Perioperative steroid use for tonsillectomy and its association with reoperation for post-tonsillectomy hemorrhage: a retrospective cohort study

This is a retrospective cohort study of 6149 patients having tonsillectomy with or without adenoidectomy or grommets. A hospital-based claims database over a period of 6 years and including patients treated at 68 hospitals was analysed for reoperation for bleeding on postoperative days 1-14. Half the study cohort were children.

There was no significant difference in the rate of reoperation between patients receiving steroids on the day of surgery and those who did not. This applied to both adult and paediatric subgroups. Increasing patient age and perhaps unsurprisingly increased anaesthetic time for the initial surgery were associated with an increased reoperation rate. Patients given steroids were also more likely to have received NSAIDs in the perioperative period.

In this Japanese study, only 13.7% of patients received steroids intraoperatively, and 30.2% in the immediate postoperative period which would appear to differ from our local practice. However, in this cohort steroids were more likely to be given to older patients with an infective indication for tonsillectomy who were also administered NSAIDs – a possibly higher risk group for a post tonsillectomy bleed.

Take Home Message

Steroids have been shown to reduce postoperative complications after tonsillectomy such as nausea and vomiting, pain and delayed recovery. The results of this study support the safety of steroids in this setting with regards to post-tonsillectomy bleeding.

Reviewed by: Stephanie Aplin