Is weekend surgery a risk factor for post-tonsillectomy haemorrhage?

Post-tonsillectomy dietary advice and haemorrhage risk: Systematic review

OBJECTIVES

Tonsillectomy remains one of the commonest operations performed in children. Post-operative diet may affect post-tonsillectomy haemorrhage rate, although post-operative dietary advice varies. We undertook a systematic review of the published literature to assess if and how different post-operative diets were associated with differences in PTH rates following paediatric tonsillectomy, to provide an evidence base to inform individual otorhinolaryngologists' practice and for future guideline development.

METHODS

A systematic review of the published English literature of the PubMed, Medline and Cochrane Collaboration databases, using search terms used included 'post-tonsillectomy', 'diet', 'dietary advice', 'bleeding', 'haemorrhage', 'paediatric' &'children'.

RESULTS

Eight publications were included in the review, including 5 randomised controlled trials, 2 case-control studies and 1 cohort study. These involved 1039 patients with 545 patients following a restricted/non-additive diet after tonsillectomy and 494 patients following an unrestricted/additive diet. The average reported PTH rate of patients in the restricted diet groups was 2.3% and 0.8% in patients in the unrestricted diet groups, which is not statistically significant (p = 0.12, one tailed t-test).

CONCLUSION

PTH following paediatric surgery does not appear to be affected by different post-operative diets or regimes followed by patients. Clinicians should not change the advice provided regarding oral intake and diet following tonsillectomy surgery in children.

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Introduction:

Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate.

Aims:

To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists.

Methods:

We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1^st 2015 and October 31^st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis).

Results:

1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012).

Conclusion:

We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.