Effect of post-operative oral steroids on bleeding rate after pediatric tonsillectomy

Purpose: In 2013, the FDA placed a black box warning on the usage of opioid pain medications in the postoperative setting after pediatric adenotonsillectomy. Since then, alternative pain management regimens have been employed. Some have advocated for post-operative oral steroids, in part due to the effectiveness of intraoperative intravenous steroids in reducing post-operative pain and nausea. The evidence regarding the efficacy and safety of post-operative oral steroids is not as clear. The purpose of this study was to examine whether post-tonsillectomy hemorrhage rates in pediatric patients were affected by post-operative oral steroid usage. Materials and methods: Case-control retrospective chart review using a deidentified data set of patients undergoing tonsillectomy with or without adenoidectomy at a single academic medical center between June 2012 and November 2015. Results: A total of 1416 patients were included in the study, with 704 in the no post-operative oral steroids group and 712 in the group who did receive post-operative oral steroids. The rate of post-tonsillectomy hemorrhage in the post-operative oral steroid group was 3.1 % compared to 1.8 % in the group who did not receive postoperative oral steroids, however, this was not a statistically significant difference (P =.132). Conclusions: Our study suggests that post-operative oral steroids are safe and do not increase the risk of postoperative hemorrhage after pediatric tonsillectomy.