Preoperative survey of bleeding in patients undergoing tonsillectomy and or adenoidectomy

Abstract

Introduction: It is reported between 1% and 6% of post-tonsillectomy hemorrhage and / or adenoidectomy. The literature discusses the real usefulness of routine hemosta- sis tests. Standardized questionnaires bleeding could define who make a study of post- tonsillectomy bleeding bleeding to predict and/or adenoidectomy. Aim: To determine the usefulness of a preoperative questionnaire to assess history of bleeding and routine coagulation tests to predict bleeding associated with tonsillectomy and/or adenoidectomy. Material and method: We performed a prospective cohort study in the Department of Otolaryngology, Hospital Barros Luco. We included patients undergoing tonsillectomy and / or adenoidectomy, with guest under 18 years between January 2008 and June 2010. We used chi-square, Fisher, Student t test as appropriate for the analysis of the groups. Statistical significance was p <0.05. Results: We reviewed 951 records of patients operated in the study period, a total of 1288 surgeries (73.8%). 65 were excluded due to incomplete information and 272 without questionnaire. The mean (SD) age was 7.70 + 3.5 years (range: 1 to 18 years). 54% of patients were male. The frequency of bleeding was 2.6%. The ratio of ratios (OR) for age was 1.11 (95% CI 1.01 to 1.23) for chronic tonsillitis was 2.56 (95% CI 1.15 to 5.69). The tests showed a sensitivity of 4% and positive predictive value of 3%. The preoperative bleeding questionnaire had a sensitivity of 24% and positive predictive value of 3%. Discussion: The low positive predictive value of the questionnaire and examinations (3%) was associated with low prevalence of bleeding and other factors involved in postoperative bleeding. The questionnaire had agreater ability to detectpostoperative bleeding (24%). The use of the questionnaire represents a reliable tool that tests, but less expensive and less traumatic. Altered to a questionnaire study should be performed by complete blood specialist. Conclusions: The preoperative questionnaire is useful to discriminate on who you should coagulation. The routine preoperative tests, prothrombin time (PT) and activated partial thromboplastin time (aPTT) in patients without a history not seem to help.