Postoperative Bleeding Associated with Ibuprofen Use after Tonsillectomy

A Meta-analysis

William Stokes, Robert T. Swanson, Jane R. Schubart, Michele M. Carr

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). Data Sources: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. Review Method: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. Results: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. Conclusion: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StatePublished - Jan 1 2019

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Tonsillectomy
Ibuprofen
Meta-Analysis
Hemorrhage
Cohort Studies
Randomized Controlled Trials
Retrospective Studies
Clinical Trials
Databases
Perioperative Period
Information Storage and Retrieval
MEDLINE
Sample Size
Publications
Anti-Inflammatory Agents
Language
Odds Ratio
Prospective Studies
Confidence Intervals
Pediatrics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Otorhinolaryngology

Cite this

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title = "Postoperative Bleeding Associated with Ibuprofen Use after Tonsillectomy: A Meta-analysis",
abstract = "Objective: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). Data Sources: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. Review Method: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. Results: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95{\%} confidence interval, 1.11-1.72). The I2 statistic of 20.8{\%} demonstrates overall low study heterogeneity and good comparability of the results. Conclusion: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.",
author = "William Stokes and Swanson, {Robert T.} and Schubart, {Jane R.} and Carr, {Michele M.}",
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Postoperative Bleeding Associated with Ibuprofen Use after Tonsillectomy : A Meta-analysis. / Stokes, William; Swanson, Robert T.; Schubart, Jane R.; Carr, Michele M.

In: Otolaryngology - Head and Neck Surgery (United States), 01.01.2019.

Research output: Contribution to journalArticle

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T1 - Postoperative Bleeding Associated with Ibuprofen Use after Tonsillectomy

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N2 - Objective: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). Data Sources: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. Review Method: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. Results: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. Conclusion: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.

AB - Objective: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). Data Sources: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. Review Method: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. Results: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. Conclusion: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.

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