Risk Factors for Postoperative Bleeding after Adenoidectomy.

Milan Urík,Klára Perceová,Jiří Jarkovský,Petr Štourač,Michal Bartoš,Jana Jančíková,Soňa Šikolová,Petr Jabandžiev,Eva Klabusayová

doi:10.3390/children8030242

Abstract

IMPORTANCE: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable. OBJECTIVE: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children. DESIGN: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding. SETTING: Tertiary pediatric otorhinolaryngology center. PARTICIPANTS: A total of 288 children aged 0–18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. MAIN OUTCOMES AND MEASURES: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy. RESULTS: Elevated systolic (p = 0.046), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.007) (Mann–Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery (p < 0.001) (Fisher’s exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon’s level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy. CONCLUSIONS AND RELEVANCE: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

Highlights

Adenoidectomy (AT) is one of the most common surgeries in childhood
The questionnaire contained patient identification data, age, sex, atmospheric air pressure, blood pressure, anesthesiological complications, adenoid vegetation (AV) size, AV content, recurrence of AV, a preoperative examination of coagulation parameters, experience of the surgeon (5 years), time of surgery, and history of recurrent respiratory tract infections
We showed that higher SBP, diastolic blood pressures (DBP), and mean arterial pressure (MAP) are associated with higher risk of bleeding

Summary

Introduction

Adenoidectomy (AT) is one of the most common surgeries in childhood. The main indications for AT include recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. The most common and serious complication is postoperative bleeding, the incidence of which is 0.5–2.2% [1,2,3]. We focused on evaluating common factors (based upon an analysis of the literature) [7,8,9,10,11,12] and less common factors that may affect the risk of bleeding after AT. The identification of these risk factors could result in better care for these patients

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