Association Between Ibuprofen Use and Severity of Surgically Managed Posttonsillectomy Hemorrhage.

Autor:	Mudd PA; School of Medicine and Health Sciences, George Washington University, Washington, DC2Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC., Thottathil P; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania4Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Giordano T; Division of Otolaryngology (Ear, Nose, and Throat), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Wetmore RF; Division of Otolaryngology (Ear, Nose, and Throat), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania6Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Elden L; Division of Otolaryngology (Ear, Nose, and Throat), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania6Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Jawad AF; Department of Biostatistics in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Ahumada L; Enterprise Reporting and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 9Section of Biomedical Informatics, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Gálvez JA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania4Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia9Section of Biomedical Informatics, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 10Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2017 Jul 01; Vol. 143 (7), pp. 712-717.
DOI:	10.1001/jamaoto.2016.3839
Abstrakt:	Importance: Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure. Objective: To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity. Design, Setting, and Participants: This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia. Of these patients, 6710 met the inclusion criteria. Data were collected using electronic database acquisition and query. Main Outcomes and Measures: Multivariate analysis was performed to identify independent prognostic factors for PTH and receipt of transfusion. Results: Of the 6710 patients who met criteria for analysis (3454 male [51.5%] and 3256 female [48.5%]; median age, 5.4 years [interquartile range, 3.7-8.2 years]), 222 (3.3%) presented with PTH that required surgical control (sPTH). A total of 15 of the 8868 patients required transfusion for an overall risk for transfusion after tonsillectomy of 0.2%. Fifteen of 222 patients undergoing sPTH (6.8%) received transfusions. No significant independent increased risk for sPTH was associated with use of ibuprofen (adjusted odds ratio [OR], 0.90; 95% CI, 0.68-1.19). A significant independent association was found in the risk for sPTH in patients 12 years or older (adjusted OR, 2.74; 95% CI, 1.99-3.76) and in patients with a history of recurrent tonsillitis (adjusted OR, 1.52; 95% CI, 1.12-2.06). When using transfusion rates as a surrogate for severity of sPTH, transfusion increased by more than 3-fold among ibuprofen users compared with nonusers (adjusted OR, 3.16; 95% CI, 1.01-9.91), and the upper limit of the 95% CI suggests the difference could be nearly 10 times greater. Conclusions and Relevance: The risk for sPTH is not increased with use of postoperative ibuprofen but is increased in patients 12 years or older and patients undergoing tonsillectomy with a history of recurrent tonsillitis. Hemorrhage severity is significantly increased with ibuprofen use when using transfusion rate as a surrogate marker for severity.
Databáze:	MEDLINE
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