Adeno-tonsillectomy in children: preoperative coagulation screening and bleeding complications

Abstract

In 2006 German medical societies published recommendations: Before carrying out an adenoidectomy and/or a tonsillectomy in childhood a specific bleeding-anamnesis should be performed instead of a laboratory coagulation screening in order to determine a clinically relevant bleeding disorder. In the context of this survey it was investigated how many of the Bavarian ENT physicians in private practice had implemented these recommendations and what experiences they made with them. In addition, further data such as the number of performed operations and occurred bleeding complications were collected. Between 2009 and 2010 a prepared questionnaire was sent to all Bavarian ENT physicians, who were in private practice. If even after further sent covering letters no reply was received they were contacted by telephone. The analysis period was 2008. In total 601 ENT physicians were contacted, whereas 495 valid replies could be obtained (rate of valid return>80%). 325 (66%) of these performed surgery in 2008, but only one of 3 of these operating ENT physicians had completely implemented the recommendations. The rate of postoperative bleeding complications following tonsillectomy was 1.80%, following adenoidectomy 0.30%. A significant difference in the postoperative bleeding rate between those, who had implemented the recommendations and those, who had not, could not be shown. But a highly significant difference favouring the surgeons, who quantitatively had performed more tonsillectomies could be revealed. The results of this retrospective survey support the recommendations given by German medical societies.