Utility of preoperative hematologic screening for pediatric adenotonsillectomy

August 10, 2012
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Abstract

We conducted a 3-year retrospective study to examine the results of preoperative 
hematologic screening, the incidence of postoperative bleeding, and the possible 
relationship between the two factors in patients who had undergone tonsillectomy 
with or without adenoidectomy. Our study population was made up of 875 patients—441 
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at 
our institution from January 2004 through December 2006. In addition to demographic 
data, we compiled information on each patient’s medical and surgical history, personal 
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative 
hematologic screening results. The latter included determinations of the prothrombin 
time, activated partial thromboplastin time, international normalized ratio (INR), and 
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative 
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively, 
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients 
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality 
(7.1%); the difference between the two groups was statistically significant (p = 0.041). 
The abnormalities in the latter group consisted of an elevated INR but no otherwise 
identifiable coagulopathy. Another 14 patients with an abnormal screening result 
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during 
our preoperative evaluation; they were treated perioperatively, and none bled 
postoperatively. Of 21 patients who had a personal or family history of abnormal 
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery. 
In conclusion, we found that preoperative hematologic screening identified patients 
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able 
to prevent some bleeding events in these patients. Our finding that patients with a 
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants 
further study.

Introduction

Tonsillectomy, one of the oldest surgical procedures, was first described by Celsus in 30 AD.1Approximately 300,000 of these procedures are performed in the United States annually.2It also represents the first surgical experience for most children.

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