Abstract
There are gender-specific differences in the frequency and course of different diseases. Specifically, some studies have shown an increased risk of post-tonsillectomy hemorrhage (PTH). The aim of the study was to investigate gender-specific risk factors for hemorrhage after tonsillectomy (TE)/abscess-TE. We anonymously reviewed and recorded the relevant data of all patients (≥14 years) who underwent a TE/abscess-TE between 2011 and 2013 in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin. A patient survey was used to complete missing data. We analyzed gender-specific risk factors for PTH. During the study period, 460 operations were performed and the data of 250 patients were analyzed (213 TE and 37 abscess-TE). The median patient age was 27 years (ranging from 14 to 83 years). The rate of primary PTH (<24 h after TE/abscess-TE) was 3 %, and the rate of secondary PTH (>24 h) was 23 %. A significantly higher PTH rate was associated with males (p = 0.037), which was still apparent in ages 21–30 after sub-classification. Multivariate analysis calculated diagnosis, regular alcohol consumption and administration of glucocorticoids to be independent risk factors associated with gender. In conclusion, the PTH rate is gender-specific, and male patients are at higher risk, especially in young adulthood. Therefore, doctors should advise male patients of the increased risk of bleeding and stress the importance of compliance. Also, close postoperative follow-up is desirable.
Similar content being viewed by others
References
Choudhry MA, Bland KI, Chaudry IH (2006) Gender and susceptibility to sepsis following trauma. Endocr Metab Immune Disord Drug Targets 6(2):127–135
Orshal JM, Khalil RA (2004) Gender, sex hormones, and vascular tone. Am J Physiol Regul Integr Comp Physiol 286(2):R233–R249
Angele MK, Frantz MC, Chaudry IH (2006) Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo) 61(5):479–488
Gibson CL (2013) Cerebral ischemic stroke: is gender important? J Cereb Blood Flow Metab 33(9):1355–1361
Choudhry MA, Bland KI, Chaudry IH (2007) Trauma and immune response—effect of gender differences. Injury 38(12):1382–1391
Mueller J et al (2015) Population-based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol 272(12):3769–3777
Ikoma R et al (2014) Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx 41(4):376–379
Tolska HK et al (2013) Post-tonsillectomy haemorrhage more common than previously described—an institutional chart review. Acta Otolaryngol 133(2):181–186
Sarny S et al (2011) Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 121(12):2553–2560
Ranjit S et al (1999) The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience. Singap Med J 40(10):622–626
Kristensen S, Tveteras K (1984) Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol Allied Sci 9(6):347–350
Tomkinson A et al (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121(2):279–288
Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 132(2):281–286
Tugrul S et al (2015) Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial. Eur Arch Otorhinolaryngol 279(12):2483–2487
Arnoldner C et al (2008) Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr 120(11–12):336–342
Perkins JN et al (2012) Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10):2311–2315
Bhattacharyya N (2001) Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 80(8):544–549
Lehnerdt G et al (2005) Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy. Acta Otolaryngol 125(12):1312–1317
Olsen NJ, Kovacs WJ (1996) Gonadal steroids and immunity. Endocr Rev 17(4):369–384
Grimaldi CM et al (2005) Hormonal modulation of B cell development and repertoire selection. Mol Immunol 42(7):811–820
Roubinian JR et al (1978) Effect of castration and sex hormone treatment on survival, anti-nucleic acid antibodies, and glomerulonephritis in NZB/NZW F1 mice. J Exp Med 147(6):1568–1583
Hochberg MC, Spector TD (1990) Epidemiology of rheumatoid arthritis: update. Epidemiol Rev 12:247–252
Kalland T, Strand O, Forsberg JG (1979) Long-term effects of neonatal estrogen treatment on mitogen responsiveness of mouse spleen lymphocytes. J Natl Cancer Inst 63(2):413–421
Coordes A et al. (2015) Tonsillectomy in adults: Length of hospital stay has no influence on the frequency of postoperative hemorrhage. HNO 63(12):841–844, 846–849 doi:10.1007/s00106-015-0077-7
Windfuhr JP et al (2008) Life-threatening posttonsillectomy hemorrhage. Laryngoscope 118(8):1389–1394
Windfuhr JP, Ulbrich T (2001) Post-tonsillectomy hemorrhage: results of a 3-month follow-up. Ear Nose Throat J 80(11):790 (pp 795–798, 800 passim)
Hultcrantz E et al (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536
Raut V et al (2001) Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study. Laryngoscope 111(12):2178–2182
Windfuhr JP (2013) Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 75(3):166–173
Drake-Lee A, Stokes M (1998) A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clin Otolaryngol Allied Sci 23(6):491–495
Blomgren K, Qvarnberg YH, Valtonen HJ (2001) A prospective study on pros and cons of electrodissection tonsillectomy. Laryngoscope 111(3):478–482
Windfuhr JP, Wienke A, Chen YS (2009) Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 266(1):111–116
Kim DW et al (2010) Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 37(4):456–460
Demars SM, Harsha WJ, Crawford JV (2008) The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 134(8):811–814
Giger R, Landis BN, Dulguerov P (2005) Hemorrhage risk after quinsy tonsillectomy. Otolaryngol Head Neck Surg 133(5):729–734
Riggin L et al (2013) A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 38(2):115–129
Gallagher TQ et al (2012) Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial. JAMA 308(12):1221–1226
Al-Kindy SA (2002) Do antibiotics decrease post-tonsillectomy morbidity? Saudi Med J 23(6):705–707
Majholm B et al (2012) Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand 56(3):323–331
Schafer C (2010) Do men and women in illness and stress situations show different measures of risk attitude and therapy behaviour? Versicherungsmedizin 62(3):115–119
Glombiewski JA et al (2012) Medication adherence in the general population. PLoS One 7(12):e50537
Knipping S et al (2009) Is postoperative antibiotic treatment mandatory after abscess tonsillectomy. HNO 57(3):230–238
Lehnerdt G et al (2005) Smoking promotes the formation of peritonsillar abscesses. Laryngorhinootologie 84(9):676–679
Dilkes MG, Dilkes JE, Ghufoor K (1992) Smoking and quinsy. Lancet 339(8808):1552
Lampert T, von der Lippe E, Muters S (2013) Prevalence of smoking in the adult population of Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5–6):802–808
Bellis JR et al (2014) Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 113(1):23–42
Windfuhr JP et al (2011) The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol 77(3):373–379
Kraus L, Bauernfeind R (1998) Repräsentativerhebung zum Gebrauch Psychoaktiver Substanzen bei Erwachsenen in Deutschland 1997. Sucht 44(1):5–82
Makarov VK, Starikov SV (2011) Blood serum phospholipids in patients with tonsillitis under combinated alcohol-bacterial influence. Biomed Khim 57(6):657–660
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflicts of interest relevant to this article and no financial support or funding.
Additional information
V. M. Hofmann and M. Lenarz contributed equally.
Rights and permissions
About this article
Cite this article
Coordes, A., Soudry, J., Hofmann, V.M. et al. Gender-specific risk factors in post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 273, 4535–4541 (2016). https://doi.org/10.1007/s00405-016-4146-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-016-4146-7