Management of post tonsillectomy secondary haemorrhage: Flinders experience

Abstract

Background: Secondary posttonsillectomy haemorrhage (sPTH) is a significant complication inOtolaryngology. Most studies have focussed on different risk factors associatedwith sPTH. However, few studies have reported on the outcomes of sPTH afterpresentation to a tertiary public hospital. We sought to present our experiencewith the management of sPTH. Methods: A retrospectivereview of all patients (n=145) presenting with a sPTH to Flinders MedicalCentre (FMC) was analysed over a two-year period. The Stammberger grade forsPTH was applied and recorded in the case notes at presentation of allpatients. Results: 59% of thesepatients were adults. Overall, 79% of patients were conservatively treated anddischarged safely without returning to the operating theatre. Adults weremarginally more likely to return to theatre (RTT) with a relative risk (RR) of1.07 (CI 0.5–2.3). Patients who had coblation (COB) tonsillectomy had a higherRR of RTT (RR =1.45) compared to cold steel (CS) tonsillectomy. Patients whohad a COB tonsillectomy (16.6%) were also more likely represent with a secondbleeding episode compared to CS tonsillectomy (9.8%). The length of stay (LOS)was significantly longer (13 hours) in adults with Stammberger grade C sPTH(P<0.05) compared to grade A1 sPTH, with other factors having no significanteffect on LOS. Conclusions: The overall riskof a second bleeding episode is low in patients with sPTH, and conservativemanagement in the first instance is safe. Patients with a COB tonsillectomy arelikely to present with multiple episodes of sPTH if initial management wasconservative. Stammberger grade at initial sPTH presentation is not predictiveof subsequent presentations.