Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; Department of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; Department of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
Int J Pediatr Otorhinolaryngol. 2021 May;144:110671. doi: 10.1016/j.ijporl.2021.110671. Epub 2021 Mar 11.
Post tonsillectomy hemorrhage (PTH) is a common complication of tonsillectomy. Our objectives were to: 1) Examine the postoperative course of patients presenting to St. Christopher's Hospital for Children (SCHC) with PTH; 2) Compare patients with and without a blood clot visualized in the tonsillar fossa at time of presentation to determine if outcomes regarding return to the operating room (OR) differ.
This was a retrospective chart review conducted at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients who underwent a tonsillectomy with concurrent adenoidectomy and were admitted for observation following secondary post tonsillectomy hemorrhage were reviewed. The effects of age, gender, indication, and clinical exam findings on admission on the rate of eventual return to the OR for control of hemorrhage were also analyzed. Chi-square analysis and Fisher's exact test were used to compare the significance of categorical frequencies.
The rate of blood clot presence in our cohort was 50.9% (28/55). Return to OR rates were defined as patients who began actively hemorrhaging following admission for observation, further stratified by presence or absence of clot on admission physical exam. There was a statistically significant higher rate of return to OR in patients who presented with a clot (46.6%) on clinical exam versus no clot (18.5%) after resolved post tonsillectomy hemorrhage (p < .027). Furthermore, patients with a blood clot present were significantly more likely to require OR sooner (21.31 h from admission) than those without a clot (100.75 h from admission) (p < .012). There was no statistically significant higher rate of blood clot presence or rate of return to OR in groups based on age, gender, or indication.
Pediatric patients presenting after resolved secondary PTH with a blood clot visualized in the tonsillar fossa are more likely to require return to the OR for hemostasis and cautery than are those without a blood clot, and this is more likely to occur within 24 h of admission. Thus, patients with a blood clot on initial presentation may benefit from admission for a 24-h observation period, while a similar observation period may be unproductive for patients without a blood clot.
Patients who present with a resolved secondary PTH and a blood clot present on clinical exam require return to the OR more often than patients presenting without a blood clot. While previously controversial, we feel that this demonstrates that a 24-h observation of a patient with a clot on exam is reasonable.
扁桃体切除术后出血（PTH）是扁桃体切除术的常见并发症。我们的目的是：1）检查在圣克里斯托弗儿童医院（SCHC）就诊的 PTH 患者的术后病程；2）比较在就诊时可见扁桃体窝内有血凝块和无血凝块的患者，以确定返回手术室（OR）的结果是否不同。
这是一项在城市环境中的学术性三级儿科医院进行的回顾性图表审查。对接受扁桃体切除术联合腺样体切除术并因继发性扁桃体切除术后出血而接受观察的儿科患者进行了回顾。还分析了年龄、性别、适应证和入院时临床检查结果对最终因出血控制而返回 OR 的发生率的影响。卡方分析和 Fisher 精确检验用于比较分类频率的显著性。
我们队列中血凝块存在率为 50.9%（28/55）。返回 OR 的比率定义为在观察入院后开始积极出血的患者，并根据入院体检时是否存在血凝块进一步分层。在临床检查时出现血凝块（46.6%）的患者返回 OR 的比率明显高于无血凝块（18.5%）的患者（p<.027）。此外，有血凝块的患者需要 OR 的时间明显更早（入院后 21.31 小时），而无血凝块的患者需要 OR 的时间（入院后 100.75 小时）（p<.012）。根据年龄、性别或适应证，血凝块存在率或返回 OR 的比率没有统计学意义更高。
在继发性 PTH 消退后出现血凝块的儿科患者比无血凝块的患者更有可能需要返回 OR 进行止血和烧灼，而且这种情况更可能发生在入院后 24 小时内。因此，最初出现血凝块的患者可能受益于 24 小时观察期，而无血凝块的患者进行类似的观察期可能没有效果。
在就诊时出现继发性 PTH 消退且临床检查可见血凝块的患者比就诊时无血凝块的患者更需要返回 OR。虽然之前存在争议，但我们认为这表明对检查时存在血凝块的患者进行 24 小时观察是合理的。
