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Research ArticleOriginal Article
Open Access

Incidence and predictive factors of bleeding following tonsillectomy among pediatrics

A retrospective cohort study

Shmokh Alsalamah, Sultan Alsumairi, Abdulaziz Alaraifi, Abdulrhman Alfayez and Mohammed Halawani
Saudi Medical Journal July 2024, 45 (7) 694-699; DOI: https://doi.org/10.15537/smj.2024.45.7.20240253
Shmokh Alsalamah
From the College of Medicine, (Alsalamah, Alsumairi), King Saud bin Abdulaziz University for Health Sciences; from Otolaryngology-Head and Neck Surgery (Alaraifi, Alfayez, Halawani), King Abdullah International Medical Research Center; from the Department of Surgery (Alaraifi, Alfayez, Halawani), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
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  • ORCID record for Shmokh Alsalamah
  • For correspondence: [email protected]
Sultan Alsumairi
From the College of Medicine, (Alsalamah, Alsumairi), King Saud bin Abdulaziz University for Health Sciences; from Otolaryngology-Head and Neck Surgery (Alaraifi, Alfayez, Halawani), King Abdullah International Medical Research Center; from the Department of Surgery (Alaraifi, Alfayez, Halawani), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
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Abdulaziz Alaraifi
From the College of Medicine, (Alsalamah, Alsumairi), King Saud bin Abdulaziz University for Health Sciences; from Otolaryngology-Head and Neck Surgery (Alaraifi, Alfayez, Halawani), King Abdullah International Medical Research Center; from the Department of Surgery (Alaraifi, Alfayez, Halawani), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
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Abdulrhman Alfayez
From the College of Medicine, (Alsalamah, Alsumairi), King Saud bin Abdulaziz University for Health Sciences; from Otolaryngology-Head and Neck Surgery (Alaraifi, Alfayez, Halawani), King Abdullah International Medical Research Center; from the Department of Surgery (Alaraifi, Alfayez, Halawani), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
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Mohammed Halawani
From the College of Medicine, (Alsalamah, Alsumairi), King Saud bin Abdulaziz University for Health Sciences; from Otolaryngology-Head and Neck Surgery (Alaraifi, Alfayez, Halawani), King Abdullah International Medical Research Center; from the Department of Surgery (Alaraifi, Alfayez, Halawani), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
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  • Article
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Article Figures & Data

Tables

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    Table 1

    - Demographics and baseline clinical characteristics of all tonsillectomy patients.

    VariablesStatistics (n = 1280)
    Age6.473 (± 3.28)
    <12 years1162 (90.8)
    ≥12 years118 (9.2)
    Gender 
    Male795 (62.1)
    Female485 (37.9)
    BMI17.39 (± 5.11)
    ASA Score 
    ASA 1630 (49.2)
    ASA 2607 (47.4)
    ASA 343 (3.4)
    SDB793 (62.0)
    Recurrent tonsillitis976 (76.3)
    Concurrent procedure 
    Adenoidectomy1199 (93.7)
    Myringotomy61 (4.8)
    Laryngobronchoscopy2 (0.2)
    Post tonsillectomy bleeding43 (3.4)

    Values are presented as numbers and percentages (%) for categorical variables or mean ± standard deviation (SD) for continuous variables. ASA: American Society of Anesthesiologists

      • View popup
      Table 2

      - Predictors of bleeding following tonsillectomy compared to the control group.

      VariablesBleeding n=43 (%)No bleeding n=1237 (%)P-value
      Age6.95±3.866.46±3.250.328
      <12 years1127 (91.1)35 (81.4)0.030*
      ≥12 years110 (8.9)8 (18.6)
      Gender   
      Male30 (69.8)765 (61.8)0.292
      Female13 (30.2)472 (38.2) 
      Body mass index18.87±6.0417.34±5.070.053
      ASA Score   
      ASA 115 (34.9)61 (49.7)0.097
      ASA 225 (58.1)582 (47.0)
      ASA 33 (7.0)40 (3.2)
      SDB25 (58.1)768 (62.1)0.600
      Recurrent tonsillitis33 (76.7)943 (76.2)0.938
      Bleeding disorder1 (2.3)18 (1.5)0.643
      Syndromes4 (9.3)36 (2.9)0.018*
      Tonsillectomy technique   
      Hot tonsillectomy42 (97.7)1202 (97.2)0.630
      Cold steel tonsillectomy1 (2.3)35 (2.8) 
      Intraoperative local anesthesia33 (76.7)976 (78.9)0.734
      Postoperative poor oral intake7 (16.3)50 (4.0)0.000*
      Postoperative vomiting2 (4.7)12 (1.0)0.023*
      Postoperative analgesia   
      Single15 (34.9)32 (2.6)0.000*
      Dual28 (65.1)1205 (97.4) 
      • View popup
      Table 3

      - Multi-variable logistic regression analysis of predictors independently associated with bleeding post tonsillectomy.

      VariableOdd ratioP-value95% LCI95% UCI
      Age (≥12 years)2.6850.027*1.1216.431
      Gender (male)1.6900.1530.8233.472
      Bleeding disorder2.3680.4130.30118.646
      Syndromes2.0890.2500.5967.330
      Tonsillectomy technique (hot)1.4900.3440.6533.399
      Postoperative poor oral intake4.2440.042 *1.05717.044
      Postoperative vomiting1.0960.9230.1717.011
      Postoperative analgesia (single)53.124<0.001*17.538160.920

      LCI: lower confidence interval, UCI: upper confidence interval

      • ↵* Statistically significant p-value of ≤0.05.

      • View popup
      Table 4

      - Sub-analysis of patients with post tonsillectomy bleeding

      Variablesn=43 (%)
      Type of post tonsillectomy bleeding 
      Primary9.3 (9.3)
      Secondary39 (90.7)
      Time to postoperative bleeding (days)6.93±3.10
      Management 
      Conservative management16 (37.2)
      Surgical intervention27 (62.8)
      Required bleeding control twice2 (4.7)
      Durations of admission (days)2.14±1.10

      Values are presented as numbers and percentages (%) for categorical variables or mean ± standard deviation (SD) for continuous variables.

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      Saudi Medical Journal: 45 (7)
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      1 Jul 2024
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      Incidence and predictive factors of bleeding following tonsillectomy among pediatrics
      Shmokh Alsalamah, Sultan Alsumairi, Abdulaziz Alaraifi, Abdulrhman Alfayez, Mohammed Halawani
      Saudi Medical Journal Jul 2024, 45 (7) 694-699; DOI: 10.15537/smj.2024.45.7.20240253

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      Incidence and predictive factors of bleeding following tonsillectomy among pediatrics
      Shmokh Alsalamah, Sultan Alsumairi, Abdulaziz Alaraifi, Abdulrhman Alfayez, Mohammed Halawani
      Saudi Medical Journal Jul 2024, 45 (7) 694-699; DOI: 10.15537/smj.2024.45.7.20240253
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      Keywords

      • tonsillectomy
      • recurrent tonsillitis
      • bleeding

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