Fonseca Alexandra C G, Engelhardt Margaret I, Huang Zhen J, Jiang Zi Yang, Yuksel Sancak, Roy Soham
McGovern Medical School, University of Texas Health Science Center at Houston, Department of Otorhinolaryngology, 6431 Fannin Street, Houston, TX 77030, United States.
McGovern Medical School, University of Texas Health Science Center at Houston, Department of Otorhinolaryngology, 6431 Fannin Street, Houston, TX 77030, United States.
Am J Otolaryngol. 2018 Jul-Aug;39(4):445-447. doi: 10.1016/j.amjoto.2018.03.028. Epub 2018 Apr 5.
To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management.
A retrospective review was performed of tonsillectomies conducted at a single institution between 1/1/2013 and 1/1/2017. The rates of PTH and subsequent intervention were calculated. These were categorized into patients having surgery pre- and post-July 1, 2015, the former group receiving narcotics and the latter ibuprofen with acetaminophen.
Of 1351 total tonsillectomies, 3.04% had PTH requiring return to the hospital. 0.74% required no further surgical intervention, whereas 2.30% required secondary surgical control. The bleed rate prior to July 2015 was 3.15%, with 1.05% non-surgical bleeds and 2.10% requiring surgery. Post-July 2015, the bleed rate was 2.92%, with 0.44% non-surgical bleeds and 2.49% requiring surgery. There were no statistically significant differences between the two groups with respect to overall, non-surgical, and surgical hemorrhage rates (p > 0.05). Of the total bleeds, the need for secondary surgery in the narcotic group was 66.7% and 85% in the NSAID group (p = 0.18). During the study period, 36 patients with PTH had their initial tonsillectomy performed at outside institutions; 53% required surgical intervention.
Secondary hemorrhage remains a significant cause of morbidity in post-tonsillectomy patients, often requiring surgical intervention. This review found no increased bleeding risk associated with use of ibuprofen and acetaminophen as opposed to narcotic pain relief.
III.
回顾一家四级医疗中心的扁桃体切除术后出血（PTH）发生率，包括麻醉性镇痛药与非甾体抗炎药（NSAID）术后疼痛管理的影响。
对2013年1月1日至2017年1月1日在单一机构进行的扁桃体切除术进行回顾性研究。计算PTH发生率及后续干预情况。患者分为2015年7月1日前手术组和术后手术组，前一组使用麻醉性镇痛药，后一组使用布洛芬与对乙酰氨基酚。
在总共1351例扁桃体切除术中，3.04%发生PTH需要返回医院。0.74%无需进一步手术干预，而2.30%需要二次手术控制出血。2015年7月前出血率为3.15%，其中1.05%为非手术性出血，2.10%需要手术。2015年7月后，出血率为2.92%，其中0.44%为非手术性出血，2.49%需要手术。两组在总体、非手术和手术出血率方面无统计学显著差异（p>0.05）。在所有出血病例中，麻醉性镇痛药组二次手术需求率为66.7%，NSAID组为85%（p = 0.18）。研究期间，36例PTH患者最初在外部机构进行扁桃体切除术，53%需要手术干预。
继发性出血仍是扁桃体切除术后患者发病的重要原因，常需手术干预。本研究发现，与使用麻醉性镇痛药缓解疼痛相比，使用布洛芬与对乙酰氨基酚不会增加出血风险。
III级
