AUTHORS: Miyamoto, Yoshihisa MD, MPH et al
Anesthesia & Analgesia: March 2018 – Volume 126 – Issue 3 – p 806–814
BACKGROUND: Steroids reduce postoperative complications after tonsillectomy such as nausea and vomiting, pain, and delayed recovery. However, steroids may also increase the risk of severe posttonsillectomy bleeding requiring reoperation.
METHODS: To evaluate the risk of postoperative bleeding requiring reoperation related to perioperative steroid use, we conducted a retrospective cohort study of 6149 patients treated at 68 hospitals using a hospital-based claims database. The primary outcome was reoperation for bleeding within 14 postoperative days. We estimated odds ratios (ORs) between perioperative steroid use and reoperation by multivariable logistic regression analysis adjusted for confounders. We also estimated differences in the adjusted risk. Subgroup analyses after dividing patients into adults and children were also performed.
RESULTS: The incidence of reoperation did not differ significantly between patients who received steroids on the day of tonsillectomy and those who did not (1.8%, n = 15 vs 1.5%, n = 79; adjusted OR 0.81, 95% confidence interval [CI], 0.45–1.43; P = .46). We also found nonsignificant associations in both adults (OR, 0.73; 95% CI, 0.38–1.38; P = .33) and children (OR, 1.18; 95% CI, 0.34–4.11; P = .80). The adjusted risk differences estimated by the logistic regression model were −0.30% (95% CI, −1.05 to 0.45) in all patients, −0.64% (95% CI, −1.82 to 0.54) in adults, and 0.13% (95% CI, −0.93 to 1.19) in children.
CONCLUSIONS: Steroid use on the day of tonsillectomy was not associated with an increased risk of reoperation for bleeding. Although the wide range of CIs for the ORs could not eliminate the possibility of increased risk, especially in children, the incremental risks of reoperation for steroid use were within an acceptable range for both adults and children. Our results support the safety of perioperative steroid use for tonsillectomy, considering the magnitude of risk of reoperation because of bleeding.