Impact of systemic steroids on posttonsillectomy bleeding: analysis of 61 430 patients using a national inpatient database in Japan.

Abstract

Although postoperative bleeding after tonsillectomy is rare, it is potentially life-threatening. The association between steroid administration and postoperative bleeding remains controversial. The findings of previous studies were limited by small sample sizes. To examine the impact of intravenous steroid administration on posttonsillectomy bleeding requiring reoperation in children and adults. Retrospective cohort study of 61 430 patients from 718 hospitals who underwent tonsillectomy between 2007 and 2013, using the Diagnosis Procedure Combination database in Japan. Intravenous steroid administration on the day of tonsillectomy. The main outcome measure was reoperation for hemostasis under general anesthesia. Patient characteristics (age, sex, comorbidities) and steroid use were examined. Patients were classified as children (age ≤15 years, n = 31 934) and adults (age >15 years, n = 29 496), and subclassified into those who received intravenous steroid therapy on the day of tonsillectomy (steroid group) and those who did not (control group). Multivariable logistic regression analysis was performed to analyze the association between steroid use and posttonsillectomy bleeding with adjustment for patient characteristics. The rate of reoperation was significantly higher in the steroid group than in the control group for children (1.2% vs 0.5%) (P < .001) but not for adults (1.7% vs 1.4%) (P = .14). Reoperation was most frequently performed at about 7 days after tonsillectomy. After adjusting for patient characteristics, we found a significant increase in the rate of reoperation in the steroid group in children (adjusted odds ratio [OR], 2.50 [95% CI, 1.47-4.23]) (P = .001) but not in adults (OR, 1.18 [95% CI, 0.85-1.64]) (P = .31). Intravenous steroid administration on the day of tonsillectomy in children was an independent risk factor for severe bleeding requiring reoperation.