To the Editor Chua et al1 have put forward compelling evidence to suggest potential risk of constipation in children undergoing tonsillectomy with or without adenoidectomy after being prescribed opioid medications. However, we would like to suggest 2 further considerations that interested readers may find helpful to be included in the study.
First, Chua et al1 did not include primary hemorrhage in the study because the authors presumed this to be more likely associated with the surgical technique used. However, there has not been conclusive evidence to support this stance because there has been great variability in reported bleeding frequencies and a lack of statistically significant difference among the various techniques.2 It is of great interest to many otolaryngologists to reduce the risk of primary hemorrhage as much as possible. Therefore we believe it would be most desirable to include this complication together with available data on surgical technique adopted (ie, electrocautery dissection, coblation, or cold steel dissection) as part of the analysis. Understandably, surgical technique data may be difficult to procure through the insurance claims database, but with a sufficiently large sample size such as that in this study, the average occurrence of primary hemorrhage owing to technique-related factors in either group may even cancel out (assuming technique is unrelated to prescribing opioid medication). Therefore, we would suggest that the authors consider including primary hemorrhage in any related subsequent studies.
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Sun L, Wong RTW, Ng MPE. Opioid Prescriptions and Risk of Complications After Tonsillectomy in Children. JAMA Otolaryngol Head Neck Surg. 2020;146(2):208–209. doi:10.1001/jamaoto.2019.3430
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