The utility of preoperative hemostatic assessment in adenotonsillectomy.
Routine preoperative coagulation screening in patients undergoing tonsillectomy and/or adenoidectomy (T and A) is considered by some to be mandatory. T and A is often the first hemostatic challenge in children; therefore, screening is thought to be useful in predicting patients who may experience postoperative hemorrhage. On the other hand, in today's cost-conscious medical environment, routine screening is considered by some to be an unnecessary added expense. At our institution, among 4373 patients who underwent T and A between 1989 and 1994, 43 returned with postoperative bleeding (0.98%). We retrospectively evaluated the usefulness of prothrombin time (PT) and activated partial thromboplastin time (PTT) in predicting intraoperative and postoperative bleeding. All children had extensive bleeding histories taken; however, preoperative laboratory screening was left to the discretion of the attending physician. Preoperative PT/PTT did not predict intraoperative or postoperative bleeding. In our experience, laboratory screening has a very low positive predictive value in detecting occult bleeding disorders or perioperative hemorrhage; thus, we feel it should be used selectively. Routine preoperative PT/PTT is not recommended to screen T and A patients and does not appear to be cost-effective.
Zwack
G C
GC
Department of Otolaryngology, Head and Neck Surgery, Eastern Virginia Medical School, Norfolk 23507-1912, USA.
Derkay
C S
CS
D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*