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

Abstract

[Accepted Research Article]

Background: This study aimed to document intraoperative blood loss for adenoidectomy and tonsillectomy, to consider adenoidectomy as a day case procedure, and to assess clinical factors that could be associated with appreciable intraoperative blood loss.

Methods: Prospective analytical clinical study conducted in a tertiary hospital.  Patients were categorized based on sleep disordered breathing (SDB) symptoms.  Body mass index (BMI), packed cell volume (PCV), and platelets count were noted. Intraoperative blood loss measurement was by gauze-weighing technique.  Changes in PCV 24 hours post- surgery were recorded.

Descriptive and analytical statistics performed with Chi square test, Student’s t-test and Analyses of variance, ANOVA with Statistical Package for Social Sciences  SPSS version 20.

Results: There were 40 patients, with mean age 5.5±5.4 years, 70.0% males,  65.0% had acceptable BMI, 57.5% had SDB symptoms, 47.5% had adenotonsillectomy     There were no statistically significant differences between preoperative PCV and platelet counts of the patients (p=0.163, and p=0.324) respectively.

Intraoperative blood loss revealed a difference between adenoidectomy and tonsillectomy (1.25 ± 0.09 Vs 3.61± 0.18) and adenoidectomy versus adenotonsillectomy (1.25 ±0.09 Vs 3.69±0.34), p=0.034, and p=0.013 respectively.  No significant blood loss between tonsillectomy and adenotonsillectomy, p= 0.988. 24-hours post-operative PCV changes was significantly different for adenoidectomy versus tonsillectomy (p=0.031), and adenoidectomy versus adenotonsillectomy (p=0.022), but no significant difference between tonsillectomy and adenotonsillectomy (p=0.976).

Intraoperative blood loss >3ml/kg body weight was considered appreciable; age of patient, and presence of SDB were associated with appreciable intraoperative blood loss.

Conclusions: Intra operative blood loss for adenoidectomy and tonsillectomy were generally acceptable.  Adenoidectomy is advocated as a day-case procedure. The clinical factors associated with appreciable blood loss in tonsillectomy are patients’ age, and presence of SDB symptoms.