Preoperative plasma fibrinogen as a predictive factor for post-tonsillectomy haemorrhage.

Autor: Grasl S; Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Janik S; Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Vyskocil E; Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Kadletz L; Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Grasl MC; Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria., Erovic BM; Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria.
Jazyk: angličtina
Zdroj: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery [Clin Otolaryngol] 2019 Nov; Vol. 44 (6), pp. 935-941. Date of Electronic Publication: 2019 Oct 09.
DOI: 10.1111/coa.13404
Abstrakt: Objectives: To assess whether preoperative plasma fibrinogen is able to predict severe post-tonsillectomy haemorrhage.
Study Design: Retrospective chart review.
Methods: We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses.
Results: 414 (90.8%) had no severe post-tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (P = .023) in patients with a severe bleeding. Univariate Cox-regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (P = .003; HR 2.66; 95% CI 1.38-5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post-tonsillectomy haemorrhage (P = .016; HR 15.4; 95% CI 0.01-0.6). High preoperative PFL was associated with significantly higher risk for post-tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker.
Conclusions: Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.
(© 2019 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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