Abstract
Objectives: To perform a meta-analysis of studies of the timing of primary tonsillectomy haemorrhage. In particular to compare the difference in risk between 0–8 and 8–24 h; that is whether overnight inpatient tonsillectomy is required.
Design: Medline search of all tonsillectomy studies to perform a meta-analysis of the timing of primary haemorrhages.
Setting: Literature-based study.
Participants: All adult and paediatric tonsillectomy studies giving the absolute number and timing of all primary haemorrhages.
Main outcome measures: The overall incidence of haemorrhage occurring between 0–8 and 8–24 h. The overall incidence of haemorrhage for each of the first 24 h after operation. Compare risk of a bleed occurring 0–8, 8–24 and >24 h where data were available.
Results: From a 1.4% overall risk of a primary haemorrhage only one in 14 occur after 8 h, i.e. 0.1% (95% CI = 0.08–0.16%). A total of 833 patients would require to be kept overnight in order to identify one case of bleeding after 8 h.
Conclusions: Little benefit was conferred from overnight admission from the point of view of monitoring for primary haemorrhage. A case can be made for either day-case tonsillectomy (hospital stay over the period in which 93% of primary haemorrhages would occur) or the ‘belt-and-braces’ approach of a 1-week stay (during which all haemorrhages would occur) but current 24-h admission appears illogical.
Design: Medline search of all tonsillectomy studies to perform a meta-analysis of the timing of primary haemorrhages.
Setting: Literature-based study.
Participants: All adult and paediatric tonsillectomy studies giving the absolute number and timing of all primary haemorrhages.
Main outcome measures: The overall incidence of haemorrhage occurring between 0–8 and 8–24 h. The overall incidence of haemorrhage for each of the first 24 h after operation. Compare risk of a bleed occurring 0–8, 8–24 and >24 h where data were available.
Results: From a 1.4% overall risk of a primary haemorrhage only one in 14 occur after 8 h, i.e. 0.1% (95% CI = 0.08–0.16%). A total of 833 patients would require to be kept overnight in order to identify one case of bleeding after 8 h.
Conclusions: Little benefit was conferred from overnight admission from the point of view of monitoring for primary haemorrhage. A case can be made for either day-case tonsillectomy (hospital stay over the period in which 93% of primary haemorrhages would occur) or the ‘belt-and-braces’ approach of a 1-week stay (during which all haemorrhages would occur) but current 24-h admission appears illogical.
| Original language | English |
|---|---|
| Pages (from-to) | 418-423 |
| Number of pages | 6 |
| Journal | Clinical Otolaryngology |
| Volume | 30 |
| Issue number | 5 |
| Early online date | 20 Sept 2005 |
| DOIs | |
| Publication status | Published - Oct 2005 |