Medical Student University of Missouri-Kansas City School of Medicine Kansas City, Missouri
Introduction: Post-tonsillectomy bleeding (PTB) is a surgical emergency that can result in significant morbidity, and even mortality. There is currently no standard screening application that predicts postoperative bleeding. We evaluated the effect of routine preoperative administration of a validated bleeding disorder questionnaire (Šrámek et al, 1995) on the rate of PTB.
Methods: This is retrospective cohort analysis, comparing PTB rates before and after instituting routine use of a bleeding questionnaire from January 1, 2014 to December 31, 2019. We compared bleeding rates for patients who received the questionnaire and those who did not. Additionally, the rate of referral to hematology in each group was compared using a relative risk ratio regression model (Risk Ratio 95% CI). The number of patients in which a bleeding disorder was identified through a hematology referral or following a postoperative bleed was also recorded.
Results: 1447 patients were included (1057 who did not receive the questionnaire and 437 who received the questionnaire). Bleeding rate was 6.14% for the group that received the questionnaire and 6.22% for the group that did not. Patients in the questionnaire group were 2.46 (p < 0.001) times as likely to have a hematology consult ordered compared with those who did not receive the questionnaire. Eight patients were diagnosed with a bleeding disorder, all of whom were in the group who did not receive the questionnaire (0.8% vs 0.0%, p = 1.24).
Conclusion: The use of a validated preoperative family history questionnaire has not been well assessed in the literature. We conclude that standardized use of this validated questionnaire was no better than routine family history. Additionally, implementing standardized family history questions led to an increased rate of referral to hematology for further testing which resulted in increased costs for patients and a delay in the time to surgery.