Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
Clin Otolaryngol. 2023 Jul;48(4):672-679. doi: 10.1111/coa.14068. Epub 2023 May 2.
To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases.
Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020.
patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH.
One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001).
BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.
在连续的成人和儿科 BiZact™扁桃体切除术病例队列中，确定原发性和继发性扁桃体切除术后出血（PTH）的发生率，并确定预测因素。
回顾性队列研究。2017 年至 2020 年期间，弗林德斯医学中心、诺拉隆加医院和私人耳鼻喉科诊所接受 BiZact™扁桃体切除术的患者。
患者年龄、扁桃体切除术指征、手术医生经验、PTH 的时间和严重程度，包括返回手术室。每例继发性 PTH 均采用 Stammberger 分级进行分级。使用逻辑回归确定继发性 PTH 的预测因素。
评估了 1717 份患者病历（658 名成人和 1059 名儿童）。原发性 PTH 发生率为 0.1%，继发性 PTH 发生率为 5.9%。大多数继发性 PTH 病例为 Stammberger 分级 A（80/102，78.4%），仅需观察。少数继发性 PTH 需要药物干预（分级 B；9/102，8.8%）、返回手术室（分级 C；12/102，11.8%）或输血（分级 D；1/102，1.0%），无死亡报告（分级 E；0/102，0.0%）。8 例患者（0.5%）出现复发性继发性 PTH。儿童继发性 PTH 的预测因素是手术医生的经验，带实习生的医生发生 PTH 的几率更高（OR 2.502，95%CI 1.345-4.654；p=0.004）和儿童年龄（OR 1.095，95%CI 1.025-1.170；p=0.007）。手术医生的经验是成人的预测因素（OR 3.804，95%CI 2.139-6.674；p<0.001）。
BiZact™扁桃体切除术的原发性 PTH 发生率较低，继发性 PTH 发生率与其他“热扁桃体切除术”技术相当。大多数 PTH 事件较轻且为自我报告。似乎存在实习医生的学习曲线。
