ORIGINAL RESEARCH
A Meta-analysis Study on Possible Risk Factors for Primary and Secondary Hemorrhage After Tonsillectomy
Tonsillektomi Sonrası Gelişen Primer ve Sekonder Kanamalarda Olası Risk Faktörleri Üzerine Bir Metaanaliz Çalışması
Received Date : 14 Feb 2021
Accepted Date : 26 May 2021
Available Online : 31 May 2021
Sinem GÖKÇE KÜTÜKa, Fatih BORAa
aClinic of Otorhinolaryngology, Aydın State Hospital, Aydın, TURKEY
Doi: 10.24179/kbbbbc.2021-82301 - Makale Dili: EN
KBB ve BBC Dergisi. 2021;29(3):176-84
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Tonsillectomy is one of the most common
surgical operation performed by otorhinolaryngologists, with significantly
reduced morbidity and mortality rates due to the operation in
parallel with the advances in surgical technique and anesthesia. Posttonsillectomy
hemorrhage (PTH) is one of the most common, most reported,
and serious complication of tonsillectomy operations. In this
context, the aim of this research is to synthesize and reveal a wide-ranging
study through meta-analysis of studies examining the risk factors
that may cause primary and secondary hemorrhage in patients who have
undergone tonsillectomy surgery using data from relatively small samples.
Material and Methods: In this study, a meta-analysis of a total
of 12 studies on PTH risk factors was conducted. In this meta-analysis,
the "effect size" criterion was used, which indicates how much a new
method makes a difference compared to the old one. Results: As a result
of the study, like the literature, the risk of PTH was found to be
higher in men than in women in adults, in children under the age of 15,
the difference between boys and girls was quite low. It is considered
that fewer studies, especially for children under the age of 15, may influence
this. In addition, studies have shown that secondary hemorrhage
occurs. Conclusion: As a result of the study, it was determined
that women experience PTH more frequently than men, and secondary
PTH risk is higher than primary PTH.
Keywords: Tonsillectomy; postoperative hemorrhage; bleeding; postoperative complication
ÖZET
Amaç: Tonsillektomi, cerrahi teknik ve anestezideki gelişmelere
paralel olarak operasyona bağlı morbidite ve mortalite oranlarının
önemli ölçüde azaldığı, kulak-burun-boğaz uzmanları tarafından en sık
uygulanan cerrahi operasyonlardan biridir. Tonsillektomi sonrası kanama
[post-tonsillectomy hemorrhage (PTH)], tonsillektomi ameliyatlarının
en yaygın, en çok bildirilen ve ciddi komplikasyonlarından
biridir. Bu bağlamda, bu araştırmanın amacı, tonsillektomi ameliyatı
geçiren hastalarda birincil ve ikincil kanamaya neden olabilecek risk
faktörlerini nispeten küçük örneklemlerden elde edilen verilerle inceleyen
çalışmaların metaanalizi ile geniş kapsamlı bir çalışmayı sentezlemek
ve ortaya çıkarmaktır. Gereç ve Yöntemler: Bu çalışmada, PTH
risk faktörleri ile ilgili toplam 12 çalışmanın metaanalizi yapılmıştır.
Bu metaanalizde, yeni bir yöntemin eskisine göre ne kadar fark yarattığını
gösteren “etki büyüklüğü” kriteri kullanılmıştır. Bulgular: Çalışma
sonucunda, literatürde olduğu gibi erkeklerde PTH riski
erişkinlerde kadınlara göre daha yüksek, 15 yaş altı çocuklarda kız ve
erkek çocuklar arasındaki fark oldukça düşük bulunmuştur. Özellikle
15 yaş altı çocuklar için daha az sayıda çalışmanın bunu etkileyebileceği
düşünülmektedir. Ek olarak, çalışmalar ikincil kanamanın meydana
geldiğini göstermiştir. Sonuç: Çalışma sonucunda, kadınların
erkeklerden daha sık PTH yaşadığı ve ikincil PTH riskinin birincil
PTH’den daha yüksek olduğu belirlendi.
Anahtar Kelimeler: Tonsillektomi; postoperatif hemoraji; kanama; postoperatif komplikasyon
KAYNAKLAR
- Mahadevan M, van der Meer G, Gruber M, Reed P, Jackson C, Brown C, et al. The starship children's hospital tonsillectomy: A further 10 years of experience. Laryngoscope. 2016; 126(12):E416-E20. [Crossref] [PubMed]
- Keklik Karadağ F, Saydam G, Şahin F. Preoperatif ve postoperatif kanama hastasına yaklaşım. Ergene Ü, editör. Kanama Diyatezi Olan Hastaya Yaklaşım. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.15-21. [Link]
- Elbistanlı MS, Elbistanlı Ş, Kumral TL, Açıkalın RM. [Evaluation of patients with post-tonsillectomy bleeding in a second-degree state hospital our patients with post-tonsillectomy bleeding]. Haseki Tıp Bülteni. 2014;52(1):1-4. [Crossref]
- Akçam E. [Post tonsillectomy bleeding; possible risk factors]. Van Tıp Derg. 2020;26(1):61-6. [Crossref]
- Gökgöz MC, Taşlı H. [Retrospective evaluation of the operations and approaches to the complications of the two new ear nose throat specialists for the first year]. Journal of Harran University Medical Faculty. 2019;16(2):336-40. [Crossref]
- Dündar Y, Bayram Akcan H, Cebeci D, Uluat A, Akcan FA. Does surgical technique significantly change the rate of post-tonsillectomy hemorrhage? Düzce Tıp Fakültesi Derg. 2018;20(1):7-10. [Crossref]
- Kaya Z, Mutlu V. [Post tonsillectomy bleeding; possible risk factors]. Van Med J. 2019;26(1): 61-6. [Crossref]
- Başaran B, Orhan KS, Yıldırmaz K, Hafız G. [A case of secondary post-tonsillectomy bleeding: necrosis of the internal carotid artery]. Kulak Burun Bogaz Ihtis Derg. 2011;21(2):98-101. [Crossref] [PubMed]
- Çakır A. [Post-tonsillectomy bleeding: Our 10-year experience]. Turkish J Ear Nose Throat. 2017;27(1): 1-9. [Crossref]
- Aksakal C. [Posttonsillectomy bleeding: Difference between children and adults]. Journal of Harran University Medical Faculty. 2019; 16(2):365-9. [Crossref]
- Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N. Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx. 2014;41(4):376-9. [Crossref]
- Kaplama ME. [Analysis of hematological parameters in late period post-tonsillectomy bleedings]. KBB-Forum. 2019;18(4):295-9. [Link]
- Østvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, et al. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol. 2015;272(3): 737-43. [Crossref] [PubMed]
- Ronen O, Sela E, Degabli L. The effect of bleeding on children's haemodynamic indices: an analysis of previous post-tonsillectomy bleeding cases. J Laryngol Otol. 2020;134(5): 453-7. [Crossref] [PubMed]
- Kilic S. [Effect size]. J Mood Disord. 2014; 4:42-4. [Link]
- Lipsey MW, Wilson DB. Practical Meta-Analysis. Vol.49. Thousand Oaks: SAGE Publications; 2001. [Link]
- Alvo A, Hall A, Johnston J, Mahadevan M. Paediatric posttonsillectomy haemorrhage rates in auckland: a retrospective case series. Int J Otolaryngol. 2019 [Crossref]
- Hoshino T, Tanigawa T, Yanohara G, Murotani K, Horibe Y, Murohara T, et al. Effect of body mass index on posttonsillectomy hemorrhage. Biomed Res Int. 2017;2017:1-4. [Crossref]
- Inuzuka Y, Mizutari K, Kamide D, Sato M, Shiotani A. Risk factors of post‐tonsillectomy hemorrhage in adults. Laryngoscope Investig Otolaryngol. 2020;5(6):1056-62. [Crossref]
- Johnston J, Vergeer A, Donaldson N, Shetty S, Mahadevan M. Our experience of the increased rates of post-tonsillectomy haemorrhage in 1538 children with pre-operative infec tive symptoms or signs. Clin Otolaryngol. 2020;45(6):944-5. [Crossref] [PubMed]
- Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx. 2010; 37(4):456-60. [Crossref] [PubMed]
- Kim SJ, Walsh J, Tunkel DE, Boss EF, Ryan M, Lee AH. Frequency of post-tonsillectomy hemorrhage relative to time of day. Laryngoscope. 2020;130(7): 1823-7. [Crossref] [PubMed]
- Nami Saber C, Klug TE. Post-operative haemorrhage after acute bilateral tonsillectomy in patients with peritonsillar abscess: prevalence, treatment, risk factors, and side of bleeding. Acta Otolaryngol. 2020;140(1):66-71. [Crossref] [PubMed]
- Ordemann AG, Hartzog AJ, Seals SR, Spankovich C, Stringer SP. Is weight a predictive risk factor of postoperative tonsillectomy bleed? Laryngoscope Investig Otolary ngol. 2018;3(3):238-43. [Crossref] [PubMed] [PMC]
- Perkins JN, Liang C, Gao D, Shultz L, Friedman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope. 2012;122(10):2311-5. [Crossref] [PubMed]
- Spektor Z, Saint-Victor S, Kay DJ, Mandell DL. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016;84:151-5. [Crossref] [PubMed]
- Seyhun N, Dizdar SK, Çoktur A, Bektaş ME, Albuz O, Erol ZN, et al. Risk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact? Am J Otolaryngol. 2020;41(1): 102341. [Crossref] [PubMed]
- Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope. 2011;121(2):279-88. [Crossref] [PubMed]
- Windfuhr JP, Verspohl BC, Chen YS, Dahm JD, Werner JA. Post-tonsillectomy hemorrhage--some facts will never change. Eur Arch Otorhinolaryngol. 2015;272(5):1211-8. [Crossref] [PubMed]
- Yorgancılar E, Yıldırım M, Meriç F. [Hemorrhage following tonsillectomy]. Dicle Med J. 2008; 35(3):177-80. [Link]
- Akin RC, Holst R, Schousboe LP. Risk factors for post-tonsillectomy haemorrhage. Acta Otolaryngol. 2012;132(7):773-7. [Crossref] [PubMed]