Risk of Postoperative Bleeding in Tonsillectomy for Peritonsillar Abscess, as Opposed to in Recurrent and Chronic Tonsillitis-A Retrospective Study.

Petr Hrabačka,Štěpánka Čejková,David Kalfeřt,Václav Šimánek,David Slouka,Stanislav Kormunda,Jana Hanáková,Radek Kucera,Alena Skálová

doi:10.3390/ijerph18041946

Abstract

Tonsillectomy is a routine surgery in otorhinolaryngology and the occurrence of postoperative bleeding is not a rare complication. The aim of this retrospective, observational, analytic, cohort study is to compare the incidence of this complication for the most common indications. A group of patients indicated for tonsillectomies for peritonsillar abscess (group I) was compared to a group of patients indicated for chronic and recurrent tonsillitis (group II). There are a lot of pathophysiological differences in patients indicated for acute tonsillectomy for peritonsillar abscess and in patients indicated for elective tonsillectomy for chronic or recurrent tonsillitis. No technique to minimize the risk of bleeding after tonsillectomy has been found and a large part of postoperative bleeding occurs in postoperative home-care, which makes this issue topical. In total, 2842 unilateral tonsillectomies from the years 2014–2019 were included in the study. Bleeding occurred in 10.03% and, surprisingly, despite completely different conditions in the field of surgery (oedema, acute inflammation in peritonsillar abscess), there was no statistically significant difference between incidence of postoperative bleeding in the studied groups (p = 0.9920). The highest incidence of bleeding was found in the patients of group I on the eighth postoperative day, with those aged 20–24 years (p = 0.0235) being the most at risk, and in group II, on the sixth postoperative day, with those aged 25–29 years (p = 0.0128) and 45–49 years (p = 0.0249) being the most at risk.

Highlights

In the examined group of diagnoses II (CHT + recurrent tonsillitis (RT)), there was no difference in the incidence of bleeding on the right and left sides of the operation, but a statistically significant difference was found for the gender subgroups: men had a higher risk of bleeding (p = 0.0129)
Our study investigated the idea of different risk levels of postoperative bleeding after tonsillectomy for peritonsillar abscess (PTA), chronic tonsillitis (CHT) or RT because the maximum inflammatory and repair processes in CHT, as well as in RT, occur in tonsil tissue and bilaterally, with only a minimum of these processes taking place in the surrounding tissue of tonsillar fossa; the basic anatomical conditions remain intact
After dividing the studied groups into five-year periods, we demonstrated that the PTA group included a subgroup that was more at risk: 20–24 years (p = 0.0235); men have twice the risk of bleeding than women (p = 0.0329); two age groups were found to be more at risk in the CHT + RT group: 25–29 years (p = 0.0128) and 45–49 years (p = 0.0249), with the 25–29 year-old men are being twice as likely to bleed

Summary

Introduction

Due to a wide range of indications [1,2], tonsillectomy (TE) is one of the most common surgical procedures in ENT departments. Tonsillectomy is classified as a minor operation, yet various complications associated with these operations are quite common [3,4]. We divide complications into perioperative and postoperative categories. Perioperative complications include: bleeding, anesthesiology complications, injury to surrounding structures, the retention of tonsil tissue residues, etc. Postoperative complications include: bleeding, dysphagic problems (sometimes associated with insufficient food intake), tonsillar fossa infection, velopharyngeal dysfunction, chronic hypertrophic pharyngitis, voice changes, Int. J.

Objectives

Methods

Results

Discussion

Conclusion