Evidence check
A rapid review outlining the available evidence on a discrete topic or question. Evidence includes grey and peer review literature. View all Evidence Checks by date of publication.
Post-tonsillectomy bleeding and pain
Added: 5 Feb 2024
Do the following factors influence the likelihood of post-tonsillectomy bleeding and pain?
- Surgery technique.
- Patient and clinical characteristics.
What are the main reasons for patients presenting to the emergency department (ED) following tonsillectomy surgery?
When (how many days after) do patients usually present to an ED after the surgery?
How long do patients need to stay close to where they had the tonsillectomy surgery, especially in rural or regional areas?
- The method and techniques of tonsillectomy can be associated with different risk profiles for post-operative haemorrhage and pain in both paediatrics and adults. Overall, the intracapsular coblation method appears to be associated with lower risks of bleeding and pain compared to other methods. Several patient and clinical characteristics, such as male gender, older age (15 years or over), multiple indications for surgery, comorbidity and coagulopathy, and the severity of illness at admission, are associated with an increased risk of post-tonsillectomy bleeding.
- The main reasons for presenting to an ED following tonsillectomy surgery include bleeding, dehydration, infection, nausea and pain in paediatrics. For adults, the most common reasons include pain and bleeding. The median days to presentation post-operation ranged from 5-7 for paediatrics and a similar range for adults.
- The evidence evaluating the safe geographical proximity or travel distance for patients to stay close to where they had the operation is scant.
Post-tonsillectomy bleeding in children
Added: 3 Nov 2023
- In Australia, between 2000 and 2020, the overall rate of post-tonsillectomy haemorrhage for all ages remained relatively constant at around 1.6%.1 The rate for the paediatric age group was around 1% for the study period.
- In patients who present to the emergency department (ED) with secondary post-tonsillectomy bleed, an Australian study found that the average post-operative day of presentation was 7. The risk of rebleeding was 2.9% and the median time to rebleed was 4.4 hours.
Surgery post COVID-19
Added: 11 Feb 2022
Updated: 31 Aug 2023
- The evidence for the association between a recent COVID-19 infection history and the risk of surgical complications and mortality is mixed. Study findings vary depending on factors such as the severity of the infection, surgical types, patient health status, SARS-CoV-2 variants and vaccination history.
- COVID-19 vaccinations reduce the risk of postoperative adverse outcomes among patients with a recent history of SARS-CoV-2 infection.
- Professional societies in Australia, the United States, the United Kingdom, and Canada have updated their recommendations this year (2023) to advise to proceed with surgery two to three weeks post COVID-19 infection. This advice may differ for high-risk patients or in certain circumstance
COVID-19 vaccines - retired living evidence
Added: 4 Apr 2023
- This evidence table includes information on vaccines that have published phase 3 trial data in the peer reviewed literature and are provisionally approved by the Australian Government Therapeutic Goods Administration (TGA).
- It focuses on information related to efficacy and safety.
SARS-CoV-2 variants - retired living evidence
Added: 4 Apr 2023
- This table includes information on Omicron subvariants that are currently causing concern in the scientific community and are under monitoring by the World Health Organization.
- It focuses on information related to transmissibility, virulence and severity, impact on immunity and treatments.
Archive Current and emerging patient safety issues during COVID-19
Added: 17 Jun 2022
Updated: 14 Dec 2022
- There are wide-ranging reports on the indirect impacts of COVID-19 and associated mitigation strategies such as lockdowns and service shutdowns.
- The literature not only discusses conventional patient safety issues, but also issues around delayed access to healthcare and equity issues.
Archive Bivalent COVID-19 vaccines
Added: 16 Nov 2022
- The bivalent COVID-19 vaccines have components that target both the original virus strain and the Omicron variant strain of the SARS-CoV-2 virus.
- The Spikevax bivalent booster vaccine (Moderna, BA.1-adapted, data from an ongoing phase 2–3 trial) is found to induce stronger neutralising antibody activities against the Omicron variant (including BA.4/BA.5 subvariants) than the original booster version. It has a similar safety and reactogenicity profile to the original version.
- The Comirnaty bivalent booster vaccine (Pfizer-BioNTech, BA.1-adapted, data from regulatory submission) is found to induce stronger neutralising antibody activities against the Omicron BA.1 subvariant than the original booster version.
Archive Molnupiravir
Added: 14 Oct 2021
Updated: 9 Nov 2022
- Molnupiravir (MK-4482/EIDD-2801) is an antiviral medication that is administered orally.
- Molnupiravir is a potent ribonucleoside analogue that inhibits the viral replication of SARS-CoV-2 (or other viruses that employ RNA-dependant RNA polymerase) by introducing errors in the viral genome.
- Despite some of evidence of risk reduction associated with molnupiravir treatment in non-hospitalised unvaccinated adults with mild to moderate COVID-19 symptoms pre-Omicron, a more recent clinical trial (pre-print) from the Omicron predominant period has suggested no risk reduction in all-cause hospitalisation or mortality among non-hospitalised vaccinated adults.
- In real-world studies from the Omicron predominant period, molnupiravir reduced the risk of disease progression in hospitalised patients not requiring oxygen therapy on admission and who are older than 65 or not fully vaccinated. In community-dwelling outpatients with mild symptoms who are at a higher risk of progressing to severe disease, molnupiravir treatment was associated with reduced risk of all-cause mortality, hospitalisation and in-hospital disease progression in patients older than 60 only.
Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Evidence checks are archived a year after the date of publication.