From the Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Anesth Analg. 2018 Mar;126(3):806-814. doi: 10.1213/ANE.0000000000002681.
Steroids reduce postoperative complications after tonsillectomy such as nausea and vomiting, pain, and delayed recovery. However, steroids may also increase the risk of severe posttonsillectomy bleeding requiring reoperation.
To evaluate the risk of postoperative bleeding requiring reoperation related to perioperative steroid use, we conducted a retrospective cohort study of 6149 patients treated at 68 hospitals using a hospital-based claims database. The primary outcome was reoperation for bleeding within 14 postoperative days. We estimated odds ratios (ORs) between perioperative steroid use and reoperation by multivariable logistic regression analysis adjusted for confounders. We also estimated differences in the adjusted risk. Subgroup analyses after dividing patients into adults and children were also performed.
The incidence of reoperation did not differ significantly between patients who received steroids on the day of tonsillectomy and those who did not (1.8%, n = 15 vs 1.5%, n = 79; adjusted OR 0.81, 95% confidence interval [CI], 0.45-1.43; P = .46). We also found nonsignificant associations in both adults (OR, 0.73; 95% CI, 0.38-1.38; P = .33) and children (OR, 1.18; 95% CI, 0.34-4.11; P = .80). The adjusted risk differences estimated by the logistic regression model were -0.30% (95% CI, -1.05 to 0.45) in all patients, -0.64% (95% CI, -1.82 to 0.54) in adults, and 0.13% (95% CI, -0.93 to 1.19) in children.
Steroid use on the day of tonsillectomy was not associated with an increased risk of reoperation for bleeding. Although the wide range of CIs for the ORs could not eliminate the possibility of increased risk, especially in children, the incremental risks of reoperation for steroid use were within an acceptable range for both adults and children. Our results support the safety of perioperative steroid use for tonsillectomy, considering the magnitude of risk of reoperation because of bleeding.
类固醇可减少扁桃体切除术后的并发症，如恶心和呕吐、疼痛和恢复延迟。然而，类固醇也可能增加需要再次手术的严重扁桃体切除术后出血的风险。
为了评估围手术期使用类固醇与术后出血需要再次手术之间的关系，我们使用医院基于索赔的数据库对 68 家医院的 6149 例患者进行了回顾性队列研究。主要结局是术后 14 天内因出血而再次手术。我们通过多变量逻辑回归分析，在校正混杂因素后，估计了围手术期使用类固醇与再次手术之间的比值比（OR）。我们还估计了调整风险的差异。还对患者分为成人和儿童进行了亚组分析。
接受扁桃体切除术当天使用类固醇的患者与未使用类固醇的患者之间，再次手术的发生率无显著差异（1.8%，n=15 与 1.5%，n=79；调整后的 OR 0.81，95%置信区间[CI]，0.45-1.43；P=0.46）。我们还发现，成人（OR，0.73；95% CI，0.38-1.38；P=0.33）和儿童（OR，1.18；95% CI，0.34-4.11；P=0.80）中均无显著关联。逻辑回归模型估计的调整风险差异在所有患者中为-0.30%（95%CI，-1.05 至 0.45），在成人中为-0.64%（95%CI，-1.82 至 0.54），在儿童中为 0.13%（95%CI，-0.93 至 1.19）。
扁桃体切除当天使用类固醇与出血再次手术风险增加无关。尽管 OR 的置信区间范围较宽，不能排除风险增加的可能性，尤其是在儿童中，但类固醇使用导致再次手术的增量风险在成人和儿童中均在可接受范围内。考虑到因出血而再次手术的风险程度，我们的结果支持围手术期使用类固醇用于扁桃体切除术的安全性。
