Adenoidectomy and tonsillectomy: is clotting profile relevant?

Background : Adenoidectomy and tonsillectomy are common surgical procedures performed mostly in paediatric population. They have the risk of haemorrhage in an area that may not be easily accessible. Thus the need to preoperatively do coagulation screening and this has remained controversial. Hence, the purpose of this study was to retrospectively evaluate our experience in Ibadan. Method : The records of sixty-eight patients that underwent adenoidectomy/tonsillectomy from 1998 to 2002 in the Department of ORL, UC H were evaluated for demographic data, history and physical findings that could suggest bleeding disorders, values of prothrombin/activated partial thromboplastin time and occurrence of peri-/postoperative haemorrhage. Results : There were 41 males and 27 females with M: F ratio of 1.5: 1. The age range was 6 months to 38 years, while the common age group involved was 0 – 10 years (75%). Four patients (5.9%) had history of risk factor of bleeding. Eight patients (11.8%) and 23 patients (33.5%) had prolonged PT and aPTT respectively. One patient with normal coagulation study had postoperative haemorrhage due to remnant of tonsillar tissue. There was no documentation of further confirmatory coagulation investigation in those that were prolonged. No correlation was observed between the coagulation tests and intraoperative blood loss and duration of surgery generally. Conclusion : Although these tests are routinely done in our centre, there was no clear evidence in support of their relevance. However, we advocate a flexible approach to this issue and each patient must be individually assessed and effort must be made to standardise the approach to adequate history taking with proper documentation of all relevant information before one decides to perform any investigation.