After Tonsillectomy, Steroids May Not Increase Bleeding

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, Sept. 25 (HealthDay News) -- A class of drugs commonly given to children undergoing tonsillectomy is not likely to increase the risk of serious bleeding after surgery, according to a new U.S. study.

Corticosteroids, which are similar to a natural hormone produced by the adrenal glands, have been used for many years to prevent postoperative nausea and vomiting and to decrease airway swelling, according to background information included in the study. The practice was approved in guidelines for pediatric tonsillectomy developed by the American Academy of Otolaryngology-Head and Neck Surgery in 2011.

But European research recently concluded that the drugs can trigger increased bleeding or hemorrhage. The research was halted before it was completed due to the increased risk of bleeding that scientists were seeing among study participants.

"The European study, which was well constructed and designed, had more than a 20 percent bleed rate at the dose most of us use for kids," said Dr. Christopher Hartnick, chief of otolaryngology at the Massachusetts Eye and Ear Infirmary in Boston, and co-author of the U.S. study.

That's what prompted the U.S. researchers to do the new study. Because the use of corticosteroids in tonsillectomies is common, they wanted to definitively resolve the question of whether they put children at greater risk for hemorrhage.

"Just about every surgeon in the U.S. doing tonsillectomies is probably using corticosteroids," said Dr. Peter Koltai, chief of the division of pediatric otolaryngology at Stanford University School of Medicine, in California.

The study, published Sept. 26 in the Journal of the American Medical Association, found that corticosteroids given to children undergoing tonsillectomy were not associated with excessive or serious bleeding following surgery compared to patients who received a placebo.

Tonsillectomy involves removing the two walnut-sized lumps of lymph tissue visible at the back of the mouth, in the throat. As many as 530,000 tonsillectomies are performed every year in the United States in children younger than 15, the study noted.

The study included 314 children and teens, ranging in age from 3 to 18 years, who were randomly put into two groups. Children in one group received corticosteroids (dexamethasone) and the others were given a placebo.

Of the 157 children getting corticosteroids, 11 were reported to have postoperative bleeding during the 14 days after the surgery, three had to be admitted to the hospital due to postoperative hemorrhage and three had to return to the operating room to control bleeding. Of those getting a placebo, seven were reported to have developed bleeding issues during that period, five had to be admitted to the hospital and one had to return to the operating room to control bleeding.

The overall rate of bleeding events for all participants was slightly less than 10 percent (30 children).

Four patients had bleeding within 24 hours of surgery: two from the corticosteroid group and two from the placebo group. Although overall the corticosteroid group had a slightly increased incidence of developing significant bleeding, the number was not deemed statistically significant.

Despite the positive results of the study, some physicians remain wary of using corticosteroids.

"My impression is, if you're weighing whether a kid should be at risk of having nausea and vomiting or increased risk of bleeding, nausea and vomiting would win," said Dr. Dennis Woo, associate professor of pediatrics at the David Geffen School of Medicine and staff pediatrician at the University of California, Los Angeles, Santa Monica Medical Center. "Studies like this are important to help us reduce the risk of tonsillectomy and keep it as safe as possible."

A 3,000-year-old surgical procedure, tonsillectomy has waxed and waned in popularity over the years. Although frequently prescribed decades ago for children with recurrent throat infections, a large number of tonsillectomies are now done for childhood sleep apnea, often caused by obesity, Hartnick said.

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SOURCES: Christopher Hartnick, M.D., professor, otolaryngology, department of pediatric otolaryngology, Massachusetts Eye and Ear Infirmary, Boston; Peter Koltai, M.D., professor and chief, division of pediatric otolaryngology, Stanford University School of Medicine, Palo Alto, Calif.; Dennis Woo, M.D., associate professor, David Geffen School of Medicine, University of California, Los Angeles, and staff pediatrician, Santa Monica-UCLA Hospital; Sept. 26, 2012, Journal of the American Medical Association