Abstract
Objective: To assess the risk factors which determine the magnitude of post-tonsillectomy hemorrhage. 
 Study Design: Prospective cross sectional study.
 Setting: A study carried out at otolyrangical unit at a tertiary care Isra University hospital Hyderabad, from June 2018 to April 2019.
 Materials and Methods: 110 pediatric patients age 5-17 years were included in this study. We administrated a structured questionnaire to parents of the patients. We selected cases for tonsillectomy as per criteria of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). Those patients with a history of recurrent tonsillitis presented at the otolaryngology department were included. Patients with a history of use of anticoagulant therapy, obstructive sleep apnea, patients with a history of a bleeding disorder, and patients not giving consent were excluded. We diagnosed patients selected for tonsillectomy included with recurrent tonsillitis, peri-tonsillar hypertrophy, and tonsillar hypertrophy. Patients were observed and followed for postoperative hemorrhage. Data were analyzed by using Statistical Package for Social Sciences version 21 (SPSS 21).
 Results: Among 110 children included in the study, 41.8% patients were in the age group of 5-10 years, 30% were in the age group of 11-15 years and 28.2% were over 15 years. Among 110 patients 21.8% underwent tonsillectomy were diagnosed as recurrent tonsillitis, 19% were diagnosed as having tonsillar hypertrophy, 40.0% were suffering from both recurrent tonsillitis and tonsillar hypertrophy and 19.2% had peritonsillar hypertrophy. This shows that 14.5% were admitted to the hospital after 1-5 days, 58.1% developed post-tonsillectomy hemorrhage after 6-10 days and 27.2% developed post-tonsillectomy hemorrhage after 10 days.
 Conclusion: We conclude that age >10 years was significant predictive risk factors for post-tonsillectomy hemorrhage among children who undergo tonsillectomy.
Highlights
Tonsillectomy is the most frequently performed surgical procedure in otolaryngology settings all over the world, both in pediatric patients
Among 110 patients 21.8% underwent tonsillectomy were diagnosed as recurrent tonsillitis, 19% were diagnosed as having tonsillar hypertrophy, 40.0% were suffering from both recurrent tonsillitis and tonsillar hypertrophy and 19.2% had peritonsillar hypertrophy
We have estimated that incidence of overall hemorrhage because of tonsillectomy is about 4.5%, whereas primary hemorrhage can occur in 0.2-2.5% and incidence of secondary post-tonsillectomy hemorrhage is about 1-3.5%
Summary
Tonsillectomy is the most frequently performed surgical procedure in otolaryngology settings all over the world, both in pediatric patients. The frequency of Tonsillectomy procedures accounts for about 20% to 40 percent of all surgeries in otolaryngic units throughout the world. The indications for tonsillectomy include recurrent tonsillitis, hypertrophic tonsils, peritonsillar abscess, and obstructed airway. Post tonsillectomy hemorrhage is a frequent complication associated with morbidity and mortality. We have estimated that incidence of overall hemorrhage because of tonsillectomy is about 4.5%, whereas primary hemorrhage can occur in 0.2-2.5% and incidence of secondary post-tonsillectomy hemorrhage is about 1-3.5%. Post-operative hemorrhage is associated with high morbidity and mortality unless managed properly, depending on prevalent risk factors [1]
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