Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children.

Autor:	Cheung PKF; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Walton J; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Hobson ML; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Taylor P; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Chin M; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Boardman S; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia., Cheng ATL; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia.; Discipline of Paediatric and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia., Birman CS; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia.; Discipline of Paediatric and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia.; Faculty of Medicine and Health Sciences, Macquarie University, Macquarie, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	Ear, nose, & throat journal [Ear Nose Throat J] 2023 Apr; Vol. 102 (4), pp. 244-250. Date of Electronic Publication: 2021 Mar 09.
DOI:	10.1177/0145561321999594
Abstrakt:	Objective: To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14. Methods: A retrospective chart review was performed for all pediatric patients admitted to The Children's Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis. Results: Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage. Conclusions: Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.
Databáze:	MEDLINE
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