Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Sarny, SA.
MULTICENTRE PROSPECTIVE STUDY ON ALL PATIENTS UNDERGOING TONSILLECTOMY, TONSILLOTOMY OR ADENOIDECTOMY IN AUSTRIA IN 2009 AND 2010
[ Dissertation ] Medical University of Graz; 2012. pp. 153
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- Autor*innen der Med Uni Graz:
- Sarny Stephanie
- Betreuer*innen:
- Habermann Walter
- Stammberger Heinz
- Altmetrics:
- Abstract:
- Background Postoperative haemorrhage as a serious complication after tonsillectomy (TE), tonsillotomy (TO) or adenoidectomy (AE) is covered in many studies, using rather inconsistent measurement methods. We introduce a new classification for the severity of postoperative hemorrhage and investigate risk factors for both the frequency and severity of bleeding episodes. Methods Our study is based on a prospective census recording all TE, TO and AE from 1 October 2009 to 30 June 2010 in Austria. Information was collected concerning indications for surgery, grade of surgeon, operation technique and postoperative haemorrhage, defined as any bleeding episode after extubation. Results A total of 9,405 patients were included. The haemorrhage rate for TE with or without (±) AE was 15.0%, for TO±AE 2.3% and for AE 0.8%. The return to theatre rate for TE±AE was 4.6%, for TO±AE 0.9% and for AE 0.3%. Minor bleeding episodes doubled the risk of a subsequent severe bleeding episode (p<0.001). Elevated haemorrhage rates were observed for adults (p<0.001), TE±AE (p<0.001) and cold steel dissection combined with bipolar diathermy (p=0.05). A multivariate logistic regression model for the frequency of post-tonsillectomy haemorrhage showed significant odds ratios for males, children aged under six, children aged 6-15, abscess TE and cold steel combined with bipolar diathermy. Additionally we found a significantly higher risk of severe bleeding episodes in children aged 6-15 (p=0.007), males (p=0.02) and for all bipolar operation techniques (p=0.005). Intraoperative blood loss of more than 110 ml indicated a significantly higher postoperative haemorrhage risk, while a blood loss lower than 30 ml was associated with fewer postoperative bleeding episodes. Finally, a positive coagulation history predicted an elevated haemorrhage rate (p<0.001) better than any result of the coagulation test. Conclusions The occurrence of a minor postoperative bleeding episode increases the risk of a subsequent severe bleeding episode. Funding Austrian Society of Oto-Rhino-Laryngology, Head and Neck Surgery