Posttonsillectomy hemorrhage: blame on surgeons or genes?

OBJECTIVE

To investigate whether the insertion/deletion polymorphism (-94ins/delATTG) in the promoter of NF kappa B1 is associated with the risk of bleeding after tonsillectomy.

DESIGN AND SETTING

Retrospective study with genotyping performed from tonsillar tissue or blood.

PATIENTS

One hundred forty-eight patients having undergone tonsillectomy due to chronic tonsillitis, with or without posttonsillectomy hemorrhage.

MEASUREMENTS AND RESULTS

DNA-extraction from paraffin-embedded tonsillectomy tissue or blood was followed by genotyping for the insertion/deletion (-94ins/delATTG) promoter NF kappa B1 polymorphism. Genotypes differed significantly between patients with (n = 56) and without (n = 92) posttonsillectomy hemorrhage, with the frequency of the homozygous deletion genotype carriers (DD) significantly increased in those with posttonsillectomy bleeding with an odds ratio (OR) for bleeding of 3.78 (95% confidence interval [CI] 1.2-11.7, P = .023) but not in homozygous (II) insertion and heterozygous (ID) genotype carriers (II/ID). Genotype distribution in patients was compatible with the Hardy Weinberg equilibrium. In contrast, there were no statistically significant differences between patients with or without posttonsillectomy hemorrhage with regard to demographic characteristics, different surgeons, postoperative medications like analgesics, antibiotics, anticoagulation therapy, or values of variables of pre- and postoperative coagulation studies. Likewise, these variables revealed no differences between genotypes.

CONCLUSIONS

Carriers of the homozygous deletion allele were at an almost fourfold risk to develop posttonsillectomy hemorrhage compared to homozygous and heterozygous insertion allele carriers, independent of other risk factors.