Study examines association of smoking with hemorrhage after throat surgery

Smoking appears to be associated with an increased rate of hemorrhage (bleeding) in patients who undergo uvulopalatopharyngoplasty (UPPP, a surgical procedure used to remove excess tissue from the throat) with tonsillectomy (a surgical procedure in which the tonsils are removed), but not in those who undergo tonsillectomy alone, according to a report in the August issue of Archives of Otolaryngology−Head & Neck Surgery, one of the JAMA/Archives journals.

Although indications for tonsillectomy have changed over the years, it remains a common surgical procedure with a substantial risk for complications, the greatest of which is post-operative hemorrhage, according to background information in the article.

Sean M. Demars, M.D., then of Madigan Army Medical Center, Tacoma, Wash., and now of Bassett Army Community Hospital, Fort Wainwright, Alaska, and colleagues evaluated the rate of post-operative bleeding in 1,010 tonsillectomy patients from 2000 to 2005. Age, sex and smoking status were also noted.

The total bleeding rate for all patients was 6.7 percent. When divided into smokers and non-smokers, the bleeding rate for patients was 10.2 percent and 5.4 percent, respectively. The large difference was found "to be attributable to a marked increase in post-operative hemorrhage in the patients who underwent UPPP [10.9 percent in smokers vs. 3.3 percent in non-smokers]," the authors write. In addition, "men who underwent tonsillectomy alone bled significantly more than women (11.2 percent and 5.4 percent, respectively)."

Awareness of the association between smoking and post-operative hemorrhage "may help clinicians further counsel their patients before surgery," the authors conclude. "Further investigation of this relationship is needed, with stratification of patients by the number of cigarettes smoked and attention to the length of time before and/or after surgery that patients refrain from smoking."

(Arch Otolaryngol Head Neck Surg. 2008;134[8]:811-814. Available pre-embargo to the media at www.jamamedia.org.)

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