Skip to main content
Top
Published in: European Archives of Oto-Rhino-Laryngology 12/2016

01-12-2016 | Head and Neck

Gender-specific risk factors in post-tonsillectomy hemorrhage

Authors: Annekatrin Coordes, Janina Soudry, Veit Maria Hofmann, Minoo Lenarz

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2016

Login to get access

Abstract

There are gender-specific differences in the frequency and course of different diseases. Specifically, some studies have shown an increased risk of post-tonsillectomy hemorrhage (PTH). The aim of the study was to investigate gender-specific risk factors for hemorrhage after tonsillectomy (TE)/abscess-TE. We anonymously reviewed and recorded the relevant data of all patients (≥14 years) who underwent a TE/abscess-TE between 2011 and 2013 in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin. A patient survey was used to complete missing data. We analyzed gender-specific risk factors for PTH. During the study period, 460 operations were performed and the data of 250 patients were analyzed (213 TE and 37 abscess-TE). The median patient age was 27 years (ranging from 14 to 83 years). The rate of primary PTH (<24 h after TE/abscess-TE) was 3 %, and the rate of secondary PTH (>24 h) was 23 %. A significantly higher PTH rate was associated with males (p = 0.037), which was still apparent in ages 21–30 after sub-classification. Multivariate analysis calculated diagnosis, regular alcohol consumption and administration of glucocorticoids to be independent risk factors associated with gender. In conclusion, the PTH rate is gender-specific, and male patients are at higher risk, especially in young adulthood. Therefore, doctors should advise male patients of the increased risk of bleeding and stress the importance of compliance. Also, close postoperative follow-up is desirable.
Literature
1.
go back to reference Choudhry MA, Bland KI, Chaudry IH (2006) Gender and susceptibility to sepsis following trauma. Endocr Metab Immune Disord Drug Targets 6(2):127–135CrossRefPubMed Choudhry MA, Bland KI, Chaudry IH (2006) Gender and susceptibility to sepsis following trauma. Endocr Metab Immune Disord Drug Targets 6(2):127–135CrossRefPubMed
2.
go back to reference Orshal JM, Khalil RA (2004) Gender, sex hormones, and vascular tone. Am J Physiol Regul Integr Comp Physiol 286(2):R233–R249CrossRefPubMed Orshal JM, Khalil RA (2004) Gender, sex hormones, and vascular tone. Am J Physiol Regul Integr Comp Physiol 286(2):R233–R249CrossRefPubMed
3.
go back to reference Angele MK, Frantz MC, Chaudry IH (2006) Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo) 61(5):479–488CrossRef Angele MK, Frantz MC, Chaudry IH (2006) Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo) 61(5):479–488CrossRef
6.
go back to reference Mueller J et al (2015) Population-based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol 272(12):3769–3777CrossRefPubMed Mueller J et al (2015) Population-based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol 272(12):3769–3777CrossRefPubMed
7.
go back to reference Ikoma R et al (2014) Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx 41(4):376–379CrossRefPubMed Ikoma R et al (2014) Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx 41(4):376–379CrossRefPubMed
8.
go back to reference Tolska HK et al (2013) Post-tonsillectomy haemorrhage more common than previously described—an institutional chart review. Acta Otolaryngol 133(2):181–186CrossRefPubMed Tolska HK et al (2013) Post-tonsillectomy haemorrhage more common than previously described—an institutional chart review. Acta Otolaryngol 133(2):181–186CrossRefPubMed
9.
go back to reference Sarny S et al (2011) Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 121(12):2553–2560CrossRefPubMed Sarny S et al (2011) Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 121(12):2553–2560CrossRefPubMed
10.
go back to reference Ranjit S et al (1999) The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience. Singap Med J 40(10):622–626 Ranjit S et al (1999) The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience. Singap Med J 40(10):622–626
11.
go back to reference Kristensen S, Tveteras K (1984) Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol Allied Sci 9(6):347–350CrossRefPubMed Kristensen S, Tveteras K (1984) Post-tonsillectomy haemorrhage. A retrospective study of 1150 operations. Clin Otolaryngol Allied Sci 9(6):347–350CrossRefPubMed
12.
go back to reference Tomkinson A et al (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121(2):279–288CrossRefPubMed Tomkinson A et al (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121(2):279–288CrossRefPubMed
13.
go back to reference Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 132(2):281–286CrossRefPubMed Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 132(2):281–286CrossRefPubMed
14.
go back to reference Tugrul S et al (2015) Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial. Eur Arch Otorhinolaryngol 279(12):2483–2487CrossRef Tugrul S et al (2015) Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial. Eur Arch Otorhinolaryngol 279(12):2483–2487CrossRef
15.
go back to reference Arnoldner C et al (2008) Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr 120(11–12):336–342CrossRefPubMed Arnoldner C et al (2008) Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr 120(11–12):336–342CrossRefPubMed
16.
go back to reference Perkins JN et al (2012) Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10):2311–2315CrossRefPubMed Perkins JN et al (2012) Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10):2311–2315CrossRefPubMed
17.
go back to reference Bhattacharyya N (2001) Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 80(8):544–549PubMed Bhattacharyya N (2001) Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 80(8):544–549PubMed
18.
go back to reference Lehnerdt G et al (2005) Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy. Acta Otolaryngol 125(12):1312–1317CrossRefPubMed Lehnerdt G et al (2005) Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy. Acta Otolaryngol 125(12):1312–1317CrossRefPubMed
19.
go back to reference Olsen NJ, Kovacs WJ (1996) Gonadal steroids and immunity. Endocr Rev 17(4):369–384PubMed Olsen NJ, Kovacs WJ (1996) Gonadal steroids and immunity. Endocr Rev 17(4):369–384PubMed
20.
go back to reference Grimaldi CM et al (2005) Hormonal modulation of B cell development and repertoire selection. Mol Immunol 42(7):811–820CrossRefPubMed Grimaldi CM et al (2005) Hormonal modulation of B cell development and repertoire selection. Mol Immunol 42(7):811–820CrossRefPubMed
21.
go back to reference Roubinian JR et al (1978) Effect of castration and sex hormone treatment on survival, anti-nucleic acid antibodies, and glomerulonephritis in NZB/NZW F1 mice. J Exp Med 147(6):1568–1583CrossRefPubMed Roubinian JR et al (1978) Effect of castration and sex hormone treatment on survival, anti-nucleic acid antibodies, and glomerulonephritis in NZB/NZW F1 mice. J Exp Med 147(6):1568–1583CrossRefPubMed
22.
go back to reference Hochberg MC, Spector TD (1990) Epidemiology of rheumatoid arthritis: update. Epidemiol Rev 12:247–252PubMed Hochberg MC, Spector TD (1990) Epidemiology of rheumatoid arthritis: update. Epidemiol Rev 12:247–252PubMed
23.
go back to reference Kalland T, Strand O, Forsberg JG (1979) Long-term effects of neonatal estrogen treatment on mitogen responsiveness of mouse spleen lymphocytes. J Natl Cancer Inst 63(2):413–421PubMed Kalland T, Strand O, Forsberg JG (1979) Long-term effects of neonatal estrogen treatment on mitogen responsiveness of mouse spleen lymphocytes. J Natl Cancer Inst 63(2):413–421PubMed
24.
go back to reference Coordes A et al. (2015) Tonsillectomy in adults: Length of hospital stay has no influence on the frequency of postoperative hemorrhage. HNO 63(12):841–844, 846–849 doi:10.1007/s00106-015-0077-7 Coordes A et al. (2015) Tonsillectomy in adults: Length of hospital stay has no influence on the frequency of postoperative hemorrhage. HNO 63(12):841–844, 846–849 doi:10.​1007/​s00106-015-0077-7
25.
go back to reference Windfuhr JP et al (2008) Life-threatening posttonsillectomy hemorrhage. Laryngoscope 118(8):1389–1394CrossRefPubMed Windfuhr JP et al (2008) Life-threatening posttonsillectomy hemorrhage. Laryngoscope 118(8):1389–1394CrossRefPubMed
26.
go back to reference Windfuhr JP, Ulbrich T (2001) Post-tonsillectomy hemorrhage: results of a 3-month follow-up. Ear Nose Throat J 80(11):790 (pp 795–798, 800 passim) PubMed Windfuhr JP, Ulbrich T (2001) Post-tonsillectomy hemorrhage: results of a 3-month follow-up. Ear Nose Throat J 80(11):790 (pp 795–798, 800 passim) PubMed
27.
go back to reference Hultcrantz E et al (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536CrossRefPubMed Hultcrantz E et al (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536CrossRefPubMed
28.
go back to reference Raut V et al (2001) Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study. Laryngoscope 111(12):2178–2182CrossRefPubMed Raut V et al (2001) Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study. Laryngoscope 111(12):2178–2182CrossRefPubMed
29.
go back to reference Windfuhr JP (2013) Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 75(3):166–173CrossRefPubMed Windfuhr JP (2013) Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 75(3):166–173CrossRefPubMed
30.
go back to reference Drake-Lee A, Stokes M (1998) A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clin Otolaryngol Allied Sci 23(6):491–495CrossRefPubMed Drake-Lee A, Stokes M (1998) A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clin Otolaryngol Allied Sci 23(6):491–495CrossRefPubMed
31.
go back to reference Blomgren K, Qvarnberg YH, Valtonen HJ (2001) A prospective study on pros and cons of electrodissection tonsillectomy. Laryngoscope 111(3):478–482CrossRefPubMed Blomgren K, Qvarnberg YH, Valtonen HJ (2001) A prospective study on pros and cons of electrodissection tonsillectomy. Laryngoscope 111(3):478–482CrossRefPubMed
32.
go back to reference Windfuhr JP, Wienke A, Chen YS (2009) Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 266(1):111–116CrossRefPubMed Windfuhr JP, Wienke A, Chen YS (2009) Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 266(1):111–116CrossRefPubMed
33.
go back to reference Kim DW et al (2010) Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 37(4):456–460CrossRefPubMed Kim DW et al (2010) Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 37(4):456–460CrossRefPubMed
34.
go back to reference Demars SM, Harsha WJ, Crawford JV (2008) The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 134(8):811–814CrossRefPubMed Demars SM, Harsha WJ, Crawford JV (2008) The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 134(8):811–814CrossRefPubMed
35.
go back to reference Giger R, Landis BN, Dulguerov P (2005) Hemorrhage risk after quinsy tonsillectomy. Otolaryngol Head Neck Surg 133(5):729–734CrossRefPubMed Giger R, Landis BN, Dulguerov P (2005) Hemorrhage risk after quinsy tonsillectomy. Otolaryngol Head Neck Surg 133(5):729–734CrossRefPubMed
36.
go back to reference Riggin L et al (2013) A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 38(2):115–129CrossRefPubMed Riggin L et al (2013) A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol 38(2):115–129CrossRefPubMed
37.
go back to reference Gallagher TQ et al (2012) Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial. JAMA 308(12):1221–1226CrossRefPubMed Gallagher TQ et al (2012) Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial. JAMA 308(12):1221–1226CrossRefPubMed
38.
go back to reference Al-Kindy SA (2002) Do antibiotics decrease post-tonsillectomy morbidity? Saudi Med J 23(6):705–707PubMed Al-Kindy SA (2002) Do antibiotics decrease post-tonsillectomy morbidity? Saudi Med J 23(6):705–707PubMed
39.
go back to reference Majholm B et al (2012) Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand 56(3):323–331CrossRefPubMed Majholm B et al (2012) Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand 56(3):323–331CrossRefPubMed
40.
go back to reference Schafer C (2010) Do men and women in illness and stress situations show different measures of risk attitude and therapy behaviour? Versicherungsmedizin 62(3):115–119PubMed Schafer C (2010) Do men and women in illness and stress situations show different measures of risk attitude and therapy behaviour? Versicherungsmedizin 62(3):115–119PubMed
42.
go back to reference Knipping S et al (2009) Is postoperative antibiotic treatment mandatory after abscess tonsillectomy. HNO 57(3):230–238CrossRefPubMed Knipping S et al (2009) Is postoperative antibiotic treatment mandatory after abscess tonsillectomy. HNO 57(3):230–238CrossRefPubMed
43.
go back to reference Lehnerdt G et al (2005) Smoking promotes the formation of peritonsillar abscesses. Laryngorhinootologie 84(9):676–679CrossRefPubMed Lehnerdt G et al (2005) Smoking promotes the formation of peritonsillar abscesses. Laryngorhinootologie 84(9):676–679CrossRefPubMed
45.
go back to reference Lampert T, von der Lippe E, Muters S (2013) Prevalence of smoking in the adult population of Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5–6):802–808CrossRefPubMed Lampert T, von der Lippe E, Muters S (2013) Prevalence of smoking in the adult population of Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5–6):802–808CrossRefPubMed
46.
go back to reference Bellis JR et al (2014) Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 113(1):23–42CrossRefPubMed Bellis JR et al (2014) Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 113(1):23–42CrossRefPubMed
47.
go back to reference Windfuhr JP et al (2011) The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol 77(3):373–379CrossRefPubMed Windfuhr JP et al (2011) The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol 77(3):373–379CrossRefPubMed
48.
go back to reference Kraus L, Bauernfeind R (1998) Repräsentativerhebung zum Gebrauch Psychoaktiver Substanzen bei Erwachsenen in Deutschland 1997. Sucht 44(1):5–82 Kraus L, Bauernfeind R (1998) Repräsentativerhebung zum Gebrauch Psychoaktiver Substanzen bei Erwachsenen in Deutschland 1997. Sucht 44(1):5–82
49.
go back to reference Makarov VK, Starikov SV (2011) Blood serum phospholipids in patients with tonsillitis under combinated alcohol-bacterial influence. Biomed Khim 57(6):657–660CrossRefPubMed Makarov VK, Starikov SV (2011) Blood serum phospholipids in patients with tonsillitis under combinated alcohol-bacterial influence. Biomed Khim 57(6):657–660CrossRefPubMed
Metadata
Title
Gender-specific risk factors in post-tonsillectomy hemorrhage
Authors
Annekatrin Coordes
Janina Soudry
Veit Maria Hofmann
Minoo Lenarz
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 12/2016
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-016-4146-7

Other articles of this Issue 12/2016

European Archives of Oto-Rhino-Laryngology 12/2016 Go to the issue