Non-Steroidal Anti-Inflammatory Drugs Not Associated with Post-Tonsillectomy Hemorrhage Rates

by Linda Kossoff •

What can be learned from a single-institution investigation into the incidence and management of adult post-tonsillectomy hemorrhage (PTH) rates, and any possible association between use of non-steroidal anti-inflammatory drugs (NSAIDs) and PTH in adults?

BOTTOM LINE

In a retrospective cohort study of 1,057 adult patients, the incidence of PTH was low, and no association between NSAID use and PTH rate was found.

BACKGROUND: Tonsillectomy is performed on 100,000-plus patients age 15 and older in the U.S. annually. The rate of PTH in adults ranges widely in the literature. Many otolaryngologists hesitate to incorporate NSAIDs into their post-tonsillectomy pain regimen due to a lack of study and these drugs’ role in inhibiting platelet aggregation.

STUDY DESIGN: Retrospective chart review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Va.

SYNOPSIS: Researchers conducted a retrospective chart review and identified 1,057 adult patients who had undergone tonsillectomy at a single institution between Jan. 1, 2012, and Dec. 31, 2019, who did not have a bleeding disorder and/or were not taking coagulants pre-operatively. A total of 432 patients were prescribed NSAIDs for their postoperative regimen. In total, 126 (11.9%) of the 1,057 tonsillectomy patients had bleeding events, representing a higher rate of postoperative hemorrhage than is typically reported in the literature. Of the 126 patients, 29 experienced multiple events. Most of these patients did not require operating room (OR) intervention, two-thirds had bedside interventions, and roughly a quarter did not require any intervention. OR Intervention was most successful in avoiding additional hemorrhage. A subgroup analysis showed that bleeding rates in patients with and without prescriptions for preoperative NSAIDS were 12.5% and 11.9%, respectively, indicating no association between PTH and NSAID use. Authors noted that different NSAIDs have varying effects on platelet aggregation. Study limitations included the representation of only ibuprofen and naproxen in the study and the inability to collect data regarding smoking status.

CITATION: McLean JE, Hill CJ, Riddick JB, et al. Investigation of adult post-tonsillectomy hemorrhage rates and the impact of NSAID use. Laryngoscope. 2022;132:949-953