title: Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders.
abstract: Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.
authors.affiliation: Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Warad
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: F T N
authors.initials: FTN
authors.lastname: Hussain
authors.affiliation: Division of Pediatric Hematology Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Rao
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Cofer
authors.affiliation: Division of Pediatric Hematology Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: V
authors.initials: V
authors.lastname: Rodriguez
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*; D055815:Young Adult
keywords: adenoidectomy; bleeding disorders; children; paediatric; postoperative haemorrhage; tonsillectomy