? Arch. Otolaryngol. Head Neck Surg. 127(10): 1271-1275.

Maksimovic, Z., Vranjes, Z., Zubcic, Z. & Birtic, D. 2007. Incidence of post-tonsillectomy and post-tonsillectomy haemorrhage in 5125 patients operated during the 1994-2005 period at Department of ENT Head and Neck Surgery, Osijek University Hospital in Osijek Croatia. Act Clin. Croat. 46: 247-250.

Miyamoto, Y., Shinzawa, M., Tanaka, S., Tanaka-Mizuno, S. & Kawakami, K. 2018. Perioperative steroid use for tonsillectomy and its association with reoperation for post tonsillectomy hemorrhage: A retrospective cohort study. Anesthetic Clinical Pharmacology 126(3): 806-814.

Myssiorek, D. & Alvi, A. 1996. Post-tonsillectomy hemorrhage: An assessment of risk factors. Int. J. Pediatr. Otorhinolaryngol. 37(1): 35-43.

Negm, H., Atef, A., Lasheen, H., Kamel, A.A., Azooz, K. & Elhoussainy, O. 2017. Factors affecting secondary post-tonsillectomy hemorrhage: A case study. The Egyptian Journal of Otolaryngology 33: 50-55.

Perkins, J.N., Liang, C., Gao, D., Shultz, L. & Friedman, N.R. 2012. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10): 2311-2315.

Plante, J.A.F., Zarychanski, R., Lauzier, F., Vigneault, L., Moore, L., Boutin, A. & Fergusson, D.A. 2012. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: Systematic review and meta-analysis of randomized controlled trials. BMJ 345: e5389.

Sarny, S., Ossimitz, G., Habermann, W. & Stammberger, H. 2011. Hemorrhage following tonsil surgery: A multicenter prospective study. Laryngoscope 121(12): 2553-2560.

Spektor, Z., Saint-Victor, S., Kay, D.J. & Mandell, D.L. 2016. Risk factors for pediatric post-tonsillectomy hemorrhage. Int. J. Pediatr. Otorhinolaryngol. 84: 151-155.

Suzuki, S., Yasunaga, H., Matsui, H., Horiguchi, H., Fushimi, K. & Yamasoba, T. 2014. Impact of systemic steroids on post tonsillectomy bleeding analysis of 61430 patients using a national inpatient database in Japan. JAMA Otolaryngol. Head Neck Surg. 140(10): 906-910.

Szeremeta, W., Novelly, N.J. & Benninger, M. 1996. Postoperative bleeding in tonsillectomy patients. Ear Nose Throat J. 75: 373-376.

Tami, T.A., Parker, G.S. & Taylor, R.E. 1987. Post-tonsillectomy bleeding: An evaluation of risk factors. Laryngoscope 97(11): 1307-1311.

Tomkinson, A., Harrison, W., Owens, D., Fishpool, S. & Temple, M. 2012. Postoperative hemorrhage following adenoidectomy. Laryngoscope 122(6): 1246-1253.

Wetmore, R.F. 2017. Surgical management of the tonsillectomy and adenoidectomy patient. World Journal of Otorhinolaryngology-Head and Neck Surgery 3: 176e182.

Windfuhr, J.P., Chen, Y.S. & Remmert, S. 2005. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol. Head Neck Surg. 132(2): 281-286.

*Corresponding author; email: subhast2@yahoo.com