Hemorrhage following pediatric tonsillectomy before puberty

Abstract

Objective: Control of postoperative bleeding, considered as the major complication following tonsillectomy, serves as a landmark for the safety of the operation. There is a constant decrease of the concentration of hemoglobin during childhood with lowest values around 6 years of age with normal values at the beginning of puberty accompanied by a constant decrease of the number of platelets after birth. Dehydration, poor oral intake and airway problems are predominant complications in early childhood. A retrospective study was undertaken to evaluate if the incidence of bleeding is associated with certain age groups in pediatric patients. We assessed if there is a questionable higher risk for blood transfusions due to the age-specific lower hemoglobin concentration in children. Methods: Between January 1988 and August 2000, 2330 patients under 12 years of age underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg. Group A (age<6 years) consisted of 1467 patients of whom 59.6% were male. Group B (aged 6–12 years) consisted of 863 patients, of whom 48.1% were male. Results: Postoperative bleeding from the tonsillar fossae requiring treatment under general anesthesia occurred in group A (1%) and B (2.3%). Bleeding from the adenoidectomy site was treated in group A (0.3%) and B (0.3%). Primary bleeding occurred in the majority of patients in both groups group A (55%) and group B (75%). The latest bleeding was observed 6 days (group A) and 10 days (group B) following surgery, due to statistical analysis the difference was found to be significant ( P<0.025). In group A there was one 42-month-old boy who died due to massive bleeding despite ligature of the external carotid artery and blood transfusions. Statistical evaluation shows a significant increase of postoperative bleeding with age ( P=0.024). No blood transfusion was required in other patients. Conclusion: Tonsillectomy can be safely performed in children under 6 years of age with no increased risk of postoperative bleeding or risk of receiving blood transfusion. Rare cases of secondary hemorrhage seem to occur more frequently in younger children and should be treated immediately under general anesthesia to avoid severe complications.