Hemorrhage risk after coblation tonsillectomy in Chinese pediatric: a multicenter, prospective, observational cohort study

Hongming Xu; Shuyao Qiu; Jinxia Wang; Fugen Han; Zhongfang Xia; Liyan Ni; Jing Ma; Chunguang Chen; Xingqiang Gao; Junmei Zhang; Haixia Liu; Haibing Liu; Hongbing Yao; Qianger Zhuang; Wei Song; Sijun Zhao; Dabo Liu; Xiaoyan Li

doi:10.1007/s00405-024-09140-8

Hemorrhage risk after coblation tonsillectomy in Chinese pediatric: a multicenter, prospective, observational cohort study

Eur Arch Otorhinolaryngol. 2024 Dec 23. doi: 10.1007/s00405-024-09140-8. Online ahead of print.

Authors

Hongming Xu^#¹, Shuyao Qiu^#², Jinxia Wang^#³, Fugen Han⁴, Zhongfang Xia⁵, Liyan Ni⁶, Jing Ma⁷, Chunguang Chen⁸, Xingqiang Gao⁹, Junmei Zhang¹⁰, Haixia Liu¹¹, Haibing Liu¹², Hongbing Yao¹³, Qianger Zhuang¹⁴, Wei Song¹⁵, Sijun Zhao¹⁶, Dabo Liu¹⁷, Xiaoyan Li¹⁸

Affiliations

¹ Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, China.
² Department of Pediatric Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
³ Clinical Research Unit, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Children's Hospital of Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou, China.
⁵ Department of Otorhinolaryngology Head and Neck Surgery, Wuhan Children's Hospital, Wuhan, China.
⁶ Department of otolaryngology head and neck surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁷ Department of Otorhinolaryngology Head and Neck Surgery, Kunming Children's Hospital, Kunming, China.
⁸ Department of Otorhinolaryngology Head and Neck Surgery, Anyang Maternal and Child Health Hospital, Anyan, China.
⁹ Department of Otorhinolaryngology Head and Neck Surgery, Xiamen Children's Hospital, Xiamen, China.
¹⁰ Department of Otorhinolaryngology Head and Neck Surgery, Tianjin Children's Hospital, Tianjin, China.
¹¹ Department of Otorhinolaryngology, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Shanxi, China.
¹² Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.
¹³ Ministry of Education Key Laboratory of child Development and Disorders. Chongqing Key laboratory of Structural Birth defect and Reconstruction, Department of Otorhinolaryngology Head and Neck Surgery, National Clinical research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁴ Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital), Wuxi, Jiangsu, China.
¹⁵ Department of Otorhinolaryngology Head and Neck Surgery, Dalian Women and Children's Medical Group, Dalian, China.
¹⁶ Department of Otorhinolaryngology Head and Neck Surgery, Hunan Children's Hospital, Changsha, China.
¹⁷ Department of Pediatric Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China. [email protected].
¹⁸ Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, China. [email protected].

^# Contributed equally.

PMID: 39714620
DOI: 10.1007/s00405-024-09140-8

Abstract

Objectives: The study aimed to assess the incidence of post-coblation tonsillectomy hemorrhage (PCTH) and identify associated risk factors in a pediatric Chinese population.

Methods: This prospective, multicenter cohort study, conducted over 17 months, included 8854 pediatric patients who underwent coblation tonsillectomy across 15 research centers in China. Patient data were collected through an Electronic Data Capture (EDC) system. The primary outcome was the incidence of PCTH within 21 days post-surgery. Secondary outcomes involved analyzing risk factors for PCTH using multivariable logistic regression.

Results: The incidence of PCTH was 1.99%, with 176 patients experiencing hemorrhage. Significant risk factors included abnormal coagulation indicators (OR 10.56), longer surgery duration (OR 1.02), simultaneous adenoidectomy (OR 0.35), semi-liquid diet (OR 0.13), postoperative cough (OR 1.76), and the use of hemostatic agents (OR 1.58), intravenous antibiotics (OR 2.34), and painkillers (OR 2.33). Regional variations showed lower hemorrhage rates in East, Southwest, Central, and South China compared to North China.

Conclusions: The study found that the hemorrhage rate after coblation tonsillectomy is comparable to traditional tonsillectomy. Risk factors include coagulation status, surgical duration, and postoperative care. Regional differences in hemorrhage rates suggest the need for tailored approaches based on location. Coblation tonsillectomy is a safe and effective procedure for pediatric patients. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: This study was registered on Clinical trials.gov (NCT05206799), and approved by the Ethics Committee of Shanghai Children's Hospital, Shanghai Jiaotong University (2021R096-E01).

Keywords: Coblation; Multicentre; Pediatric; Post-coblation tonsillectomy hemorrhage; Tonsillectomy.

Abstract

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