What is the relationship between pre-operative clinical diagnosis of obstructive sleep apnea (OSA) and post-operative hemorrhage?
Background: In general, post-operative complications following tonsillectomy are rare, with hemorrhage being one of the most serious complications. The overall rate of hemorrhage following the surgery is approximately 4.5 percent. The variability of primary and secondary hemorrhage rates can be attributed mostly to differences in study inclusion criteria for hemorrhages.
Study design: Seven-year retrospective case-control study.
Setting: Department of Pediatric Otolaryngology, Children’s Hospital Colorado and Department of Otolaryngology, University of Colorado School of Medicine; Department of Pediatrics, University of Colorado School of Medicine; Department of Biostatistics and Informatics, Colorado School of Public Health; Clinical Informatics, Children’s Hospital Colorado, Aurora, Colo.
Synopsis: Of 9,023 tonsillectomy patients with a mean age of 6.9 years, 2.4 percent presented with hemorrhage (22.6 percent primary and 77.4 percent secondary). The literature has documented that OSA has an effect on blood coagulation and may contribute to a higher incidence of cardiovascular disease in OSA patients. In this study, OSA patients were half as likely to hemorrhage when compared with chronic tonsillitis patients. Sleep-disordered breathing patients also had a lower chance of hemorrhage compared with chronic tonsillitis patients. The mean age of patients who hemorrhaged was 8.85 years.
Bottom line: Patients with OSA are less likely to have post-operative hemorrhage when compared with chronic tonsillitis patients. This information may support the hypothesis that patients with OSA have an upregulation of prothrombotic factors, which is protective during the post-operative healing period.
Reference: Perkins JN, Liang C, Gao D, Shultz L, Friedman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope. 2012;122(10); 2311-2315.