The effect of postoperative steroids on post-tonsillectomy pain and need for postoperative physician contact.

Abstract

Examine the effect of postoperative steroids on postoperative physician contacts and determine the hemorrhage rate for patients taking postoperative steroids. Retrospective review of medical records. A retrospective review was performed of children undergoing tonsillectomies before and after the institution of a standard postoperative course of three doses of dexamethasone (0.5 mg/kg). Tylenol and ibuprofen were also used for all patients, with oxycodone given as a rescue medication for children ≥6 years of age. Postoperative hemorrhage rate (all visits to the emergency department [ED] with concern for post-tonsillectomy hemorrhage), return to the ED for pain, and phone calls to the office for pain were recorded. A total of 1,200 children were included (300 without and 900 with steroids); there was no difference in age or weight between groups. Overall, the mean age was 6.6 ± 2.1 years and the hemorrhage rate was 7%. Parental phone calls decreased from 23.3% prior to steroid use to 14.7% after (P < .001), and post-tonsillectomy hemorrhage rates decreased from 9.7% to 5.7% (P = .02). There was no difference in ED visit rates (P = 0.70). Regression analysis showed that bleeding increased by 4% (95% confidence interval [CI]: 1%-13%) for each increasing year of age (P < .001), whereas postoperative steroids decreased hemorrhage rates by 7% (95% CI: 1%-9% reduction) (P = .013). The risk of a phone call increased by 2% for each year of age; postoperative steroids decreased phone calls by 9% (P < .001). There were no steroid-related complications within 1 month of surgery. A short course of postoperative steroids decreased the number of postoperative phone calls for pain by 9% after tonsillectomy, and decreased the risk of postoperative tonsillectomy hemorrhage by 7%. 4. Laryngoscope, 128:2187-2192, 2018.