A descriptive study of post-tonsillectomy bleeding

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Mazin Rajeh Jaber



Background: Tonsillectomy is a commonly performed surgery in the world. The common indicators of tonsillectomy include recurrent tonsillitis, recurrent peritonsillar abscess, and obstructive sleep apnea. Tonsillectomy may be followed by many complications like dehydration, vomiting, nausea, bleeding, pain, and infections, among which bleeding is the most serious complication.
Objective: The study aimed to evaluate the incidence and possible risk factors post-tonsillectomy hemorrhage.
Methods: This prospective descriptive study included 100 patients (54 females and 46 males) aged between 5-30 years from the otolaryngology unit in Ad-Diwaniah hospital, Ad-Diwania governorate, Iraq, between May 2017 and October 2019. T Inclusion criteria: recurrent tonsillitis, tonsillar enlargement affecting sleep pattern, obstructive sleep apnea syndrome, and immunoglobulin-A nephropathy. Post-tonsillectomy, the hemorrhage was classified based on the bleeding time postsurgery. If bleeding occurred on the first day (24 hours) after operation, it was called primary post- tonsillectomy bleeding, and post that, it was termed
secondary post-tonsillectomy bleeding.
Results: Of 100 patients, only 11 developed post-tonsillectomy hemorrhage (11%). Primary post-tonsillectomy bleeding occurred in eight patients, whereas secondary post- tonsillectomy bleeding occurred in three patients. Nine male and two female patients developed post-tonsillectomy hemorrhage. Primary post-tonsillectomy hemorrhage occurred in those with obstructive sleep apnea, recurrent tonsillitis, and history of non-steroidal
anti-inflammatory drug use, smoking, and obesity and secondary posttonsillectomy hemorrhage occurred in those with smoking history, obesity, obstructive sleep apnea, and recurrent tonsillitis.
Conclusion: Older age group, male sex, recurrent tonsillitis, and smoking history are pivotal factors of post tonsillectomy hemorrhage.

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1. Burton MJ. et al. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014;2014(11):CD001802.
2. Burton MJ. et al. tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Otolaryngol Neck Surg. 2016;154(4):581–585.
3. MacFarlane PL. et al. Tonsillectomy in Australia: an audit of surgical technique and postoperative care. Otolaryngol Neck Surg. 2008;139(1):109–114.
4. Archer S. et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Neck Surg. 2010;143:P12–P12.
5. Hoddeson EK. et al. Adult tonsillectomy: current indications and outcomes. Otolaryngol Head Neck Surg. 2009;140:19?22.
6. Mitchell RB. et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160:S1?S42.
7. Johnson LB. et al. Complications of adenotonsillectomy. Laryngoscope. 2002;112:35?36.
8. De Luca Canto G. et al. Adenotonsillectomy complications: a meta?analysis. Pediatrics. 2015;136:702?718.
9. Chadha NK. Tonsillectomy return-to-theatre rates demonstrate a monthly and seasonal variation: an analysis of 256 799 patients. J Laryngol Otol. 2007;121:1088–1093.
10. Windfuhr JP. et al. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Neck Surg. 2005;132(2):281–286.
11. Manimaran V. et al. A retrospective analysis of peroperative risk factors associated with posttonsillectomy reactionary hemorrhage in a teaching hospital. Int Arch Otorhinolaryngol. 2019;23(4):e403–e407.
12. Aljabr IK et al. Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia. Alexandria J Med. 2016;52(2):169–172.
13. Yogesh bajaj et.al diseases of tonsils, tonsillectomy and tonsillotomy,. Scott-brown’s otorhinolaryngology head and neck surgery. volume 2. 8th edition ,section 1: paediatrics ,p 438
14. Meng H. et al. IgA production and tonsillar focal infection in IgA nephropathy. J Clin Exp Hematop. 2012;52:161?170.
15. Noda Y. Pre?operative diagnosis for dermatoses due to tonsillar focal infections: recent views. Auris Nasus Larynx. 1989;16(suppl 1):S59?S64.
16. Windfuhr J. et al. Classification of haemorrhage following tonsillectomy. J Laryngol Otol. 2001;115:457?461.
17. Kim MK. et al. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Oto-Rhino-Laryngology. 2012;269(3):977–981.
18. Perkins. et al. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope. 2012;122(10):2311–2315.
19. Hussain, S. et al. Time between first and second posttonsillectomy bleeds. Int J Otolaryngol. 2017;2017:3275683.
20. Spektor, Z. et al. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016;84:151–155.
21. Tomkinson, A. et al. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope. 2011;121(2):279–288.
22. Ordemann. et al. Is weight a predictive risk factor of postoperative tonsillectomy bleed Laryngoscope Investig Otolaryngol. 2018;3(3):238–243.
23. Yoshiaki Inuzuka . et al. Risk factors of post?tonsillectomy hemorrhage in adults. Laryngoscope Investig Otolaryngol. 2020 Dec; 5(6): 1056–1062.
24. Hardman MJ. et al. Macrophage migration inhibitory factor: a central regulator of wound healing. Am J Pathol. 2005;167:1561?1574.
25. Francis DO. et al. Postoperative bleeding and associated utilization following tonsillectomy in children. Otolaryngol Head Neck Surg. 2017;156:442?455.
26. Bhattacharyya N. et al. Associations between socioeconomic status and race with complications after tonsillectomy in children. Otolaryngol Neck Surg. 2014;151(6):1055–1060.
27. Kshirsagar R. et al. Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy. Int J Pediatr Otorhinolaryngol. 2016;84:119–123.
28. Burckardt E. et al. Predictors for hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2019;117:143–147.
29. Reckley LK. et al. The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews. Nat Sci Sleep. 2018;10:105.
30. Seyhun N. et al. Risk factors for post?tonsillectomy hemorrhage in adult population: does smoking history have an impact? Am J Otolaryngol. 2020;41:102341.
31. Demars SM. et al. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 2008;134:811?814.
32. Giger R. et al. Hemorrhage risk after quinsy tonsillectomy. Otolaryngol Head Neck Surg. 2005;133:729?734.
33. Cinamon U. et al. The impact of tobacco smoking upon chronic/recurrent tonsillitis and post tonsillectomy bleeding. Int Arch Otorhinolaryngol. 2017;21:165?170.
34. Yamashita S. et al. Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients. Respir Med. 2004;98:760?766.
35. Marret E. et al. Effects of postoperative, nonsteroidal, anti inflammatory drugs on bleeding risk after tonsillectomy: meta?analysis of randomized, controlled trials. Anesthesiology. 2003;98:1497?1502.
36. D’Souza, JN. et al. Postoperative nonsteroidal anti-inflammatory drugs and risk of bleeding in pediatric intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2015;79(9):1472–1476.
37. Swanson, RT. et al. Association of ibuprofen use with post-tonsillectomy bleeding in older children. Am J Otolaryngol. 2018;39(5):618–622.
38. Riggin L. et al. A 2013 updated systematic review & meta?analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti?inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol. 2013;38:115?129.
39. Qasim MT, Al-Mayali HK. Investigate the relation between Baicalin effect and Gene expression of LH, FSH, Testosterone in male rats treated with Gemcitabine drug. Research Journal of Pharmacy and Technology. 2019 Sep 30;12(9):4135-41.
40. Qasim MT, Al-Mayali HK. The immunological and protective role of Baicalin in male rats treated with chemotherapy (Gemcitabine). InJournal of Physics: Conference Series 2019 Jul 1 (Vol. 1234, No. 1, p. 012065). IOP Publishing.
41. Tahmasebi S, Qasim MT, Krivenkova MV, Zekiy AO, Thangavelu L, Aravindhan S, Izadi M, Jadidi?Niaragh F, Ghaebi M, Aslani S, Aghebat?Maleki L. The effects of Oxygen?Ozone therapy on regulatory T?cell responses in multiple sclerosis patients. Cell biology international. 2021 Mar 16.
42. Mousa HM, Qasim MT. Microbial Infection and IL-6 Urine Levels for Pregnant women in Thi-Qar Province. World J. Pharma. Res. 2015 Mar 6;4(05):358-65.
43. Ahmed Jassem AL-Naely, Maytham T. Qasim, Hussein Abbas Al-Hamadawi. Transfusion of Blood Components in the Newborn Service of the Hospital. Annals of RSCB [Internet]. 2021Apr.7 [cited 2021Apr.14];:952-8. Available from: http://annalsofrscb.ro/index.php/journal/article/view/2525.
44. Zainab I. Mohammed, Maytham T. Qasim. Correlation of AMH and LH Levels in PCOS Patients with Pregnancy Rate. Annals of RSCB [Internet]. 2021Apr.7 [cited 2021Apr.14];:945-51. Available from: http://annalsofrscb.ro/index.php/journal/article/view/2524.
45. Gowhari Shabgah A, Qasim MT, Mojtaba Mostafavi S, et al. CXC chemokine ligand 16: a Swiss army knife chemokine in cancer. Expert Reviews in Molecular Medicine. 2021;23:e4. doi:10.1017/erm.2021.7.