SICKLE-CELL DISEASE AND TONSILLECTOMY - PREOPERATIVE MANAGEMENT AND POSTOPERATIVE COMPLICATIONS

Background: Patients with sickle cell disease are recognized as having a relatively higher risk for postoperative complications, including f ever, atelectasis, pneumonia, or sickle cell vaso-occlusion. Objective : To present a protocol for preoperative management of patients with s ickle cell disease undergoing tonsillectomy, including the use of tran sfusions and intravenous hydration. Design: Retrospective chart review . Setting: Academic, tertiary care referral medical center. Patients: Seventy-five patients with sickle cell disease who underwent tonsillec tomy with or without adenoidectomy were included for review. Preoperat ive management was documented, and risk factors were assessed. Intraop erative management was reviewed, and postoperative complications were identified and compared with preoperative data and management. Results : Preoperative management consisted of transfusions to a hemoglobin S ratio (hemoglobin S-total hemoglobin) less than 40% or a hemoglobin le vel greater than 100 g/L. Aggressive intravenous hydration of 1.5 time s the maintenance fluid was given 24 hours before surgery. Increased c omplications were associated with a preoperative hemoglobin S ratio gr eater than 40% (P<.05) and an age younger than 4 years (P<.05). Operat ive time, technique, and blood loss were not statistically significant risk factors. The average length of hospitalization was 4.8 days. Con clusions: Children with sickle cell disease presenting for elective to nsillectomy should be given a transfusion to a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. Additio nal factors, such as age and presence of obstructive sleep apnea, only increase the potential risks.