Bleeding Outcomes After Adenotonsillar Surgery in Pediatric Patients With Hemophilia: Perioperative Management and Outcomes

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BACKGROUND: Adenotonsillectomy is a prevalent surgical procedure in children, with post-tonsillectomy bleeding (PTB) being a significant complication. Pediatric patients with bleeding disorders such as hemophilia are particularly at risk, exhibiting a higher incidence of delayed hemorrhage. This study aims to explore PTB incidence among pediatric hemophilia patients and evaluate the effectiveness of perioperative management strategies. METHODS: This retrospective study reviewed medical records from January 2010 to January 2024, focusing on pediatric patients diagnosed with hemophilia who underwent adenotonsillectomy. Data were analyzed to assess the rates of PTB and compare the efficacy of different perioperative treatment protocols recommended by hematologists. RESULTS: Out of 1580 surgical procedures reviewed, 18 pediatric patients with hemophilia underwent adenoidectomy or adenotonsillectomy. The average age was 4.8 years. Only a single case of epistaxis in an adenoidectomy case was found. Hemostatic-specific management with antifibrinolytic therapy and preoperative clotting factor replacement was utilized. Postoperative management typically included continued antifibrinolytic therapy and factor replacement for an average of 5 days. The study noted minimal significant postoperative bleeding events, underscoring the potential effectiveness of perioperative strategies. CONCLUSION: Perioperative management in pediatric patients may help reduce the incidence of PTB. This study supports the need for stringent perioperative protocols and further research into optimal management strategies for this high-risk population.

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