Post-tonsillectomy Bleeding as a Stochastic Process

Abstract

Objective 1) Establish an acceptable post-tonsillectomy bleeding rate from the literature, and 2)provide a literature-based comparator for institutional bleed rates. Methods A MEDLINE literature search entering the keyword “tonsillectomy” identified 4,610 papers for all available years. The abstracts were loaded into a database and searched to identify the incidence of bleeding if reported. The weighted mean, standard deviation and 95% confidence intervals were calculated for those papers. For papers that compared a new technique to a control technique, only the control group rate was used. The definitions of bleeding rate were those used by the original authors of the papers. Results 63 papers reported post-tonsillectomy bleeding rates. The mean (4.5%) plus 2 standard deviations (9.4%) suggests a maximum “expected” sustained bleeding rate of 13.9%. Even in this literature which should reflect optimum results, there were 3 reports of bleed rates in the 18–20% range. Conclusions Post-tonsillectomy bleeding rates of about 5% are typical. Rates above 14% justify monitoring, and sustained rates over 20% occur at times. Transient increases greater than 20% may occur.