Department of Otolaryngology, Head and Neck Surgery, University Hospital Wales, Cardiff, United Kingdom.
Laryngoscope. 2011 Feb;121(2):279-88. doi: 10.1002/lary.21242. Epub 2010 Nov 16.
OBJECTIVES/HYPOTHESIS: To identify the main risk factors associated with postoperative hemorrhage following tonsillectomy.
Prospective multicenter observational study.
The Surgical Instrument Surveillance Programme (SISP) was established in 2003 to monitor tonsil and adenoid surgery and the associated complications in all hospitals in Wales. Data were examined between April 1, 2003, and June 30, 2008, by using binary logistic regression, for risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage of a severity sufficient to require a return to the operating theater.
A total of 17,480 procedures were included. Patients aged ≥12 years were 1.5 (1.0-2.1; P < .05) and 3 times (2.2-4.9; P < .0001) more likely to experience R1 and R2 complications, respectively. There were 2.5 times as many females as males aged ≥12 years who underwent tonsillectomy, but males were almost twice as likely to experience R1 (1.4-2.8), P < .0001, or R2 (1.2-2.5), P < .001, postoperative hemorrhage. There was a 1.9-fold increased likelihood of R1 (1.1-3.3), P < .05, with the most junior surgeon, and no relationship with R2. All techniques that used heat had a significantly greater adjusted odds of R2 as compared with cold dissection, with odds ranging from 2.7 (1.5-4.7), P < .001, for dissection plus bipolar diathermy and ties, to 13.0 (5.8-29.1), P < .0001, with coblation when used with other techniques. No additional risk was associated with specified single-use instruments.
Patient age and sex and operative technique were the most significant factors affecting the risk and timing of serious postoperative hemorrhage, with no additional risk associated with the use of specified single-use instruments.
目的/假设：确定扁桃体切除术后出血相关的主要危险因素。
前瞻性多中心观察性研究。
手术器械监测计划（SISP）于 2003 年成立，旨在监测威尔士所有医院的扁桃体和腺样体手术及相关并发症。2003 年 4 月 1 日至 2008 年 6 月 30 日，采用二项逻辑回归分析，对可能导致原发性（R1）或继发性（R2）术后出血严重程度需要返回手术室的危险因素进行检查。
共纳入 17480 例手术。年龄≥12 岁的患者 R1（1.0-2.1；P<.05）和 R2（2.2-4.9；P<.0001）并发症的发生风险分别为 1.5 倍和 3 倍。≥12 岁行扁桃体切除术的女性患者是男性的 2.5 倍，但男性发生 R1（1.4-2.8）和 R2（1.2-2.5）并发症的可能性几乎是女性的两倍，P<.0001。最年轻的外科医生行扁桃体切除术，R1（1.1-3.3）的发生风险增加 1.9 倍，P<.05，但与 R2 无关。与冷解剖相比，所有使用热的技术行扁桃体切除术 R2 的调整后比值比均显著增加，差异范围为 2.7（1.5-4.7），P<.001（用于解剖+双极电凝和结扎）至 13.0（5.8-29.1），P<.0001（用于等离子切割与其他技术联合使用）。指定的一次性器械的使用与任何额外的风险无关。
患者年龄和性别以及手术技术是影响严重术后出血风险和时间的最重要因素，使用指定的一次性器械与任何额外的风险无关。
