Clinical Research
Year 2023,
Volume: 6 Issue: 2, 199 - 203, 31.08.2023
Abstract
Aim: We aimed to discuss and investigate the relationship between the surgeon's experience and post-tonsillectomy bleeding (PTB) in the light of the literature.
Methods: The retrospective data was obtained from 280 patients who underwent tonsillectomy (32 PTB and 248 no-PTB) operated by residents or consultant surgeons.
Results: The overall bleeding rate after tonsillectomy was 11.43% (32/280). The bleeding rate was 14.3% in the <16 age group and 9.7% in the ≥16 age group (p=0.246). While the rate of bleeding after tonsillectomy operation was 6.16% in the resident group; it was 27.53% in the consultant group (p<0.001). In patients who bled after tonsillectomy operation, the operation time was significantly shorter in the consultant group (p=0.032). Binary Logistic Regression analysis revealed that being a consultant surgeon is a risk factor for bleeding after tonsillectomy operation (p<0.001). Short operation time was a weak risk factor (p=0.048).
Conclusions: More experience in surgery does not decrease the risk for PTB, quite the reverse, it increases the PTB risk. The effort to finish surgery in a short time, and possibility of performing a less careful and more traumatic surgery might have caused this result.
Supporting Institution
yok
Project Number
yok
Thanks
.
References
- 1.Ahsan F, Rashid H, Eng C, et al. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort. Clin Otolaryngol. 2007; 32: 24-7. https://doi.org/10.1111/j.1365-2273.2007.01381.x
- 2.Evans AS, Khan AM, Young D, et al. Assessment of secondary haemorrhage rates following adult tonsillectomy a telephone surveyand literature review. Clin Otolaryngol Allied Sci. 2003; 28: 489-91. https://doi.org/10.1046/j.1365-2273.2003.00763.x
- 3.Mora R, Jankowska B, Mora F, et al. Effects of tonsillectomy on speech and voice. J Voice. 2009; 23: 614-8. https://doi.org/10.1016/j.jvoice.2008.01.008
- 4.Lee WT, Witsell DL, Parham K, et al. Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg. 2016; 155: 28-32. https://doi.org/10.1177/0194599816630523
- 5.Witsell DL, Orvidas LJ, Stewart MG, et al. Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis. Otolaryngol. Head Neck Surg 2008; 138: 1-8. https://doi.org/10.1016/j.otohns.2007.08.015
- 6.Wieland A, Belden L, Cunningham M. Preoperative coagulation screening for adenotonsillectomy: A review and comparison of current physician practices. Otolaryngology-Head and Neck Surgery. 2009; 140: 542-7. https://doi.org/10.1016/j.otohns.2008.12.016
- 7.Windfuhr JP, Schloendorff G, Baburi D, et al. Life-threatening posttonsillectomy hemorrhage. Laryngoscope. 2008; 118: 1389-94. https://doi.org/10.1097/MLG.0b013e3181734f7e
- 8.Spektor Z, Saint-Victor S, Kay DJ, et al. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016; 84: 151-5. https://doi.org/10.1016/j.ijporl.2016.03.005
- 9.Schrock A, Send T, Heukamp L, et al. The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol. 2009; 266: 1983-7. https://doi.org/10.1007/s00405-009-0958-z
- 10.Mueller J, Boeger D, Buentzel J, et al. Population based analysis of tonsil surgery and postoperative hemorrhage, Eur. Arch Otorhinolaryngol. 2015; 272: 3769-77. https://doi.org/10.1007/s00405-014-3431-6
- 11.Bhattacharyya N, Shapiro NL. Associations between socioeconomic status and race with complications after tonsillectomy in children, Otolaryngol Head Neck Surg. 2014; 151: 1055-60. https://doi.org/10.1177/0194599814552647
- 12.Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg. 2001; 127: 1271-5. https://doi.org/10.1001/archotol.127.10.1271
- 13.Kristensen S, Tveterås K. Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol. Allied Sci. 1984; 9: 347-50. https://doi.org/10.1111/j.1365-2273.1984.tb01519.x
- 14.Rasmussen N. Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am. 1987; 20: 383-90. https://doi.org/10.1016/S0030-6665(20)31657-1
- 15.Conley SF, Ellison MD. Avoidance of primary post-tonsillectomy hemorrhage in a teaching program. Arch Otolaryngol Head Neck Surg. 1999; 125: 330-3. https://doi.org/10.1001/archotol.125.3.330
- 16.Peterson J, Losek JD. Post-tonsillectomy hemorrhage and pediatric emergency care. Clin Pediatr (Phila). 2004; 43: 445-8. https://doi.org/10.1177/000992280404300505
- 17.Ali RB, Smyth D, Kane R, et al. PTB: a regional hospital experience. Ir J Med Sci. 2008; 177: 297-301. https://doi.org/10.1007/s11845-008-0237-9
- 18.Kim DW, Koo JW, Ahn SH, et al. Difference of delayed PTB between children and adults. Auris Nasus Larynx. 2010; 37: 456-60. https://doi.org/10.1016/j.anl.2009.11.011
- 19.Szeremeta W, Novelly NJ, Benninger M. Postoperative bleeding in tonsillectomy patients. Ear Nose Throat J. 1996; 75: 373-6. https://doi.org/10.1177/014556139607500611
- 20.Irani DB, Berkowitz RG. Management of secondary hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 1997; 40: 115-24. https://doi.org/10.1016/S0165-5876(97)00025-6
- 21.Leader BA, Wiebracht ND, Meinzen-Derr J, et al. The impact of resident involvement on tonsillectomy outcomes and surgical time. Laryngoscope 2020; 130(10): 2481-6. https://doi.org/10.1002/lary.28427
- 22.Hinton-Bayre AD, Noonan K, Ling S, et al. Experience is more important than technology in paediatric post-tonsillectomy bleeding. J Laryngol Otol. 2017; 131: 35-40. https://doi.org/10.1017/S0022215117000755
- 23.Manimaran V, Mohanty S, Jayagandhi SK, 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. https://doi.org/10.1055/s-0039-1696702
Year 2023,
Volume: 6 Issue: 2, 199 - 203, 31.08.2023
Abstract
Amaç: Çalışmamızda cerrahın deneyimi ile tonsillektomi operasyonu sonrası kanama (TOSK) arasındaki ilişkiyi literatür eşliğinde tartışmayı ve araştırmayı amaçladık.
Materyal ve Metot: Retrospektif veriler, asistan veya uzman cerrahlar tarafından tonsillektomi operasyonu uygulanan (32 TOSK olan ve 248 TOSK olmayan) 280 hastadan elde edildi.
Bulgular: Tonsillektomi operasyonu sonrası genel kanama oranı %11.43 (32/280) idi. Kanama oranı <16 yaş grubunda %14.3 , ≥16 yaş grubunda %9.7 idi (p=0.246). Asistan doktor grubunda tonsillektomi operasyonu sonrası kanama oranı %6.16 iken; uzman doktor grubunda %27.53 idi (p<0.001). Tonsillektomi operasyonu sonrası kanayan hastalarda ameliyat süresi uzman doktor grubunda anlamlı olarak daha kısaydı (p=0.032). Binary Lojistik Regresyon analizi, uzman cerrah olmanın tonsillektomi operasyonu sonrası kanama için bir risk faktörü olduğunu ortaya koydu (p<0.001). Kısa operasyon süresi ise zayıf bir risk faktörüydü (p=0.048).
Sonuç: Ameliyatta daha fazla deneyim, tonsillektomi operasyonu sonrası kanama riskini azaltmaz, tam tersine; bu riski artırır. Uzman cerrahlardaki ameliyatı kısa sürede bitirme çabası, daha az dikkatli ve daha travmatik bir ameliyat yapma olasılığı bu sonuca neden olmuş olabilir.
Project Number
yok
References
- 1.Ahsan F, Rashid H, Eng C, et al. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort. Clin Otolaryngol. 2007; 32: 24-7. https://doi.org/10.1111/j.1365-2273.2007.01381.x
- 2.Evans AS, Khan AM, Young D, et al. Assessment of secondary haemorrhage rates following adult tonsillectomy a telephone surveyand literature review. Clin Otolaryngol Allied Sci. 2003; 28: 489-91. https://doi.org/10.1046/j.1365-2273.2003.00763.x
- 3.Mora R, Jankowska B, Mora F, et al. Effects of tonsillectomy on speech and voice. J Voice. 2009; 23: 614-8. https://doi.org/10.1016/j.jvoice.2008.01.008
- 4.Lee WT, Witsell DL, Parham K, et al. Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg. 2016; 155: 28-32. https://doi.org/10.1177/0194599816630523
- 5.Witsell DL, Orvidas LJ, Stewart MG, et al. Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis. Otolaryngol. Head Neck Surg 2008; 138: 1-8. https://doi.org/10.1016/j.otohns.2007.08.015
- 6.Wieland A, Belden L, Cunningham M. Preoperative coagulation screening for adenotonsillectomy: A review and comparison of current physician practices. Otolaryngology-Head and Neck Surgery. 2009; 140: 542-7. https://doi.org/10.1016/j.otohns.2008.12.016
- 7.Windfuhr JP, Schloendorff G, Baburi D, et al. Life-threatening posttonsillectomy hemorrhage. Laryngoscope. 2008; 118: 1389-94. https://doi.org/10.1097/MLG.0b013e3181734f7e
- 8.Spektor Z, Saint-Victor S, Kay DJ, et al. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016; 84: 151-5. https://doi.org/10.1016/j.ijporl.2016.03.005
- 9.Schrock A, Send T, Heukamp L, et al. The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol. 2009; 266: 1983-7. https://doi.org/10.1007/s00405-009-0958-z
- 10.Mueller J, Boeger D, Buentzel J, et al. Population based analysis of tonsil surgery and postoperative hemorrhage, Eur. Arch Otorhinolaryngol. 2015; 272: 3769-77. https://doi.org/10.1007/s00405-014-3431-6
- 11.Bhattacharyya N, Shapiro NL. Associations between socioeconomic status and race with complications after tonsillectomy in children, Otolaryngol Head Neck Surg. 2014; 151: 1055-60. https://doi.org/10.1177/0194599814552647
- 12.Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg. 2001; 127: 1271-5. https://doi.org/10.1001/archotol.127.10.1271
- 13.Kristensen S, Tveterås K. Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol. Allied Sci. 1984; 9: 347-50. https://doi.org/10.1111/j.1365-2273.1984.tb01519.x
- 14.Rasmussen N. Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am. 1987; 20: 383-90. https://doi.org/10.1016/S0030-6665(20)31657-1
- 15.Conley SF, Ellison MD. Avoidance of primary post-tonsillectomy hemorrhage in a teaching program. Arch Otolaryngol Head Neck Surg. 1999; 125: 330-3. https://doi.org/10.1001/archotol.125.3.330
- 16.Peterson J, Losek JD. Post-tonsillectomy hemorrhage and pediatric emergency care. Clin Pediatr (Phila). 2004; 43: 445-8. https://doi.org/10.1177/000992280404300505
- 17.Ali RB, Smyth D, Kane R, et al. PTB: a regional hospital experience. Ir J Med Sci. 2008; 177: 297-301. https://doi.org/10.1007/s11845-008-0237-9
- 18.Kim DW, Koo JW, Ahn SH, et al. Difference of delayed PTB between children and adults. Auris Nasus Larynx. 2010; 37: 456-60. https://doi.org/10.1016/j.anl.2009.11.011
- 19.Szeremeta W, Novelly NJ, Benninger M. Postoperative bleeding in tonsillectomy patients. Ear Nose Throat J. 1996; 75: 373-6. https://doi.org/10.1177/014556139607500611
- 20.Irani DB, Berkowitz RG. Management of secondary hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 1997; 40: 115-24. https://doi.org/10.1016/S0165-5876(97)00025-6
- 21.Leader BA, Wiebracht ND, Meinzen-Derr J, et al. The impact of resident involvement on tonsillectomy outcomes and surgical time. Laryngoscope 2020; 130(10): 2481-6. https://doi.org/10.1002/lary.28427
- 22.Hinton-Bayre AD, Noonan K, Ling S, et al. Experience is more important than technology in paediatric post-tonsillectomy bleeding. J Laryngol Otol. 2017; 131: 35-40. https://doi.org/10.1017/S0022215117000755
- 23.Manimaran V, Mohanty S, Jayagandhi SK, 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. https://doi.org/10.1055/s-0039-1696702
There are 23 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Otorhinolaryngology |
| Journal Section | Articles |
| Authors | |
| Project Number | yok |
| Publication Date | August 31, 2023 |
| Acceptance Date | June 12, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 2 |
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