Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage

Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage: This cohort study evaluates the association between ibuprofen use and severity of posttonsillectomy hemorrhage using transfusion events as a marker of severity in pediatric patients undergoing tonsillectomy.

Pamela A. Mudd, MD, MBA^1,2; Princy Thottathil, MD^3,4; Terri Giordano, DNP, CRNP, CORLN⁵; et alRalph F. Wetmore, MD^5,6; Lisa Elden, MD^5,6; Abbas F. Jawad, PhD⁷; Luis Ahumada, PhD^8,9; Jorge A. Gálvez, MD, MBI^3,4,9,10

Author Affiliations

• ¹School of Medicine and Health Sciences, George Washington University, Washington, DC
• ²Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC
• ³Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
• ⁴Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
• ⁵Division of Otolaryngology (Ear, Nose, and Throat), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
• ⁶Department of Otorhinolaryngology–Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
• ⁷Department of Biostatistics in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
• ⁸Enterprise Reporting and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
• ⁹Section of Biomedical Informatics, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
• ¹⁰Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

JAMA Otolaryngol Head Neck Surg. 2017;143(7):712-717. doi:10.1001/jamaoto.2016.3839

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Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage (JAMA Otolaryngology–Head & Neck Surgery)

 

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Key Points

Question  Is the severity of posttonsillectomy hemorrhage requiring surgical control correlated with ibuprofen use?

Findings  In this retrospective cohort study of 8868 pediatric patients undergoing tonsillectomy, 222 (3.3%) required surgical intervention for posttonsillectomy hemorrhage, with no correlation between hemorrhage requiring surgical control and ibuprofen exposure. Fifteen children (0.2%) required transfusion; children using ibuprofen had an increased risk for transfusion when hemorrhage occurred.

Meaning  Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage; the severity of bleeding is difficult to quantify but may be a more important outcome to measure.

Abstract

Importance  Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure.

Objective  To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity.

Design, Setting, and Participants  This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia. Of these patients, 6710 met the inclusion criteria. Data were collected using electronic database acquisition and query.

Main Outcomes and Measures  Multivariate analysis was performed to identify independent prognostic factors for PTH and receipt of transfusion.

Results  Of the 6710 patients who met criteria for analysis (3454 male [51.5%] and 3256 female [48.5%]; median age, 5.4 years [interquartile range, 3.7-8.2 years]), 222 (3.3%) presented with PTH that required surgical control (sPTH). A total of 15 of the 8868 patients required transfusion for an overall risk for transfusion after tonsillectomy of 0.2%. Fifteen of 222 patients undergoing sPTH (6.8%) received transfusions. No significant independent increased risk for sPTH was associated with use of ibuprofen (adjusted odds ratio [OR], 0.90; 95% CI, 0.68-1.19). A significant independent association was found in the risk for sPTH in patients 12 years or older (adjusted OR, 2.74; 95% CI, 1.99-3.76) and in patients with a history of recurrent tonsillitis (adjusted OR, 1.52; 95% CI, 1.12-2.06). When using transfusion rates as a surrogate for severity of sPTH, transfusion increased by more than 3-fold among ibuprofen users compared with nonusers (adjusted OR, 3.16; 95% CI, 1.01-9.91), and the upper limit of the 95% CI suggests the difference could be nearly 10 times greater.

Conclusions and Relevance  The risk for sPTH is not increased with use of postoperative ibuprofen but is increased in patients 12 years or older and patients undergoing tonsillectomy with a history of recurrent tonsillitis. Hemorrhage severity is significantly increased with ibuprofen use when using transfusion rate as a surrogate marker for severity.

• Editorial
  Posttonsillectomy Hemorrhage in the Ibuprofen Era

 

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Hematology Otolaryngology Pediatrics Bleeding and Transfusion

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