Intraoperative blood loss and associated clinical factors among children who have undergone adenoidectomy or tonsillectomy at a tertiary hospital in southwestern Nigeria

Abstract

Background: This study aimed to document intraoperative blood loss in adenoidectomy and tonsillectomy, to evaluate adenoidectomy as a day-case procedure, and to identify clinical factors associated with significant intraoperative blood loss.

Methods: A prospective analytical clinical study was conducted at a tertiary hospital. Patients were categorized based on sleep-disordered breathing symptoms. Body mass index, packed cell volume (PCV), and platelet count were recorded. Intraoperative blood loss was measured using the gauze-weighing technique. Changes in PCV 24 hours after surgery were also recorded. Descriptive and analytical statistics were performed using the chi-square test, Student’s t-test, and analysis of variance.

Results: The study comprised 40 patients with a mean age of 5.5±5.4 years; 70% were male, and 65% had an acceptable body mass index. Sleep-disordered breathing symptoms were present in 57.5% of patients, and 47.5% underwent adenotonsillectomy. There were no statistically significant differences between preoperative PCV and platelet counts (P=0.163 and P=0.324, respectively). Intraoperative blood loss showed a difference between adenoidectomy and tonsillectomy (1.25±0.09 vs 3.61±0.18 mL/kg), as well as between adenoidectomy and adenotonsillectomy (1.25±0.09 vs 3.69±0.34 mL/kg) (P=0.034 and P=0.013, respectively). No significant blood loss was observed between tonsillectomy and adenotonsillectomy (P=0.988). Postoperative PCV changes at 24 hours were significantly different between adenoidectomy and tonsillectomy (P=0.031), as well as between adenoidectomy and adenotonsillectomy (P=0.022), but not between tonsillectomy and adenotonsillectomy (P=0.976). Intraoperative blood loss >3 mL/kg body weight was considered significant; patient age and the presence of sleep-disordered breathing symptoms were associated with significant intraoperative blood loss.

Conclusions: Intraoperative blood loss for adenoidectomy and tonsillectomy was generally within acceptable limits. We advocate for adenoidectomy as a day-case procedure. Patient age and a background of sleep-disordered breathing were associated with significant blood loss during tonsillectomy.