Meta-analysis of the timing of haemorrhage after tonsillectomy: an important factor in determining the safety of performing tonsillectomy as a day case procedure

被引:32
|
作者
Bennett, AMD
Clark, AB
Bath, AP
Montgomery, PQ
机构
[1] Norfolk & Norwich Univ Hosp, Dept ENT, Norwich NR4 7UZ, Norfolk, England
[2] Univ E Anglia, Norwich NR4 7TJ, Norfolk, England
来源
CLINICAL OTOLARYNGOLOGY | 2005年 / 30卷 / 05期
关键词
D O I
10.1111/j.1365-2273.2005.01060.x
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
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.
引用
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页码:418 / 423
页数:6
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