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Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a single institution.

Abstract To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol.
PMID
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Authors

Mayor MeshTerms
Keywords

Bleeding

Hematologic disease

Hemorrhage

Tonsillectomy

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




PMID- 28802375
OWN - NLM
STAT- MEDLINE
DA  - 20170813
DCOM- 20170907
LR  - 20170907
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 100
DP  - 2017 Sep
TI  - Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a 
      single institution.
PG  - 216-222
LID - S0165-5876(17)30327-0 [pii]
LID - 10.1016/j.ijporl.2017.07.014 [doi]
AB  - OBJECTIVE: To report on the post-tonsillectomy bleeding outcomes and factors
      associated with hemorrhage among children with pre- or post-operatively diagnosed
      bleeding disorders treated with an institutional protocol. METHODS: Retrospective
      cohort study of patients with hematologic disorders who underwent tonsillectomy
      between 2003 and 2016 and were treated with perioperative desmopressin or factor 
      replacement and/or aminocaproic acid. Postoperative outcomes were compared to
      controls matched for age, sex, and indication for surgery. Analysis of factors
      associated with hemorrhage was performed in patients with bleeding disorders
      using Mann-Whitney U or chi-squared tests. RESULTS: 45 patients with hematologic 
      disorders met inclusion criteria. Platelet dysfunction, including von Willebrand 
      Disease (vWD), was the most common diagnosis (77.8%). Most patients had a
      preoperative diagnosis of a bleeding disorder and received perioperative
      hematologic medications (86.7%). Compared to matched controls, patients with
      hematologic disorders experienced more postoperative bleeding (15.5%; 12 bleeds, 
      7 patients vs. 1.7%; 1 bleed, 1 patient, p = 0.05) and had longer postoperative
      stays (1.3 days vs. 0.4 days, p < 0.001). Among the patients with hematologic
      disorders, patients who experienced a postoperative bleed were significantly more
      likely to have a factor deficiency (e.g. Hemophilia over vWD) and have a
      postoperative diagnosis (compared to preoperative diagnosis) for which they did
      not receive perioperative hematologic medication. Of patients with a
      postoperative bleed, all those diagnosed postoperatively required at least one
      surgical intervention to control bleeding compared to 33% of patients with a
      preoperative diagnosis. A history of post-surgical bleeding, male sex, age at
      surgery, and pharyngitis as surgical indication were not associated with higher
      hemorrhage rates in this group. CONCLUSIONS: This study suggests a clinically
      important magnitude of increased bleeding risk in patients with hematologic
      disease. This risk appears to decrease with the use of an institutional protocol 
      consisting of desmopressin or factor replacement and an antifibrinolytic agent
      extending through postoperative day 10.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Patel, Priyesh N
AU  - Patel PN
AD  - Division of Pediatric Otolaryngology, Department of Otolaryngology, Vanderbilt
      University Medical Center, Nashville, TN, USA. Electronic address:
      [email protected]
FAU - Arambula, Alexandra M
AU  - Arambula AM
AD  - Vanderbilt University Medical School, Nashville, TN, USA.
FAU - Wheeler, Allison P
AU  - Wheeler AP
AD  - Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University 
      Medical Center, Nashville, TN, USA.
FAU - Penn, Edward B
AU  - Penn EB
AD  - Division of Pediatric Otolaryngology, Department of Otolaryngology, Vanderbilt
      University Medical Center, Nashville, TN, USA.
LA  - eng
PT  - Journal Article
DEP - 20170714
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
RN  - 0 (Antifibrinolytic Agents)
SB  - IM
MH  - Adolescent
MH  - Antifibrinolytic Agents/therapeutic use
MH  - Child
MH  - Cohort Studies
MH  - Female
MH  - Hemorrhagic Disorders/*complications
MH  - Humans
MH  - Male
MH  - Postoperative Hemorrhage/drug therapy/*etiology
MH  - Retrospective Studies
MH  - Tonsillectomy/*adverse effects
OTO - NOTNLM
OT  - Bleeding
OT  - Hematologic disease
OT  - Hemorrhage
OT  - Tonsillectomy
EDAT- 2017/08/15 06:00
MHDA- 2017/09/08 06:00
CRDT- 2017/08/14 06:00
PHST- 2017/05/30 [received]
PHST- 2017/07/12 [accepted]
AID - S0165-5876(17)30327-0 [pii]
AID - 10.1016/j.ijporl.2017.07.014 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 Sep;100:216-222. doi:
      10.1016/j.ijporl.2017.07.014. Epub 2017 Jul 14.