Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis.
OBJECTIVE
To use standard meta-analysis techniques to determine the risk of postoperative hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) after tonsillectomy.


METHODS
The MEDLINE database (1966-2001) restricted to the English language was searched using the keywords tonsillectomy, hemorrhage, analgesics, and NSAID in various combinations. Additionally, published articles were cross-referenced. To ensure completeness, the search was rerun using the Science Citation Index database.


METHODS
Of the 110 articles identified, 7 were selected. Selected studies were prospective trials comparing the effects of an NSAID and a control drug on posttonsillectomy pain and hemorrhage in pediatric and/or adult patients. In all cases, the NSAID or control was administered through an enteric route in the postoperative period. Patients were monitored for early and delayed hemorrhage.


METHODS
Data were extracted independently by 2 investigators.


RESULTS
A random effects model was used to compute a pooled odds ratio. For the 1368 patients included in analysis, the pooled odds ratio of posttonsillectomy hemorrhage with NSAIDs compared with controls was 1.29 and was not statistically significant (95% confidence interval, 0.85-1.73; P>/=.05). A subgroup analysis revealed an odds ratio of 0.93 (95% confidence interval, 0.44 -1.95; P>/=.05) for the nonaspirin NSAID group, while the aspirin group had a statistically significant odds ratio of 1.94 (95% confidence interval, 1.09-3.42; P =.02).


CONCLUSIONS
There is an increased risk of posttonsillectomy hemorrhage with the use of aspirin after tonsillectomy; however, there appears to be no significant increased risk of bleeding for nonaspirin NSAIDs in this meta-analysis.
Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, USA.
Srinivasan
S
Krishna
Larry F
LF
Hughes
Sandra Y
SY
Lin
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004008:Diclofenac / Q000009:adverse effects*; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D018570:Risk Assessment; D014068:Tonsillectomy / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D001241:Aspirin; D007052:Ibuprofen