Risk Factors For Post-Tonsillectomy Hemorrhage

Abstract

Objectives: This research was undertaken to determine the frequency of post-tonsillectomy hemorrhage (PTH) in one particular clinical setting and to assess which risk factors exist for PTH. Methods: Following a retrospective case review of 892 patients who had gone through either tonsillectomy or adenotonsillectomy, a subgroup of 50 records were selected for detailed study. These 50 patients were then classified as either pediatric cases (aged under 16) or adult cases (aged over 16). Their risk factors were then assessed. Risk factors included: age, sex, surgical indication; type of surgery; time hospitalized post-operatively; timing of PTH (primary and secondary); management used to staunch bleeding and time in hospital following PTH. Results: The overall rate of PTH was 5.6% (3.0% pediatric, 2.6% adult). All PTH instances were secondary and no primary type occurred. In comparing the adult and pediatric cases of PTH, there was no statistically significant difference (p>0.05) in terms of age, sex, time hospitalized post-operatively, management used to staunch bleeding or time in hospital following PTH. There was, however, a statistically significant difference (p<0.05) between groups in terms of surgical indication and timing of PTH (primary or secondary). Conclusion: There was an increased frequency of secondary PTH in both groups. PTH typically happened between day 5 and 10 post-operatively. Patients need to be advised about this risk and show caution regarding factors that increase the risk of PTH after surgery.

Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal

“…There are also varying reports regarding the influence of age on PTH. 3 , 4 Generally, the frequency of PTH is higher in older children or adults as seen in our study. 3 , 10 This difference could be due to difference in the indication for the tonsillectomy.…”

“… 7 Severity of PTH was graded as follows: Grade I (Minor) -Haemorrhage that could be controlled by non-invasive intervention; Grade II (Moderate)-Haemorrhage necessitating local anaesthesia for control and Grade III (Severe)-Administration of general anaesthesia is necessary to control haemorrhage. 4 All those patients who bled during the hospital stay period after the operation or who were readmitted because of PTH were included in the study.…”

“… 3 It is a significant consequence of tonsillectomy that can range from blood-tinged mucus to life-threatening bleeding. 4 , 5 …”

Our experience of the increased rates of post‐tonsillectomy haemorrhage in 1538 children with pre‐operative infective symptoms or signs

“…This should be considered when making the clinical decision between surgical indication and PTH. [3][4][5] These studies have reported an increased risk of PTH in patients undergoing tonsillectomy for recurrent tonsillitis. 6,7 However, other groups have reported a higher rate of PTH in children with sleep-disordered breathing symptoms.…”

“…To our knowledge, this is the first investigation into this relationship and was undertaken to answer an important clinical question. Many other groups have evaluated the association between surgical indication and PTH 3‐5 . These studies have reported an increased risk of PTH in patients undergoing tonsillectomy for recurrent tonsillitis 6,7 .…”