American Society of Anesthesiology classification may predict severe post-tonsillectomy haemorrhage in children.

OBJECTIVE

The purpose of this study was to identify pre- or intraoperative markers for post-tonsillectomy haemorrhage (PTH) that may help to define in-/outpatient tonsillectomy.

DESIGN

A retrospective case-control study of tonsillectomized patients.

SETTING

A tertiary referral university hospital.

METHODS

Twenty-three children with PTH were compared with 69 tonsillectomized age- and sex-matched children without bleeding. The cohort consisted of 559 individuals under 18 years old who were scheduled for tonsillectomy or adenotonsillectomy between 1996 and 2000.

MAIN OUTCOME MEASURES

Physical and analytical variables were investigated, including blood pressure, haemoglobin and haematocrit levels, coagulation profile, American Society of Anesthesiology (ASA) physical status classification, indications for surgery, obstructive sleep apnea and snoring, surgical experience, addition of adenoidectomy, method of tonsillectomy, type of anaesthesia, method of haemostasis, and total surgical time. Statistical significance was calculated by the Mann-Whitney U test and Fisher's exact test.

RESULTS

The incidence of PTH was 4.11%, and all but one case were primary bleedings. Nineteen cases occurred within the first 8 hours. A possible risk marker identified was ASA class 2 (odds ratio = 5.69, p = .04). Other investigated factors were not significant.

CONCLUSIONS

The ASA classification may be a predictor for PTH and could be used to select outpatients before tonsillectomy.