Temporal fluctuations of post-tonsillectomy haemorrhage

Stefan Grasl,Christoph Arnoldner,Christoph M Grasl,Erich Vyskocil,Boban M Erovic,Lukas D Landegger,Stefan Janik,Patrick Mekhail

doi:10.1007/s00405-021-07080-1

Stefan Grasl, Christoph Arnoldner + Show 6 more

Open Access

https://doi.org/10.1007/s00405-021-07080-1

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Abstract

PurposeAlthough haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff.MethodsThis retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal–Wallis test, Mann–Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences.ResultsA total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1–19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm—6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol.ConclusionThe discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.

Highlights

Tonsillectomy is one of the most frequently performed surgical procedures in otolaryngology
All had severe Post-tonsillectomy haemorrhage (PTH) requiring emergency surgery and revision. 238 (79.3%) patients had undergone the primary intervention at our own department and 62 (20.7%) at another institution
Diurnal/nocturnal onset of PTH in context of postoperative duration We further analysed a potential association between the start time of emergency surgery due to PTH and the extent of postoperative duration after the primary surgery

Summary

Introduction

Tonsillectomy is one of the most frequently performed surgical procedures in otolaryngology. Post-tonsillectomy haemorrhage (PTH) is a serious and potentially lethal complication with an overall reported risk between 2 and 21.4% [1,2,3,4,5]. Among those affected by such an event, up to 5% experience severe PTH with a need for surgical revision under general anaesthesia [1, 4,5,6]. The first study focusing on the influence of the circadian rhythm on PTH was published by D’Agostino et al with the description of 59 bleeding events in children (average age 6.8 years) who had undergone adenotonsillectomy or tonsillectomy [19]. The researchers detected an increased occurrence of PTH between 9 pm and 9 am with two specific peaks, namely from 10 pm to 1 am and from 6 to 9 am

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