 |
 |
 |
 |
 |
 |
Sains Malaysiana 48(3)(2019): 621–627
http://dx.doi.org/10.17576/jsm-2019-4803-15
Incidence
and Risk Factors of Post-Tonsillectomy Haemorrhage in Patients Operated during
the 2012-2016 Period at ENT Department Hospital Serdang, Malaysia
(Kejadian
dan Faktor Risiko Pendarahan Selepas Tonsilektomi bagi Pesakit yang Dibedah
Sepanjang Tempoh 2012-2016 di Jabatan ENT Hospital
Serdang, Malaysia)
SETHU T. SUBHA*, ATIQAH FARAH, Z., CHONG, K.M., NOR ASHIKIN, A.H.
& MUHAMMAD FIKRI, S.
Faculty
of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang,
Selangor Darul Ehsan, Malaysia
Diserahkan:
5 Oktober 2018/Diterima: 11 Januari 2019
ABSTRACT
Tonsillectomy is the most common operation performed in the field
of Ear, Nose and Throat (ENT) Surgical speciality. Post-tonsillectomy
haemorrhage remains a significant complication leading to morbidity
and occasional mortality. The main objective of this study was
to evaluate the incidence and risk factors of post-tonsillectomy
haemorrhage in a cohort of patients who had been operated at our
institution. This retrospective cohort study reviewed the medical
records of all patients who underwent tonsillectomy from 1st January
2012 to 31st December 2016. Data on patient’s age, gender,
race, smoking habit, indication for tonsillectomy, duration and
technique of surgery, usage of post-operative drugs and management
were recorded. Out of 315 patients included this study, 54.9%
were adults (12 years and above) and majority (86.3%) of them
were of Malay descent. The common indication for tonsillectomy
was recurrent tonsillitis (84.4%). This study showed significant
associations (p<0.05) between age, smoking and the use of steroids with post-tonsillectomy
haemorrhage. However, there was no significant association between
gender, race, use of post-operative drugs (non-steroidal anti-inflammatory
drugs, antibiotics), duration of surgery, the technique of surgery
and post-tonsillectomy haemorrhage. The incidence of post-tonsillectomy
haemorrhage in our population was 10.5 % (n=33) and among
them, 54.5 % (n=18) required surgical intervention. Our
study demonstrated that older patients (12 years and above), smokers
and the use of steroids during the post-operative period have
increased the risk of post-tonsillectomy haemorrhage. An awareness
of these risk factors should help to minimize the post-tonsillectomy
haemorrhage and improve the patient outcomes.
Keywords: Post tonsillectomy haemorrhage (PTH);
risk factors; smokers; steroids
ABSTRAK
Tonsilektomi adalah pembedahan yang paling biasa dilakukan dalam
bidang kepakaran Telinga, Hidung dan Tekak (ENT).
Pendarahan selepas pembedahan tonsilektomi adalah komplikasi yang ketara
membawa kepada morbiditi dan mortaliti sekali sekala. Objektif utama kajian ini
adalah untuk menilai kejadian dan faktor risiko untuk mendapat pendarahan
selepas pembedahan tonsilektomi dalam kohort pesakit yang telah menjalani
pembedahan di institusi kami. Kajian kohort retrospektif ini mengkaji rekod
perubatan daripada semua pesakit yang menjalani tonsilektomi dari 1 Januari
2012 hingga 31 Disember 2016. Data pesakit seperti umur, jantina, bangsa,
tabiat merokok, petunjuk untuk menjalani tonsilektomi, tempoh dan teknik
pembedahan, penggunaan ubat-ubatan dan pengurusan selepas pembedahan telah
direkodkan. Antara 315 pesakit termasuk kajian ini, 54.9% adalah orang dewasa
(12 tahun ke atas) dan majoriti (86.3%) daripadanya adalah berbangsa Melayu.
Penunjuk umum untuk pembedahan adalah tonsillitis berulang (84.4%) dalam
kalangan pesakit kami. Kajian ini menunjukkan kaitan yang signifikan (p<0.05) antara umur, merokok dan
penggunaan steroid dengan pendarahan selepas pembedahan tonsilektomi. Walau
bagaimanapun, tidak terdapat hubungan yang signifikan antara jantina, bangsa,
penggunaan ubat-ubatan selepas pembedahan (NSAIDS,
antibiotik), tempoh pembedahan, teknik pembedahan dengan pendarahan selepas
pembedahan tonsilektomi. Insiden pendarahan selepas tonsilektomi dalam populasi
kami adalah 10.5% (n=33) dan antara mereka 54.5% (n=18)
memerlukan rawatan intervensi surgeri. Kajian ini menunjukkan bahawa pesakit
yang lebih tua (12 tahun ke atas), perokok dan penggunaan steroid dalam tempoh
selepas pembedahan mempunyai risiko yang lebih tinggi untuk mendapat pendarahan
selepas pembedahan. Kesedaran mengenai faktor risiko ini harus membantu
meminimumkan pendarahan selepas pembedahan tonsilektomi dan meningkatkan
penjagaan dan keadaan pesakit.
Kata kunci: Faktor risiko; pendarahan
pasca-tonsilektomi (PTH); perokok;
steroid
RUJUKAN
Al-Ani, R.M. 2012. Post-tonsillectomy bleeding:
Incidence and risk factors running title: PTB: Incidence and risk factors.
Iraqi J. Comm. Med. 3: 261-264.
Al-Shehri, A.M.S. 2014. Incidence and potential
risk factors of post-tonsillectomy hemorrhage. Bahrain Medical Bulletin 36:
3.
Alexander, R.J., Kukreja, R. & Ford, G.R.
2004. Secondary post-tonsillectomy haemorrhage and informed consent. Laryngol.
Otol. 118(12): 937-940.
Aljabr, I.K., Hassan, F.M. & Alyahya, K.A.
2016. Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection
surgical techniques in Alahsa region, Saudi Arabia. Alexandria Journal of
Medicine 52(2): 169-172.
Arora, R., Saraiya, S., Niu, X., Thomas, R.
& Kannikeswaran, N. 2015. Post-tonsillectomy haemorrhage: Who needs
intervention? Int. J. Pediatr. Otorhinolaryngol. 79(2): 165-169.
Bellis, J.R., Pirmohamed, M., Nunn, A.J., Loke, Y.K., De, S.,
Golder, S. & Kirkham, J.J. 2014. Dexamethasone and haemorrhage risk in
paediatric tonsillectomy: A systematic review and meta-analysis. Br. J.
Anaesth. 113(1): 23-42.
Bhattacharyya,
N. 2001. Evaluation of post-tonsillectomy bleeding in the adult population. Ear
Nose Throat J. 80(8): 544-549.
Bhattacharyya,
N. & Shapiro, N.L. 2014. Associations between socioeconomic status and race
with complications after tonsillectomy in children. Otolaryngol. Head Neck
Surg. 151(6): 1055-1160.
Blakley,
B.W. 2009. Post-tonsillectomy bleeding: How much is too much? Otolaryngol.
Head Neck Surg. 140(3): 288-290.
Cohen,
D. & Dor, M. 2008. Morbidity and mortality of post-tonsillectomy bleeding:
Analysis of cases. J. Laryngol. Otol. 122(1): 88-92.
Collison,
P.J. & Mettler, B. 2000. Factors associated with post-tonsillectomy
hemorrhage. Ear Nose Throat J. 79(8): 640-648.
Cooper,
L. 2016. Post-tonsillectomy management: A framework. Australian Family
Physician 45(5): 289-291.
Coordes,
A., Soudry, J., Hofmann, V.M. & Lenarz, M. 2016. Gender-specific risk
factors in post-tonsillectomy hemorrhage. Eur. Arch. Otorhinolaryngol.
273: 4535-4541.
Curtis,
J.L., Harvey, B., Willie, S., Narasimhan, E., Andrews, S., Henrichsen, J., Van
Buren, N.C., Srivastava, R. & Meier, J.D. 2015. Causes as costs of ED
visits after pediatric adenotonsillectomy. Otolaryngol. Head Neck Surg. 152(4):
691-696.
Demars,
S.M., Harsha, W.J. & Crawford, J.V.M. 2008. The effects of smoking on the
rate of postoperative hemorrhage after tonsillectomy and
uvulopalatopharyngoplasty. Arch. Otolaryngol. Head Neck Surg. 134(8):
811-814.
Dhiwakar,
M., Clement, W.A., Supriya, M. & McKerrow, W. 2012. Antibiotics to reduce
post-tonsillectomy morbidity. Cochrane Database Syst. Rev. 12: CD005607.
Harju,
T. & Numminen, J. 2017. Risk factors for secondary post-tonsillectomy
haemorrhage following tonsillectomy with bipolar scissors: Four-year
retrospective cohort study. J. Laryngol. Otol. 131(2): 155-161.
Kuo,
M., Hegarty, D., Johnson, A. & Stevenson, S. 1995. Early post-tonsillectomy
morbidity following hospital discharge: Do patients and GPs know what to expect? Health Trends 27(3): 98-100.
Kwok,
M.M., Subramaniyan, M., Rimmer, J.J. & Karahalios, A. 2018.
Post-tonsillectomy haemorrhage in Australia-A multivariable analysis of risk
factors. Aus. J. Otolaryngol. 1: 2.
Lee,
W.C. & Sharp, J.F. 1996. Complications of paediatric tonsillectomy
post-discharge. J. Laryngol. Otol. 110(2): 136-140.
Leinbach,
R.F., Markwell, S.J. & Colliver, J.A. 2003. Hot versus cold tonsillectomy:
A systematic review of the literature. Otolaryngol. Head Neck Surg. 129:
360-364.
Liu,
J.H., Anderson, K.E., Willging, J.P., Myer, C.M., Shott, S.R., Bratcher, G.O.
& Cooton, R.T. 2001. Post tonsillectomy hemorrhage. What is it and what
should be recorded? Arch. Otolaryngol. Head Neck Surg. 127(10):
1271-1275.
Maksimovic,
Z., Vranjes, Z., Zubcic, Z. & Birtic, D. 2007. Incidence of
post-tonsillectomy and post-tonsillectomy haemorrhage in 5125 patients operated
during the 1994-2005 period at Department of ENT Head and Neck Surgery, Osijek
University Hospital in Osijek Croatia. Act Clin. Croat. 46: 247-250.
Miyamoto,
Y., Shinzawa, M., Tanaka, S., Tanaka-Mizuno, S. & Kawakami, K. 2018.
Perioperative steroid use for tonsillectomy and its association with
reoperation for post tonsillectomy hemorrhage: A retrospective cohort study. Anesthetic
Clinical Pharmacology 126(3): 806-814.
Myssiorek,
D. & Alvi, A. 1996. Post-tonsillectomy hemorrhage: An assessment of risk
factors. Int. J. Pediatr. Otorhinolaryngol. 37(1): 35-43.
Negm,
H., Atef, A., Lasheen, H., Kamel, A.A., Azooz, K. & Elhoussainy, O. 2017.
Factors affecting secondary post-tonsillectomy hemorrhage: A case study. The
Egyptian Journal of Otolaryngology 33: 50-55.
Perkins,
J.N., Liang, C., Gao, D., Shultz, L. & Friedman, N.R. 2012. Risk of
post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10):
2311-2315.
Plante,
J.A.F., Zarychanski, R., Lauzier, F., Vigneault, L., Moore, L., Boutin, A.
& Fergusson, D.A. 2012. Effect of systemic steroids on post-tonsillectomy
bleeding and reinterventions: Systematic review and meta-analysis of randomized
controlled trials. BMJ 345: e5389.
Sarny,
S., Ossimitz, G., Habermann, W. & Stammberger, H. 2011. Hemorrhage
following tonsil surgery: A multicenter prospective study. Laryngoscope 121(12):
2553-2560.
Spektor,
Z., Saint-Victor, S., Kay, D.J. & Mandell, D.L. 2016. Risk factors for
pediatric post-tonsillectomy hemorrhage. Int. J. Pediatr. Otorhinolaryngol. 84:
151-155.
Suzuki,
S., Yasunaga, H., Matsui, H., Horiguchi, H., Fushimi, K. & Yamasoba, T.
2014. Impact of systemic steroids on post tonsillectomy bleeding analysis of
61430 patients using a national inpatient database in Japan. JAMA
Otolaryngol. Head Neck Surg. 140(10): 906-910.
Szeremeta,
W., Novelly, N.J. & Benninger, M. 1996. Postoperative bleeding in tonsillectomy
patients. Ear Nose Throat J. 75: 373-376.
Tami,
T.A., Parker, G.S. & Taylor, R.E. 1987. Post-tonsillectomy bleeding: An
evaluation of risk factors. Laryngoscope 97(11): 1307-1311.
Tomkinson,
A., Harrison, W., Owens, D., Fishpool, S. & Temple, M. 2012. Postoperative
hemorrhage following adenoidectomy. Laryngoscope 122(6): 1246-1253.
Wetmore,
R.F. 2017. Surgical management of the tonsillectomy and adenoidectomy patient. World
Journal of Otorhinolaryngology-Head and Neck Surgery 3: 176e182.
Windfuhr,
J.P., Chen, Y.S. & Remmert, S. 2005. Hemorrhage following tonsillectomy and
adenoidectomy in 15,218 patients. Otolaryngol. Head Neck Surg. 132(2):
281-286.
*Pengarang
untuk surat-menyurat; email: subhast2@yahoo.com
|
|||
|
