title: Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy.
abstract: BACKGROUND
  Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate post-operative setting.
  
  
  METHODS
  The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. The records of patients aged less than 18 years undergoing tonsillectomy (T) or adenotonsillectomy (AT) were extracted using relevant ICD-9 diagnosis codes. The association between hemorrhage and obesity, OSA, AH, CT, PTA, and patients' demographics among surgeries performed in the outpatient setting was evaluated.
  
  
  RESULTS
  A total of 138,998 procedures, 22,478 Ts and 116,520 ATs, were performed during 2005-2011, of which 3.0% were performed on obese children. Hemorrhage occurred in 156 cases (0.1%), and was associated with an age from 9 to 18 years (p=0.01), and obesity (p=0.02). There was no association between hemorrhage and gender (p=0.8), OSA (p=0.6), ATH (p=0.5), CT (p=0.35), PTA (p=0.47), or T versus AT (p=0.3). Multivariate analysis revealed that hemorrhage was about 2.3 times more likely to occur in obese children (odds ratio [OR]=2.3; 95% Confidence Interval: 1.1-5.1; p=0.03).
  
  
  CONCLUSIONS
  Obesity and older age are associated with an increased risk of immediate post-operative hemorrhage following tonsillectomy with or without adenoidectomy in the outpatient setting. Gender, OSA, ATH, CT, PTA, and T versus AT did not alter the risk of post-operative hemorrhage.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States.
authors.forename: Rijul
authors.initials: R
authors.lastname: Kshirsagar
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mahboubi
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States.
authors.forename: Derek
authors.initials: D
authors.lastname: Moriyama
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States.
authors.forename: Olubunmi
authors.initials: O
authors.lastname: Ajose-Popoola
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States; Division of Pediatric Otolaryngology, CHOC Children's Specialists, CHOC Children's Hospital, 1010 W. La Veta Ave., Suite 640, Orange, CA 92868, United States.
authors.forename: Nguyen S
authors.initials: NS
authors.lastname: Pham
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine. 101 The City Drive South, Orange, CA 92868, United States; Division of Pediatric Otolaryngology, CHOC Children's Specialists, CHOC Children's Hospital, 1010 W. La Veta Ave., Suite 640, Orange, CA 92868, United States. Electronic address: gahuja@choc.org.
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Ahuja
mesh_terms: D000233:Adenoidectomy / Q000379:methods; D000293:Adolescent; D000367:Age Factors; D000556:Ambulatory Surgical Procedures; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009765:Obesity / Q000150:complications*; D017063:Outcome Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D014068:Tonsillectomy / Q000379:methods; D014069:Tonsillitis / Q000150:complications / Q000601:surgery
keywords: Adenotonsillectomy; Obesity; Outpatient tonsillectomy; Tonsillectomy