Surgical technique and post-tonsillectomy hemorrhage: a single institution’s retrospective study

Abstract

Post-tonsillectomy hemorrhage is one of the most common complications of tonsillectomy. The rate varies with different methods. We retrospectively analyzed patients who underwent tonsillectomy in a period of two years. Two surgical methods, cold dissection and microscopically assisted bipolar tonsillectomy, were compared. 1007 patients were included in the study. Postoperative hemorrhage occurred in 116 patients (11.5 %). By the cold dissection method, postoperative bleeding was noted in 86 patients (10.9 %), while by the microscopic bipolar method in 30 patients (13.9 %). A surgical hemostasis was required in 47 patients (5.9 %) and 17 patients (7.9 %), respectively. Concerning the time of occurrence of the first postoperative bleeding episode, we found that it occurred mainly on day 6 by the cold dissection technique (median = 6, mean = 5.84, SD = 3.30), whereas by the bipolar technique the first episode occurred on day 5 (median = 5, mean = 5.27, SD = 2.85). However, a statistical analysis did not show a significant difference. In conclusion, our study did not show a significant difference concerning the prevalence or the postoperative day of occurrence of the first bleeding episode after tonsillectomy when comparing the two methods, but recommendations concerning the duration of the in-hospital stay could be made. Each institution should perform its own individualized statistics concerning the occurrence of postoperative bleeding and should use a standardized documentation protocol. Level of evidence 3b.

Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use

“…As such, there is a wide reported rate ranging from 2% to19%. [7][8][9][10][11][12] An accurate insight into the true incidence of PTH and possible risk factors is of paramount importance to accurately counsel patients preoperatively and because of the associated chance of readmission, reoperation, or most significantly, mortality. 13 This study demonstrates a higher rate of postoperative hemorrhage among adults than is typically reported in the literature.…”

“…The majority of published studies analyzing adult PTH are either single‐institution retrospective cohorts or larger cross‐sectional surveys utilizing coding data for tonsillectomy and PTH encounters. As such, there is a wide reported rate ranging from 2% to19% 7–12 . An accurate insight into the true incidence of PTH and possible risk factors is of paramount importance to accurately counsel patients preoperatively and because of the associated chance of readmission, reoperation, or most significantly, mortality 13 …”

Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study

“…2 The overall re-admission rate of 15.5% and the return to theatre rate of 3.1% also represent some of the highest rates in the literature. [3][4][5][6][7][8][9][10] Furthermore, across the major Health Boards in Scotland, the tonsillar haemorrhage and return to theatre rates are of a similar pattern. patients with an infective indication for their tonsillectomy, and older patients, are at increased risk of post-tonsillectomy haemorrhage.…”

Frequency of post‐tonsillectomy hemorrhage relative to time of day

“…Our findings align with previous studies reporting posttonsillectomy hemorrhage occurring primarily in patients >12 years of age 12,17,18 and 5 to 10 days postoperatively. 10,11 Whereas established risk factors for hemorrhage include older age 6,11,12,19 and a previous minor bleeding episode, 5,20 other risk factors such as sex 12,21 or indication for surgery 3,14 have been controversial.…”

“…10,12 Despite the fact that some hemorrhage episodes are selflimited and only require monitoring, others may require control of the hemorrhage in the operating room (OR). Despite years of studying different surgical techniques 13,14 and NSAID restriction, 15,16 the rate of post-tonsillectomy hemorrhage remains largely unchanged.…”