-
Ear, Nose, & Throat Journal Apr 2023To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk...
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.
Topics: Child; Humans; Tonsillectomy; Adenoidectomy; Retrospective Studies; Postoperative Hemorrhage; Risk Factors
PubMed: 33689495
DOI: 10.1177/0145561321999594 -
Otolaryngology--head and Neck Surgery :... Mar 2017Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and... (Meta-Analysis)
Meta-Analysis Review
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
Topics: Child; Humans; Patient Readmission; Postoperative Hemorrhage; Reoperation; Tonsillectomy
PubMed: 28094660
DOI: 10.1177/0194599816683915 -
Anaesthesia Jan 2013The care of sick children can be challenging for the anaesthetist who is only involved in the occasional care of paediatric patients. This paper outlines the care of... (Review)
Review
The care of sick children can be challenging for the anaesthetist who is only involved in the occasional care of paediatric patients. This paper outlines the care of medical and surgical paediatric emergencies for which an anaesthetist working at a district general hospital or equivalent may encounter. Conditions discussed include paediatric respiratory emergencies, sepsis, status epilepticus, the acute abdomen in the newborn, intussusception, the bleeding tonsil, trauma and the child with burns.
Topics: Abdomen, Acute; Anesthesia; Burns; Child; Emergencies; Emergency Medical Services; Humans; Intussusception; Pediatrics; Postoperative Hemorrhage; Respiratory Tract Diseases; Sepsis; Status Epilepticus; Tonsillectomy; Wounds and Injuries
PubMed: 23210557
DOI: 10.1111/anae.12052 -
European Archives of... Mar 2022Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the...
PURPOSE
Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff.
METHODS
This retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences.
RESULTS
A total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1-19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm-6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol.
CONCLUSION
The discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.
Topics: Adult; Child; Humans; Postoperative Hemorrhage; Postoperative Period; Retrospective Studies; Tonsillectomy
PubMed: 34557959
DOI: 10.1007/s00405-021-07080-1 -
Journal of Visceral Surgery Sep 2013
Topics: Blood Loss, Surgical; Humans; Laparotomy; Postoperative Hemorrhage; Tampons, Surgical
PubMed: 24012718
DOI: 10.1016/j.jviscsurg.2013.07.004 -
International Journal of Pediatric... Dec 2022To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
OBJECTIVES
To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
METHODS
This was a retrospective national population-based cohort study of data from the Swedish National Patient Register (NPR) and The Swedish Cause of Death Register (CDR). All patients aged 0-18 years who underwent adenoidectomy from 2007 to 2017 (without concomitant tonsil surgery) were included in this study. To evaluate postoperative morbidity and mortality, all diagnostic and surgical codes registered in the NPR for health care contacts within 30 days of surgery were analysed. The patients retrieved from the NPR were matched with the CDR to identify any deaths occurring within 30 days of the surgery.
RESULTS
A total of 51 746 adenoidectomies were included in this study. No deaths related to adenoidectomy were identified. All types of haemorrhagic complications were rare. Only 0.1% of the surgeries resulted in an outpatient contact due to postoperative haemorrhage and only 0.1% of the adenoidectomies resulted in a readmission due to haemorrhage. The rarest haemorrhagic complication was RTT (return to theatre), with only 4 events (0.01%). Postoperative haemorrhage was most frequent on the first day after surgery. Other complications were rare as well, requiring a total of 922 (2.6%) outpatient visits and 75 (0.2%) readmissions in the adenoidectomy group, with postoperative infection being the most commonly reported.
CONCLUSIONS
Overall, adenoidectomy should be considered a safe surgical procedure associated with few postoperative complications. No deaths related to adenoidectomy were found. Severe complications, such as late postoperative haemorrhage after adenoidectomy, were rare, and haemorrhage resulting in RTT was even rarer. The highest rate of postoperative haemorrhage was observed the first day after surgery, and most haemorrhagic complications occurred within a week. Comparisons with studies on tonsil surgery show that adenoidectomy is associated with substantially lower postoperative morbidity.
Topics: Child; Humans; Adenoidectomy; Tonsillectomy; Retrospective Studies; Cohort Studies; Postoperative Hemorrhage; Postoperative Complications; Morbidity
PubMed: 36265351
DOI: 10.1016/j.ijporl.2022.111335 -
Anesthesiology Nov 2010Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature.... (Review)
Review
Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.
Topics: Animals; Blood Coagulation Disorders; Hemodilution; Hemorrhage; Humans; Postoperative Hemorrhage; Treatment Outcome
PubMed: 20881594
DOI: 10.1097/ALN.0b013e3181f22b5a -
Tidsskrift For Den Norske Laegeforening... Mar 2021Tonsillectomy and tonsillotomy are common surgical procedures, especially among children and adolescents. Post-operative bleeding is a potentially alarming and dangerous...
BACKGROUND
Tonsillectomy and tonsillotomy are common surgical procedures, especially among children and adolescents. Post-operative bleeding is a potentially alarming and dangerous complication. We wished to identify the prevalence of postoperative bleeding and associated risk factors in Ålesund hospital.
MATERIAL AND METHOD
The study is based on a retrospective review of the records of all patients who underwent tonsil surgery at Ålesund hospital in the five-year period from 2015-2019.
RESULTS
Of 1394 patients who underwent tonsil surgery, tonsillectomy was performed in 1285 patients and tonsillotomy in 109 patients. Thirty patients (2.2 %) had primary haemorrhage (< 24 hours). Twenty patients (1.4 %) were hospitalised due to secondary haemorrhage (> 24 hours), after an average of 5.4 days. Five patients (0.4 %) were reoperated due to postoperative bleeding. No postoperative bleeding was recorded after tonsillotomy. Increased risk of late postoperative bleeding was found for patients aged 16 years and over, and patients with primary haemorrhage.
INTERPRETATION
The proportion of cases of postoperative bleeding was low compared to international studies. Our figures are likely representative for other otorhinolaryngology departments in Norway, and may provide useful information to clinicians and patients prior to tonsil surgery.
Topics: Adolescent; Child; Humans; Norway; Palatine Tonsil; Postoperative Hemorrhage; Retrospective Studies; Tonsillectomy
PubMed: 33754678
DOI: 10.4045/tidsskr.20.0813 -
Transplant International : Official... May 2017Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney...
Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical-site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24-hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical-site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical-site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.
Topics: Adult; Case-Control Studies; Female; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Ontario; Postoperative Hemorrhage; Risk Factors
PubMed: 28120465
DOI: 10.1111/tri.12926 -
Artificial Organs Dec 2020Nonsurgical bleeding is the most frequent complication of left ventricular assist device (LVAD) support. Supraphysiologic shear rates generated in LVAD causes impaired...
Nonsurgical bleeding is the most frequent complication of left ventricular assist device (LVAD) support. Supraphysiologic shear rates generated in LVAD causes impaired platelet aggregation, which increases the risk of bleeding. The effect of shear rate on the formation size of platelet aggregates has never been reported experimentally, although platelet aggregation size can be considered to be directly relevant to bleeding complications. Therefore, this study investigated the impact of shear rate and exposure time on the formation size of platelet aggregates, which is vital in predicting bleeding in patients with an LVAD. Human platelet-poor plasma (containing von Willebrand factor, vWF) and fluorochrome-labeled platelets were subjected to a range of shear rates (0-10 000 s ) for 0, 5, 10, and 15 minutes using a custom-built blood-shearing device. Formed sizes of platelet aggregates under a range of shear-controlled environment were visualized and measured using microscopy. The loss of high molecular weight (HMW) vWF multimers was quantified using gel electrophoresis and immunoblotting. An inhibition study was also performed to investigate the reduction in platelet aggregation size and HMW vWF multimers caused by either mechanical shear or enzymatic (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13-ADAMTS13, the von Willebrand factor protease) mechanism under low and high shear conditions (360 and 10 000 s ). We found that the average size of platelet aggregates formed under physiological shear rates of 360-3000 s (200-300 μm ) was significantly larger compared to those sheared at >6000 s (50-100 μm ). Furthermore, HMW vWF multimers were reduced with increased shear rates. The inhibition study revealed that the reduction in platelet aggregation size and HWM vWF multimers were mainly associated with ADAMTS13. In conclusion, the threshold of shear rate must not exceed >6000 s in order to maintain the optimal size of platelet aggregates to "plug off" the injury site and stop bleeding.
Topics: ADAMTS13 Protein; Blood Platelets; Healthy Volunteers; Heart-Assist Devices; Humans; Molecular Weight; Platelet Aggregation; Postoperative Hemorrhage; Prosthesis Implantation; Protein Multimerization; Risk Assessment; Stress, Mechanical; von Willebrand Factor
PubMed: 32735693
DOI: 10.1111/aor.13783