Post‐Tonsillectomy Hemorrhage: Incidence, Prevention and Management

Abstract

Tonsillectomy (with or without adenoidectomy) continues to be a commonly performed operation in the United States. Over the years, the incidence of post‐tonsillectomy hemorrhage (reported between 0% and 20%) has decreased, but continues to pose serious problems. We reviewed 1,445 tonsillectomies performed over a 2‐year period to study the incidence of post‐tonsillectomy hemorrhage. Thirty‐eight of 1,445 children (2.62%) had postoperative bleeding. The incidence of primary hemorrhage (within 24 hours) was 0.14%. Delayed hemorrhage requiring operative intervention or observation in the hospital was 1.03% and 0.76%, respectively. Ten patients (0.69%) had delayed hemorrhage of a minor nature that had stopped by the time they reached the hospital; these children were treated with observation alone and did not require hospitalization or operative intervention. The proposed reasons for this low rate of post‐tonsillectomy hemorrhage include complete preoperative coagulation screening, meticulous attention to surgical technique, use of suction‐cautery to obtain hemostasis and, possibly, use of postoperative antibiotics. Management of hemorrhage is discussed with respect to observation, surgical intervention, and blood transfusion.

Preoperative ketorolac increases bleeding after tonsillectomy in children

“…We observed a 14% incidence of excessive bleeding in the kctorolac group, which is greater than the expected rate of less than 3%. 15 The unexpected bleeding appeared to be an individual response; that is, if we excluded the patients with marked bleeding from analysis, the bleeding was almost identical in groups. When we began our study, there were no reports of ketorolac being associated with important perioperative bleeding.…”

Comparison of benzydamine hydrochloride and Salvia officinalis as an adjuvant local treatment to systemic nonsteroidal anti-inflammatory drug in controlling pain after tonsillectomy, adenoidectomy, or both: an open-label, single-blind, randomized clinical trial

“…2'3 Infection following tonsillectomy is uncommon, 4 and nasopharyngeal stenosis, atlantoaxial subluxation, meningitis, depression, and death are extremely rare. [5][6][7] Postoperative pain can be treated with systemic analgesic therapy in combination with local infiltration of anesthetics or local application of analgesics, although some investigators have been unable to show the effect of locally applied therapy. 8-11 Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief following tonsillectomy 12 and may also reduce postoperative nausea and vomiting.…”

Hemorrhage after Tonsillectomy in Pediatric Patients Living in Rural Regions

“…Wei et al [6] found that 89 of 90 bleeds were secondary in 4,662 patients. The causes of secondary bleeding are residual tonsillar tissue, infection, an incorrect diet such as an acidic liquid or solid food, trauma, and the use of nonsteroidal anti-inflammatory drugs [7,8]. However, we attribute the bleeding in our patients to extremely hot environments.…”

“…Tonsillectomy is frequently performed in otorhinolaryngological clinics, and is associated with possible bleeding, aspiration, laryngospasm, and circulatory collapse [4,8]. Primary bleeding is thought to be associated with the surgical technique employed.…”