THE UTILITY OF PREOPERATIVE HEMOSTATIC ASSESSMENT IN ADENOTONSILLECTOMY

Routine preoperative coagulation screening in patients undergoing tons illectomy and/or adenoidectomy (T and A) is considered by some to be m andatory. T and A is often the first hemostatic challenge in children; therefore, screening is thought to be useful in predicting patients w ho may experience postoperative hemorrhage. On the other hand, in toda y's cost-conscious medical environment, routine screening is considere d by some to be an unnecessary added expense. At our institution, amon g 4373 patients who underwent T and A between 1989 and 1994, 43 return ed with postoperative bleeding (0.98%). We retrospectively evaluated t he usefulness of prothrombin time (PT) and activated partial thrombopl astin time (PTT) in predicting intraoperative and postoperative bleedi ng. All children had extensive bleeding histories taken; however, preo perative laboratory screening was left to the discretion of the attend ing physician. Preoperative PT/PTT did not predict intraoperative or p ostoperative bleeding. In our experience, laboratory screening has a v ery low positive predictive value in detecting occult bleeding disorde rs or perioperative hemorrhage; thus, we feel it should be used select ively. Routine preoperative PT/PTT is not recommended to screen T and A patients and does not appear to be cost-effective. (C) 1997 Elsevier Science Ireland Ltd.