Population-based analysis of tonsil surgery and postoperative hemorrhage

Abstract

Although tonsil surgery is one of the most frequent otorhinolaryngological procedures, not many population-based regional or country-wide studies are published on the incidence of postoperative bleeding and its risk factors. 2,216 patients underwent tonsil surgery in 2012 in Thuringia, a federal state in Germany. Most frequent indications were recurrent tonsillitis (44 % of all cases), tonsillar abscess (27 %), and tonsillar hyperplasia (20 %). 29 % of the patients were <10 years of age. Most frequent methods of surgery were tonsillectomy (73 %) and tonsillotomy (19 %). 215 patients (10 %) had 221 events of a postoperative hemorrhage. Re-surgery for hemostasis was necessary in 137 patients (6 %). The interval to re-surgery was 4.4 ± 4.6 days. The re-surgery rate was 8, 0.2, and 15 % after tonsillectomy, tonsillotomy, and radical tonsillectomy, respectively. In cases of recurrent tonsillitis, male gender (p < 0.001), age >24.78 years (median; (p = 0.018), and waiving of perioperative antibiotics (p = 0.029) were independent factors associated with hemorrhage. In cases of tonsillar hyperplasia tonsillectomy instead of tonsillotomy, the only significant risk factor was postoperative hemorrhage (p = 0.005). The overall incidence of tonsillar surgery was 87.6/100,000. The highest incidence was seen for patients 3-4 years of age with 862.7/100,000. In children <10 years, the incidence was always higher for boys than for girls. Throughout all age groups, a reverse gender relation was only seen, if surgery was indicated for recurrent tonsillitis. We recommend establishing national guidelines for indication of tonsil surgery, especially of tonsillectomy, including recommendations for perioperative care to decrease variations in tonsil surgery rates and minimize postoperative complications.

Gender-specific risk factors in post-tonsillectomy hemorrhage

“…In accordance with the literature, no significant relationship was found between PTH and smoking [34], regular alcohol consumption, diabetes, hypertension [35], antihypertensive therapy, postoperative pain medication with NSAIDs (COX1 inhibitor) [8,36] or opioids [8], application of glucocorticoids [8,37], therapy with antibiotics [10,38], duration of hospital stay [24,39] and surgeon experience [15]. The only significant risk factor for PTH was being male, which is in line with other research groups [6][7][8][9][10][11][12][13], although others did not find a significant correlation [14][15][16][17][18]. A sex hormone-dependent and independent mechanism may be involved, as TE/abscess-TE are performed at a median patient age of 26 and 30, respectively.…”

“…This can occur up to 15-20 days post surgery [15,25]. In the literature, the rate of PTH ranges between 0 and 33 % [6][7][8][26][27][28]. In this study, there was a 3 % rate of primary PTH, and a 23 % rate of secondary PTH.…”

“…In males, increased risk of post-tonsillectomy hemorrhage (PTH) was shown in most studies [6][7][8][9][10][11][12][13], whereas others were not able to find this effect [14][15][16][17][18]. Gender-specific genes contribute to genetic predisposition toward specific diseases.…”

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population‐based healthcare research study

“…There are only eight hospitals with departments of otolaryngology and neurology. The departments of otolaryngology have built a network primarily to improve health services research in the field of otolaryngology . The use of this network provided an ideal platform for a population‐based analysis of the inpatient treatment of IFP in 2012 in Thuringia in daily practice with focus on similarities and differences between treatment strategies found in departments of otolaryngology as compared with departments of neurology.…”

Secondary tonsillar hemorrhage requiring surgical intervention: Analysis of 1429 tonsillectomy cases on single surgeon experience

“…A post-tonsillectomy hemorrhage rate, which is one of the complications of this procedure, varies from 2.1% to 12% when all age groups are taken into consideration (2)(3)(4). In general, the rate of second surgical procedure due to tonsillar hemorrhage is between 1.2% and 6% (3,4). Post-tonsillectomy hemorrhages are classified as primary (within 24 h postoperatively) and secondary (after 24 h postoperatively) (5).…”