Intraoperative dexamethasone and the risk of secondary posttonsillectomy hemorrhage.

摘要

OBJECTIVE: to determine whether intraoperative dexamethasone is a risk factor for secondary posttonsillectomy bleeding. DESIGN: retrospective chart review. SETTING: tertiary care referral centres in Scotland. METHOD AND PATIENTS: the charts of 530 pediatric patients undergoing tonsillectomy were reviewed over a 3-year period (January 2004 to December 2006), and data were collected regarding the use of dexamethasone intraoperatively. Data were analyzed using the SPSS for Windows statistical package (SPSS Inc, Chicago, IL). MAIN OUTCOME MEASURES: incidence of secondary posttonsillectomy bleeding. The relative risk of posttonsillectomy bleeding was measured in those receiving dexamethasone. Logistic regression analysis was performed. RESULTS: Thirty-seven episodes of secondary hemorrhage were encountered in 36 children: 9 of 253 (3.6%; 95% CI 1.6-6.7) patients receiving intraoperative dexamethasone compared to 28 of 277 (10.1%; 95% CI 6.8-14.3) not receiving dexamethasone. Six patients had to undergo an emergency reoperation to arrest bleeding, only one of whom had received dexamethasone. When added to a stepwise logistic regression model with age, gender, indication for surgery, surgeon grade, and operative technique, dexamethasone and the presence of obstructive symptoms were the only significant factors influencing the risk of bleeding. The odds ratio indicates that patients with obstructive symptoms (OR 0.16; 95% CI 0.04-0.70) and those receiving dexamethasone were less likely to develop secondary bleeding (OR 0.44; 95% CI 0.20-0.96). CONCLUSION: based on our study data, the use of intraoperative dexamethasone does not appear to increase the risk of posttonsillectomy bleeding.