title: Risk factors for pediatric post-tonsillectomy hemorrhage.
abstract: OBJECTIVE
  To determine pre-operative risk factors for post-tonsillectomy secondary hemorrhage in children, and quantify the magnitude of their risk.
  
  
  METHODS
  Retrospective case-control study of all pediatric tonsillectomy patients experiencing post-operative bleeding from 2005 to 2010 in a community practice consisting of three fellowship-trained pediatric otolaryngologists were identified. The 91 cases were matched with 151 controls that underwent tonsillectomy by the same surgeon on the same day as each identified case. All charts were reviewed, and 41 pre-operative variables were extracted and statistically analyzed with contingency and regression analysis to calculate significance and odds ratios.
  
  
  RESULTS
  Three significant predictors of post-operative bleeding were identified. Performing a tonsillectomy on a child with recurrent tonsillitis (vs. other indications) increased the risk of post-operative hemorrhage by 4.5 times (p<0.0001, 95% confidence intervals 2.41-8.38). Performing a tonsillectomy on a child with attention deficit hyperactivity disorder (ADHD) increased the risk by 8.7 times (p=0.029, 95%CI 1.4-53.6). Older children were more predisposed to post-operative bleeding. For every increase in age by one year, the hemorrhage risk increased by 1.1 times (p=0.0025, 95%CI 1.032-1.162). Children 11 years of age and older had double the risk of bleeding compared to younger children (odds ratio 1.98, p=0.0381, 95%CI 1.04-3.79). None of the remaining 38 variables showed significant differences between cases and controls.
  
  
  CONCLUSIONS
  The risk of post-tonsillectomy hemorrhage is significantly increased in older children and those with recurrent tonsillitis and ADHD.
authors.affiliation: Center for Pediatric ENT-Head and Neck Surgery, 10150 Hagen Ranch Road, Boynton Beach, FL 33437, USA; Department of Otolaryngology, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA. Electronic address: dzs@centerforpediatricent.com.
authors.forename: Zorik
authors.initials: Z
authors.lastname: Spektor
authors.affiliation: Department of Otolaryngology, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA. Electronic address: ssaintvictor@med.miami.edu.
authors.forename: Sandra
authors.initials: S
authors.lastname: Saint-Victor
authors.affiliation: Center for Pediatric ENT-Head and Neck Surgery, 10150 Hagen Ranch Road, Boynton Beach, FL 33437, USA; Department of Otolaryngology, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA. Electronic address: ddk@centerforpediatricent.com.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kay
authors.affiliation: Center for Pediatric ENT-Head and Neck Surgery, 10150 Hagen Ranch Road, Boynton Beach, FL 33437, USA; Department of Otolaryngology, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA. Electronic address: dmandel4@fau.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Mandell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy; D055815:Young Adult
keywords: Hemorrhage; Pediatric tonsillectomy; Risk factors