Preoperative coagulation screening prior to tonsillectomy in adults: current practice and recommendations
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The hypotheses of the study are: (1) a positive history of coagulopathy predicts a higher postoperative haemorrhage risk, (2) a positive laboratory screening for coagulopathy can forecast a higher haemorrhage risk and (3) the haemorrhage risk in patients with known bleeding disorder is elevated. In a multicentre study information on 3,041 tonsillectomies in adults over 9 months, from 1st October 2009 until 30th June 2010, was evaluated. The outcome variables were patient characteristics, postoperative haemorrhage, history of coagulopathy and laboratory screening for coagulopathy. A history of coagulopathy and laboratory screening for coagulopathy were performed in almost all patients (98.6 %, 2,998/3,041). The overall haemorrhage rate was 16 %, including all bleeding episodes after extubation, with 4.8 % returning to theatre. A positive history was reported in 2 % (55/3,041) and a positive laboratory screening in 3 % (94/3,041) of all patients. A positive history is significantly associated with a higher risk of postoperative haemorrhage (31 %, 17/55, p < 0.002) compared to patients with a negative history (16 %, 387/2,497). A positive laboratory for coagulopathy was not significantly associated with an increased haemorrhage risk (20 %, 19/94, p < 0.235) compared to patients with a negative laboratory (16 %, 390/2,249). The haemorrhage risk for adults with a bleeding disorder is twice as high (31 %, 17/55) as for adults without bleeding disorder (16 %, 476/2,973). In conclusion, an adult patient’s history of coagulopathy should be taken prior to tonsillectomy as a positive history doubles the haemorrhage risk while a laboratory screening for coagulopathy has no significant power to predict an elevated haemorrhage risk. Bleeding disorders double the risk of postoperative haemorrhage.
KeywordsTonsillectomy Haemorrhage risk History of coagulopathy Laboratory screening for coagulopathy
The authors would like to thank all heads of Austria’s ENT departments (year 2009): Univ. Prof. Dr. Wolfgang Biegenzahn, Univ. Prof. Dr. Klaus Böheim, Univ. Doz. Dr. Monika Cartellieri, Univ. Prof. Dr. Hans Edmund Eckel, Univ. Prof. Dr. Wolfgang Elsässer, Univ. Prof. Dr. Peter Franz, Univ. Prof. Dr. Gerhard Friedrich, Univ. Prof. Dr. Wolfgang Gstöttner, Univ. Prof. Dr. Werner Habicher, Univ. Prof. Dr. Floris Heger, OA Dr. Gerhard Herzog, Univ. Doz. Dr. Heribert Höfler, Univ. Prof. Dr. Heinz Jünger, Univ. Prof. Dr. Christoph Karas, Univ. Prof. Dr. Tilman Keck, Univ. Prof. Dr. Antonius Kierner, OA Dr. Hannes Kirschner, Univ. Prof. Dr. Josef Meindl, Univ. Prof. Dr. Antal Mink, Univ. Prof. Dr. Michael Moser, Univ. Doz. Dr. Csilla Neuchrist, OA Dr. Johannes Neumüller, Univ. Prof. Dr. Peter Ostertag, OA Dr. Robert Panholzer, Univ. Prof. Dr. Robert Pavelka, OA Dr. Richard Pauer, OA Dr. Hannes Picker, Univ. Prof. Dr. Gerd Rasp, Univ. Prof. Dr. Christoph Reisser, Univ. Prof. Dr. Ernst Richter, Univ. Prof. Dr. Herbert Riechelmann, Univ. Prof. Dr. Herwig Swoboda, Univ. Prof. Dr. Patrick Zorowka. The authors extend their special thanks to all hospital staff for collecting surgery data: Doris Aichinger M.D., Ulrich Amann M.D., Anna Aszmayr M.D., Birte Bender M.D., Elisabeth Blassnigg M.D., Christoph Brand M.D., Elisabeth Brand M.D., Otto Braumandl M.D., Martin Bruch M.D., Christoph Flux M.D., Margit Gombotz M.D., Matthias Grabner M.D., Stefan Hoier M.D., Franjo Juric M.D., Joachim Kronberger M.D., Thomas Kunst M.D., Christoph Matscheko M.D., Hermine Mayr M.D., Magdalena Necek M.D., Johannes Neumüller M.D., Anita Neuwirth M.D., Robert Panholzer M.D., Richard Pauer M.D., Christof Pauli M.D., Hannes Picker M.D., Robert Pinnitsch M.D., Julia Rechenmacher M.D., Andreas Riedler M.D., Kyros Sabbas M.D., Michael Safar M.D., Claus Schleinzer M.D., Barbara Schubert M.D., Johannes Schwarzer M.D., Anahid Seraydarian M.D., Andreas Strobl M.D., Beatrix Thalhammer M.D., Sandra Waltenberger M.D., Anette Wenzel M.D., Martin Wernig M.D., Claudia Winter M.D., Thomas Wöllner M.D., Gabriella Zahratka M.D., Michaela Zumtobel M.D. and to everybody else who has remained unnamed. The study was funded by the Austrian Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The sponsor had no role in the study design, data collection, data analysis, data interpretation, and the writing of any publication related to the study.
Conflict of interest
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