Posttonsillectomy hemorrhage: blame on surgeons or genes?
OBJECTIVE
To investigate whether the insertion/deletion polymorphism (-94ins/delATTG) in the promoter of NF kappa B1 is associated with the risk of bleeding after tonsillectomy.


METHODS
Retrospective study with genotyping performed from tonsillar tissue or blood.


METHODS
One hundred forty-eight patients having undergone tonsillectomy due to chronic tonsillitis, with or without posttonsillectomy hemorrhage.


RESULTS
DNA-extraction from paraffin-embedded tonsillectomy tissue or blood was followed by genotyping for the insertion/deletion (-94ins/delATTG) promoter NF kappa B1 polymorphism. Genotypes differed significantly between patients with (n = 56) and without (n = 92) posttonsillectomy hemorrhage, with the frequency of the homozygous deletion genotype carriers (DD) significantly increased in those with posttonsillectomy bleeding with an odds ratio (OR) for bleeding of 3.78 (95% confidence interval [CI] 1.2-11.7, P = .023) but not in homozygous (II) insertion and heterozygous (ID) genotype carriers (II/ID). Genotype distribution in patients was compatible with the Hardy Weinberg equilibrium. In contrast, there were no statistically significant differences between patients with or without posttonsillectomy hemorrhage with regard to demographic characteristics, different surgeons, postoperative medications like analgesics, antibiotics, anticoagulation therapy, or values of variables of pre- and postoperative coagulation studies. Likewise, these variables revealed no differences between genotypes.


CONCLUSIONS
Carriers of the homozygous deletion allele were at an almost fourfold risk to develop posttonsillectomy hemorrhage compared to homozygous and heterozygous insertion allele carriers, independent of other risk factors.
Arweiler-Harbeck
Diana
D
Department of Otorhinolaryngology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany. Diana.Arweiler-Harbeck@uk-essen.de
Oztürk
Ender
E
Bankfalvi
Agnes
A
Lang
Stephan
S
Siffert
Winfried
W
Schmid
Kurt Werner
KW
Peters
Jürgen
J
Adamzik
Michael
M
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005787:Gene Frequency / Q000235:genetics; D006580:Genetic Carrier Screening; D020022:Genetic Predisposition to Disease / Q000235:genetics; D005838:Genotype; D006720:Homozygote; D006801:Humans; D054643:INDEL Mutation / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D016328:NF-kappa B / Q000235:genetics*; D016017:Odds Ratio; D011110:Polymorphism, Genetic / Q000235:genetics*; D019106:Postoperative Hemorrhage / Q000235:genetics*; D011401:Promoter Regions, Genetic / Q000235:genetics*; D012189:Retrospective Studies; D014068:Tonsillectomy
D016328:NF-kappa B