Dexamethasone and risk of bleeding in children undergoing tonsillectomy.
OBJECTIVE
To determine whether dexamethasone use in children undergoing tonsillectomy is associated with increased risk of postoperative bleeding.


METHODS
Retrospective cohort study using a multihospital administrative database.


METHODS
Thirty-six US children's hospitals.


METHODS
Children undergoing same-day tonsillectomy between the years 2004 and 2010.


METHODS
We used discrete time failure models to estimate the daily hazards of revisits for bleeding (emergency department or hospital admission) up to 30 days after surgery as a function of dexamethasone use. Revisits were standardized for patient characteristics, antibiotic use, year of surgery, and hospital.


RESULTS
Of 139,715 children who underwent same-day tonsillectomy, 97,242 (69.6%) received dexamethasone and 4182 (3.0%) had a 30-day revisit for bleeding. The 30-day cumulative standardized risk of revisits for bleeding was greater with dexamethasone use (3.11% vs 2.71%; standardized difference 0.40% [95% confidence interval, 0.13%-0.67%]; P = .003), and the increased risk was observed across all age strata. Dexamethasone use was associated with a higher standardized rate of revisits for bleeding in the postdischarge time periods of days 1 through 5 but not during the peak period for secondary bleeding, days 6 and 7.


CONCLUSIONS
In a real-world practice setting, dexamethasone use was associated with a small absolute increased risk of revisits for bleeding. However, the upper bound of this risk increase does not cross published thresholds for a minimal clinically important difference. Given the benefits of dexamethasone in reducing postoperative nausea and vomiting and the larger body of evidence from trials, these results support guideline recommendations for the routine use of dexamethasone.
Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.
Sanjay
S
Mahant
Ron
R
Keren
Russell
R
Localio
Xianqun
X
Luan
Lihai
L
Song
Samir S
SS
Shah
Joel S
JS
Tieder
Karen M
KM
Wilson
Lisa
L
Elden
Rajendu
R
Srivastava
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D014068:Tonsillectomy; D014481:United States
D005938:Glucocorticoids; D003907:Dexamethasone
dexamethasone; perioperative; postoperative bleeding; quality of care; tonsillectomy