P. Waldron et al., Tonsillectomy, adenoidectomy, and myringotomy in sickle cell disease: Perioperative morbidity, J PED H ONC, 21(2), 1999, pp. 129-135
Purpose: To compare the rates of perioperative morbidity of patients with s
ickle cell anemia who were randomly assigned to 2 preoperative transfusion
regimens and to identify predisposing factors for perioperative complicatio
ns.
Patients and Methods: Investigators at 36 centers enrolled 118 patients who
were scheduled to have elective surgery and agreed to randomization betwee
n 2 preoperative transfusion regimens. Forty-seven subjects were enrolled b
ut not randomized, including 20 who were not transfused before surgery. Per
ioperative management was based on a prescribed care plan.
Results: Tonsillectomy and/or adenoidectomy (TA) were performed on 136 pers
ons, and 29 had myringotomy as their primary procedure. There were no diffe
rences in the frequency of complications between the randomized groups. The
serious, nontransfusion complication rates for randomized patients were 32
% (34 of 107) for TA and 36% (4 of 11) for myringotomy. A history of pulmon
ary disease was a predictor of postoperative sickle cell-related events for
patients undergoing TA surgery.
Conclusions: The more intensive transfusion regimen did not result in fewer
perioperative complications, The high frequency of complications emphasize
s the need for anticipatory management of persons undergoing TA. A history
of pulmonary disease identifies patients at increased risk for sickle cell-
related events after TA surgery. Patients undergoing myringotomy have a low
frequency of sickle cell-related events but a significant frequency of oth
er serious perioperative complications.