Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia.
Discipline of Paediatric and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
Ear Nose Throat J. 2023 Apr;102(4):244-250. doi: 10.1177/0145561321999594. Epub 2021 Mar 9.
To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14.
A retrospective chart review was performed for all pediatric patients admitted to The Children's Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis.
Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage.
Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.
回顾我们在一家三级儿科转诊医院治疗扁桃体切除术后和/或腺样体切除术后出血（PTAH）的经验，并评估复发性术后出血和第 14 天后延迟性出血的管理和危险因素。
对 2014 年 7 月 1 日至 2019 年 6 月 30 日期间因 PTAH 入住西悉尼儿童医院的所有儿科患者进行回顾性病历审查。对复发性出血和第 14 天后出血的患者进行亚分析。
在 291 例因 PTAH 住院的患者中，有 31 例（11%）患者出现复发性术后出血，有 11 例（4%）患者在第 14 天后出现延迟性出血。88 例（30%）患者需要手术干预以停止出血，其中 2 例患者需要不止一次返回手术室。9 例（3%）患者接受了输血。出血发作之间的平均天数为 4 天。在首次就诊时接受手术治疗的患者中，复发性术后出血的发生率为 8.5%，而接受非手术治疗的患者为 11.4%（比值比：1.1；95%置信区间 0.43-2.8）。未发现异常凝血谱、手术指征与延迟性术后出血风险之间存在关联。
复发性或延迟性术后出血在术后出血的儿童中占比较小，无法可靠预测。首次就诊时采用保守或手术治疗均可接受，因为 PTAH 的复发风险与初始就诊时的治疗选择可能无关。仔细向患者及其家属进行术前咨询，对于出现 PTAH 时帮助设定预期非常重要。
