Assessing post-tonsillectomy bleed rates: UT southwestern researchers create a novel model

New probability tools may improve the outcome of common pediatric surgery.

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Researchers at UT Southwestern have recently developed a new model to assess the rates of post-tonsillectomy bleeding. Tonsillectomy is a common surgical procedure, particularly in children, but postoperative bleeding can occur in some cases, leading to complications and requiring additional medical interventions. 

The findings published in JAMA Otolaryngology-Head and Neck Surgery help doctors and hospitals to improve outcomes for the third most common pediatric surgery in the U.S., where they evaluate the rates of post-tonsillectomy bleeding in pediatric patients and predicted distribution.

Although complications after tonsillectomies are rare, Dr. R. Johnson, Professor of Otolaryngology-Head and Neck Surgery at UT Southwestern, said, “Excessive bleeding is one of the most common and is often considered a factor in the very few deaths associated with this surgery. The guideline change was a significant step toward helping improve tonsillectomy safety.”

In 2019, the American Academy of Otolaryngology-Head and Neck Surgery Foundation issued updated guidelines for pediatric tonsillectomies, suggesting that surgeons self-monitor their patients’ bleeding rates after these procedures.

The new model developed by UT Southwestern researchers uses various factors, including the patient’s age, gender, and medical history, as well as the surgical technique and the use of medications during the surgery, to predict the risk of postoperative bleeding. By identifying patients at higher risk of complications, medical professionals can take preventive measures and provide closer monitoring to reduce the incidence of post-tonsillectomy bleeding.

To develop expected standards, Dr. Johnson, who was the first author of this study, and his colleagues collected data from the Children’s Hospital Association’s Pediatric Health Information System database, outpatient surgeries, emergency department visits, and observation not-for-profit children’s hospitals in the U.S. Researchers evaluate data involving patients who came to the emergency department or readmitted for bleeding after tonsillectomies. Researchers also collected demographic data on these patients as well as medical histories.

This retrospective cohort study of 96,415 children who underwent tonsillectomy found the predicted 5th, 50th, and 95th quantiles for bleeding after a tonsillectomy procedure were 1.17%, 1.97%, and 4.75%, respectively.

In statistics, a probability distribution is a function that describes the likelihood of different outcomes in a random process. In the case of a study on bleeding after pediatric tonsillectomy, the probability distribution would describe the likelihood of bleeding occurring after the surgery. The distribution would consider factors such as the child’s age, the type of tonsillectomy procedure performed, and any pre-existing medical conditions that may increase the risk of bleeding.

The probability distribution could take various forms, depending on the data collected and the statistical model used to analyze it. For example, it could be a normal distribution, indicating that most children have a low risk of bleeding, but some have a higher risk. Alternatively, it could be a bimodal distribution, meaning there are two distinct groups of children: one with a low risk of bleeding and one with a higher risk.

Understanding the probability distribution of bleeding after pediatric tonsillectomy can help healthcare providers and parents make informed decisions about the risks and benefits of the procedure. For example, if the distribution shows that a significant proportion of children have a high risk of bleeding, doctors may recommend alternative treatments or take extra precautions during the surgery to minimize the risk.

The development of this model is an important step forward in improving the safety and outcomes of tonsillectomy surgeries, particularly in pediatric patients.

Dr. Johnson said“This model provides a useful starting point to help surgeons look critically at their bleeding rates and help them understand why this complication might occur. It is hoped that this tool will lead to fewer complications and better postoperative recovery for patients undergoing tonsillectomy procedures. Further research is needed to validate the effectiveness of this model in clinical practice.”

Journal Reference:

  1. Romaine F. Johnson, Dylan Beams et al. Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy. JAMA Otolaryngology-Head & Neck Surgery. DOI: 10.1001/jamaoto.2023.0268