Release: Embargoed until September 26
Contact: Ken Satterfield
(in New Orleans: 9/23-29 at 504-670-5409) [email protected]
A Mayo Clinic Study Finds Outpatient Tonsillectomies Carry Minimal Risk
Results state post-operative hemorrhaging is the same for most ambulatory and inpatient procedures
New Orleans -- Each year, more than 250,000 children undergo a tonsillectomy, with or without adenoidectomy, making this one of the most commonly performed pediatric surgical procedures. Due to new cost containment measures, many health insurance plans require that this procedure be performed on an ambulatory or outpatient basis. Consequently, some suggest that parental concerns have increased regarding the possibility of post-tonsillectomy primary and secondary hemorrhage (primary hemorrhage occurs within the first 24 hours of surgery; secondary hemorrhage, after 24 hours) for young patients treated on an outpatient basis.
Otolaryngologist--head and neck surgeons from the Mayo Clinic have determined that tonsillectomies performed on an outpatient basis are safe, with no increased risk of hemorrhaging. They have also found that patients 21-30 years of age are at more risk for post-operative bleeding. The authors of "Evaluation of Post-tonsillectomy Hemorrhage and Risk Factors" are Julie L. Wei, MD, Charles W. Beatty, MD, and Ray O. Gustafson, MD, all from the Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN.
The results were presented before the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting and Oto Expo being held September 26-29, at the Ernest N. Morial Convention Center in New Orleans, LA. At the gathering, the Academy's 13,000 members will have the opportunity to hear the latest research in the diagnosis and treatment of disorders of the ear, nose, throat, and related structures of the head and neck.
Study Methodology:
The Mayo-Rochester Surgical Information Recording System identified 4,892 tonsillectomies, with or without other procedures, performed from January 1, 1985, to December 31, 1997. After exclusions, 4,662 patients were identified; 90 of that group had incurred hemorrhaging..
An optimal matching, step-by-step process was used to select 180 cases from those patients who had not incurred post-tonsillectomy hemorrhaging. For each patient who had hemorrhaged, two gender-matched controls with an age difference of less than one year were assigned. Study data included patient characteristics, procedure rated variables, post-procedure variables, vital signs at the time of treatment for hemorrhaging, and immediate patient management strategy. Key characteristics of the two groups follow:
Sex and Age
For both groups, males constituted 52 percent of the population, females, 48 percent.
The mean age for the group who had hemorrhaged was 14.6 years, the corresponding age for the control group was 14.5 years.
Outpatient/Inpatient
Of the 90 who hemorrhaged, 38 percent had their procedures conducted on an outpatient basis, 42 percent were held for 23 hour observation, and 20 percent were admitted.
Of the 180 in the control group (no hemorrhaging), 42 percent had an outpatient procedure, 39 percent were held for 23 hour observation, and 18 percent were admitted.
Pre-Op Diagnosis
Of the 90 patients, 59 percent were diagnosed with chronic tonsillitis, 28 percent with airway obstruction, six percent with chronic tonsillitis and airway obstruction, and eight percent with a history peritonsillar abscess.
For the control group, 56 percent had chronic tonsillitis, 26 percent with airway obstruction, 13 percent with chronic tonsillitis and airway obstruction, and five percent with peritonsillar obstruction.
Other variables considered included procedure, surgical method, use of antibiotics, and intraoperative blood loss. Procedure related variables and post-procedure variables were compared among cases and controls using Fisher's exact test for categorical variables and the Wilcoxin rank-sum test for continuous variables.
Conclusion:
After a statistical analysis, the research team reached the following key findings:
Total incidence of post-tonsillectomy hemorrhage was 1.93 percent.
Secondary hemorrhage was more common than primary and presents most frequently 5-7 days post-op.
There was no significant statistical difference found in procedures conducted on an inpatient and outpatient basis. Therefore, an ambulatory procedure is as safe as one conducted when the patient is admitted.
Age was found to be the only risk factor. The study found that 3.61 percent all tonsillectomy patients, between ages 21-30, had suffered a hemorrhage.
Other findings included:
Routine preoperative coagulation profiles are not cost effective in predicting postoperative bleed.
Approximately 47 percent of patients with post-tonsillectomy hemorrhaging required a second general anesthetic for hemorrhage control.
Patients who experience post-tonsillectomy hemorrhaging have a 12 percent incidence of subsequent hemorrhage.
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Editor's Note: For a copy of this study or an interview with Dr. Wei, contact Ken Satterfield at 703-519-1563 (through 9-21); 9/23-29, call the Annual Meeting Newsroom at 504-670-5409.
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