Significantly Reducing Post-Tonsillectomy Haemorrhage Requiring Surgery by Suturing the Faucial Pillars A Retrospective Analysis 英文参考文献.docVIP

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Significantly Reducing Post-Tonsillectomy Haemorrhage Requiring Surgery by Suturing the Faucial Pillars A Retrospective Analysis 英文参考文献.doc

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SignificantlyReducingPost-TonsillectomyHaemorrhage RequiringSurgerybySuturingtheFaucialPillars:A RetrospectiveAnalysis Go¨tzSenska1*,HilalSchro¨der1,CarolinPu¨tter2,PhilippDost1 1Hals-,Nasen-,Ohren-Heilkunde,PlastischeOperationen,MarienhospitalGelsenkirchenGmbH,Gelsenkirchen,Germany,2Institutfu¨rMedizinischeInformatik,Biometrie undEpidemiologieUniversita¨tsklinikum Essen,Germany Abstract Background: The tonsillectomy is one of the most frequently performed surgical procedures. Given the comparatively frequent postsurgical bleeding associated with this procedure, particular attention has been paid to reduction of the postoperative bleeding rate. In 2006, we introduced routine suturing of the faucial pillars at our clinic to reduce postoperativehaemorrhage. Methods:Twogroupsfromtheyears2003–2005(n=1000)and2007–2009(n=1000)havebeencompared.Weincludedall patientswhohadanelectivetonsillectomyduetoabenign,non-acuteinflammatorytonsilillness.Intheyears2007–2009, weadditionallysuturedthefaucialpillarsaftercompletinghaemostasis.Forprimaryhaemostasisweusedsutureligation andbipolardiathermy. Results:Therateofbleedingrequiringsecondsurgeryforhaemostasiswas3.6%in2003–2005butonly2.0%in2007–2009 (absolute risk reduction 1.6% (95% CI 0.22%–2.45%, p=0.04)). The median surgery time—including adenoidectomy and paracentesissurgery—increasedfrom25to31minutes(p,0.01). Conclusions:Wehavebeenabletosubstantiatethatsuturingofthefaucialpillarsnearlyhalvestherateofpostoperative haemorrhage.Surgerytakes8minuteslongeronaverage.Bleedingoccurslater,mostlyafter24h.Thelimitationsofthis studyrelatetoitsretrospectivecharacterandallthepotentialbiasesrelatedtoobservationalstudies. Citation:SenskaG,Schro¨derH,Pu¨tterC,DostP(2012)SignificantlyReducingPost-TonsillectomyHaemorrhageRequiringSurgerybySuturingtheFaucialPillars: ARetrospectiveAnalysis.PLoSONE7(10):e47874.doi:10.1371/journal.pone.0047874 Editor:ClaireThorne,UCLInstituteofChildHealth,UniversityCollegeLondon,UnitedKingdom ReceivedFebruary21,2012