Premium
Meta‐analysis of the timing of haemorrhage after tonsillectomy: an important factor in determining the safety of performing tonsillectomy as a day case procedure
Author(s) -
Bennett A.M.D.,
Clark A.B.,
Bath A.P.,
Montgomery P.Q.
Publication year - 2005
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/j.1365-2273.2005.01060.x
Subject(s) - tonsillectomy , medicine , bleed , incidence (geometry) , relative risk , risk factor , meta analysis , surgery , anesthesia , pediatrics , confidence interval , physics , optics
Objectives: To perform a meta‐analysis of studies of the timing of primary tonsillectomy haemorrhage. In particular to compare the difference in risk between 0–8 and 8–24 h; that is whether overnight inpatient tonsillectomy is required. Design: Medline search of all tonsillectomy studies to perform a meta‐analysis of the timing of primary haemorrhages. Setting: Literature‐based study. Participants: All adult and paediatric tonsillectomy studies giving the absolute number and timing of all primary haemorrhages. Main outcome measures: The overall incidence of haemorrhage occurring between 0–8 and 8–24 h. The overall incidence of haemorrhage for each of the first 24 h after operation. Compare risk of a bleed occurring 0–8, 8–24 and >24 h where data were available. Results: From a 1.4% overall risk of a primary haemorrhage only one in 14 occur after 8 h, i.e. 0.1% (95% CI = 0.08–0.16%). A total of 833 patients would require to be kept overnight in order to identify one case of bleeding after 8 h. Conclusions: Little benefit was conferred from overnight admission from the point of view of monitoring for primary haemorrhage. A case can be made for either day‐case tonsillectomy (hospital stay over the period in which 93% of primary haemorrhages would occur) or the ‘belt‐and‐braces’ approach of a 1‐week stay (during which all haemorrhages would occur) but current 24‐h admission appears illogical.