Tonsillectomy, adenoidectomy, and myringotomy in sickle cell disease: Perioperative morbidity

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.