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Review
. 2022 Jun 23;7(4):1206-1216.
doi: 10.1002/lio2.835. eCollection 2022 Aug.

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta-analysis

Bo Li  1 , Miaowei Wang  2 , Yanwen Wang  3 , Lingyun Zhou  4
Affiliations
Review

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta-analysis

Bo Li et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH).

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle-Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs.

Results: A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47-0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30-0.64) and 0.70 (95% CI, 0.54-0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13-2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16-0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32-0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34-0.64).

Conclusions: Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure.

Level of evidence: 5.

Keywords: meta‐analysis; postoperative hemorrhage; suture; tonsillectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart of the study selection process. The reasons for exclusion are indicated at each step
FIGURE 2
FIGURE 2
Primary outcome. Forest plot comparing the rates of PTH (odds ratio [OR] with 95% confidence interval [CI]). Events represent the number of patients with PTH
FIGURE 3
FIGURE 3
Secondary outcomes. Forest plot of odds ratio with 95% confidence interval (CI) of patients with primary PTH (A), secondary PTH (B), and returning to the operation room for hemostasis (C)
FIGURE 4
FIGURE 4
The results of subgroup analyses. Odds Ratio of the effect of different data acquisition (A), comparison models (B), suturing methods (C), surgical details (D), and age discrimination (E) on the PTH rate
FIGURE 5
FIGURE 5
Sensitivity analysis and publication bias of this meta‐analysis. (A) Funnel plot of meta‐analysis of TIS versus TsIS studies. (B) Galbraith plot for the included studies. (C) Sensitivity analysis for the included studies.
See this image and copyright information in PMC

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References

    1. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144(1):S1‐S30. - PubMed
    1. Lowe D, van der Meulen J, Cromwell D, et al. Key messages from the national prospective tonsillectomy audit. Laryngoscope. 2007;117(4):717‐724. - PubMed
    1. Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Population‐based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997‐2012. Int J Pediatr Otorhinolaryngol. 2018;108:55‐62. - PubMed
    1. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope. 2011;121(12):2553‐2560. - PubMed
    1. Söderman AC, Odhagen E, Ericsson E, et al. Post‐tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol. 2015;40(3):248‐254. - PubMed

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