Antibiotics and Ibuprofen Do Not Affect Post-tonsillectomy Bleeding Risk

Abstract

Objectives:

Determine if the use of ibuprofen or perioperative ampicillin affect post-tonsillectomy bleeding risk. Investigate other potential risk factors for post-tonsillectomy bleeding. As recommended by the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) tonsillectomy practice guideline, several members of an academic department stopped using perioperative ampicillin and also began using ibuprofen postoperatively. This quality improvement project was designed to determine whether these actions altered bleeding risk.

Methods:

Case control comparison methodology. A case was defined as any patient who returned to the operating room for cauterization. A control was defined as any patient who did not have known post-operative bleeding. Four randomly selected patients (2 cases and 2 controls) were identified in each month from November 2010 to August 2012 (n = 88).

Results:

Ibuprofen (odds ratio [OR] = 1.13, P = 0.8), perioperative ampicillin (OR = 0.91, P = 0.9), and postoperative amoxicillin (OR = 1.0, P = 1.0) had no effect on bleeding risk. Several trends were identified: Use of a microdebrider (vs. cautery) was associated with decreased bleeding risk (OR 0.21, P = 0.04). Neurologic/psychosocial comorbidity was associated with increased bleeding risk (OR 2.93, P = 0.06). Positive pre-operative bleeding risk assessment questionnaire was associated with increased bleeding risk (OR 1.76, P = 0.24).

Conclusions:

The use of ibuprofen and omission of perioperative ampicillin had no effect on the bleeding rate. The role of tonsillectomy technique, neurological/psychosocial comorbidity, and positive bleeding risk questionnaire are being examined prospectively.