全身性类固醇对扁桃体切除术后出血的影响：利用日本全国住院患者数据库对61430例患者的分析
Impact of systemic steroids on posttonsillectomy bleeding: analysis of 61 430 patients using a national inpatient database in Japan.
作者信息
Suzuki Sayaka, Yasunaga Hideo, Matsui Hiroki, Horiguchi Hiromasa, Fushimi Kiyohide, Yamasoba Tatsuya
机构信息
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan2Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
出版信息
JAMA Otolaryngol Head Neck Surg. 2014 Oct;140(10):906-10. doi: 10.1001/jamaoto.2014.2009.
IMPORTANCE
Although postoperative bleeding after tonsillectomy is rare, it is potentially life-threatening. The association between steroid administration and postoperative bleeding remains controversial. The findings of previous studies were limited by small sample sizes.
OBJECTIVE
To examine the impact of intravenous steroid administration on posttonsillectomy bleeding requiring reoperation in children and adults.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 61 430 patients from 718 hospitals who underwent tonsillectomy between 2007 and 2013, using the Diagnosis Procedure Combination database in Japan.
INTERVENTIONS
Intravenous steroid administration on the day of tonsillectomy.
MAIN OUTCOMES AND MEASURES
The main outcome measure was reoperation for hemostasis under general anesthesia. Patient characteristics (age, sex, comorbidities) and steroid use were examined. Patients were classified as children (age ≤15 years, n = 31 934) and adults (age >15 years, n = 29 496), and subclassified into those who received intravenous steroid therapy on the day of tonsillectomy (steroid group) and those who did not (control group). Multivariable logistic regression analysis was performed to analyze the association between steroid use and posttonsillectomy bleeding with adjustment for patient characteristics.
RESULTS
The rate of reoperation was significantly higher in the steroid group than in the control group for children (1.2% vs 0.5%) (P < .001) but not for adults (1.7% vs 1.4%) (P = .14). Reoperation was most frequently performed at about 7 days after tonsillectomy. After adjusting for patient characteristics, we found a significant increase in the rate of reoperation in the steroid group in children (adjusted odds ratio [OR], 2.50 [95% CI, 1.47-4.23]) (P = .001) but not in adults (OR, 1.18 [95% CI, 0.85-1.64]) (P = .31).
CONCLUSIONS AND RELEVANCE
Intravenous steroid administration on the day of tonsillectomy in children was an independent risk factor for severe bleeding requiring reoperation.
重要性
尽管扁桃体切除术后出血很少见，但有潜在生命危险。类固醇给药与术后出血之间的关联仍存在争议。以往研究的结果受样本量小的限制。
目的
探讨静脉注射类固醇对儿童和成人扁桃体切除术后因出血需再次手术的影响。
设计、设置和参与者：利用日本诊断程序组合数据库，对2007年至2013年间在718家医院接受扁桃体切除术的61430例患者进行回顾性队列研究。
干预措施
扁桃体切除当天静脉注射类固醇。
主要结局和测量指标
主要结局指标是在全身麻醉下再次手术止血。检查患者特征（年龄、性别、合并症）和类固醇使用情况。患者分为儿童（年龄≤15岁，n = 31934）和成人（年龄>15岁，n = 29496），并进一步分为在扁桃体切除当天接受静脉类固醇治疗的患者（类固醇组）和未接受治疗的患者（对照组）。进行多变量逻辑回归分析，以分析类固醇使用与扁桃体切除术后出血之间的关联，并对患者特征进行校正。
结果
儿童类固醇组再次手术率显著高于对照组（1.2%对0.5%）（P <.001），而成人类固醇组与对照组无显著差异（1.7%对1.4%）（P =.14）。再次手术最常在扁桃体切除术后约7天进行。校正患者特征后，我们发现儿童类固醇组再次手术率显著增加（校正比值比[OR]，2.50[95%CI，1.47 - 4.23]）（P =.001），而成人类固醇组无显著增加（OR，1.18[95%CI，0.85 - 1.64]）（P =.31）。
结论及相关性
儿童扁桃体切除当天静脉注射类固醇是严重出血需再次手术的独立危险因素。
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