Steroid use during tonsillectomy does not raise excessive bleeding risk

By Lauretta Ihonor, medwireNews reporter

Children who are given dexamethasone during tonsillectomy are not more likely to experience excessive bleeding after surgery than those who do not receive the steroid perioperatively, study findings suggest.

However, the risk for minor self-reported postoperative bleeding (level I) may rise with dexamethasone use, say Christopher Hartnick (Massachusetts Eye and Ear Infirmary, Boston, USA) and team.

Given that only level I bleeds appear to be associated with dexamethasone use, the authors say that concerns about serious bleeding complications with perioperative use of steroids may be unwarranted.

Writing in JAMA, the authors report that among a group of 314 children aged 3 to 18 years, rates of postoperative bleeding events serious enough to warrant inpatient admission (level II) or reoperation (level III) did not differ significantly.

Specifically, over the first 14 postoperative days, level II bleeding occurred at a rate of 1.9% among the 157 children given a single dose of intravenous (iv) dexamethasone during tonsillectomy and 3.2% among the other 157 children given iv saline as a placebo.

Rates of level III postoperative bleeding were also similar among the dexamethasone (1.9%) and placebo groups (0.6%).

By contrast, level I postoperative bleeding was noticeably more common among dexamethasone (7.0%) than placebo patients (4.5%).

This intergroup rate difference crossed the noninferiority threshold of 5% used in the study.

And as the study aimed to test the hypothesis that dexamethasone does not result in 5% more bleeding events than placebo, crossing of the noninferiority threshold indicates that "increased subjective (level I) bleeding events caused by dexamethasone could not be excluded" highlight Hartnick et al.

The American Academy of Otolaryngology recommends perioperative use of dexamethasone to minimize the risk for nausea and vomiting following tonsillectomy.

The current study provides reason to believe that this guideline can be followed without compromising patient safety, say Hartnick and co-authors.

However, they conclude that further investigation of the risks associated with steroid use during pediatric tonsillectomy is needed.

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