The effect of postoperative steroids on post‐tonsillectomy pain and need for postoperative physician contact

Objectives/Hypothesis Examine the effect of postoperative steroids on postoperative physician contacts and determine the hemorrhage rate for patients taking postoperative steroids. Study Design Retrospective review of medical records. Methods A retrospective review was performed of children undergoing tonsillectomies before and after the institution of a standard postoperative course of three doses of dexamethasone (0.5 mg/kg). Tylenol and ibuprofen were also used for all patients, with oxycodone given as a rescue medication for children ≥6 years of age. Postoperative hemorrhage rate (all visits to the emergency department [ED] with concern for post‐tonsillectomy hemorrhage), return to the ED for pain, and phone calls to the office for pain were recorded. Results A total of 1,200 children were included (300 without and 900 with steroids); there was no difference in age or weight between groups. Overall, the mean age was 6.6 ± 2.1 years and the hemorrhage rate was 7%. Parental phone calls decreased from 23.3% prior to steroid use to 14.7% after ( P  < .001), and post‐tonsillectomy hemorrhage rates decreased from 9.7% to 5.7% ( P  = .02). There was no difference in ED visit rates ( P  = 0.70). Regression analysis showed that bleeding increased by 4% (95% confidence interval [CI]: 1%‐13%) for each increasing year of age ( P  < .001), whereas postoperative steroids decreased hemorrhage rates by 7% (95% CI: 1%‐9% reduction) ( P  = .013). The risk of a phone call increased by 2% for each year of age; postoperative steroids decreased phone calls by 9% ( P  < .001). There were no steroid‐related complications within 1 month of surgery. Conclusions A short course of postoperative steroids decreased the number of postoperative phone calls for pain by 9% after tonsillectomy, and decreased the risk of postoperative tonsillectomy hemorrhage by 7%. Level of Evidence 4. Laryngoscope , 128:2187–2192, 2018