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Preoperative plasma fibrinogen as a predictive factor for post‐tonsillectomy haemorrhage
Author(s) -
Grasl Stefan,
Janik Stefan,
Vyskocil Erich,
Kadletz Lorenz,
Grasl Matthaeus C.,
Erovic Boban M.
Publication year - 2019
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13404
Subject(s) - tonsillectomy , medicine , hemostasis , surgery , univariate analysis , fibrinogen , risk factor , retrospective cohort study , anesthesia , multivariate analysis
Abstract Objectives To assess whether preoperative plasma fibrinogen is able to predict severe post‐tonsillectomy haemorrhage. Study design Retrospective chart review. Methods We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. Results 414 (90.8%) had no severe post‐tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher ( P = .023) in patients with a severe bleeding. Univariate Cox‐regression analysis revealed that elevated preoperative fibrinogen represents a significant worse ( P = .003; HR 2.66; 95% CI 1.38‐5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post‐tonsillectomy haemorrhage ( P = .016; HR 15.4; 95% CI 0.01‐0.6). High preoperative PFL was associated with significantly higher risk for post‐tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. Conclusions Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.