Post-tonsillectomy Bleeding Rate Research Articles

Blood, Sweat, and Tonsils: Bleeding After Abscess Tonsillectomy for Quinsy-A Meta-Analysis.

Abscess tonsillectomy is performed during an active episode of quinsy. Apprehensions regarding an elevated bleeding risk have hindered its widespread acceptance. This study aims to assess the prevalence of post-tonsillectomy bleeding (PTB) associated with abscess tonsillectomy. A search was performed on August 27, 2023 in Medline, Embase, PubMed, Cochrane CENTRAL, and Web of Science databases. The systematic review was conducted in adherence to the PRISMA guidelines. Pooled PTB rate was determined using a meta-analysis of proportions. The JBI tool was used to assess the quality of the included studies. Of the 525 search records, 18 studies met the eligibility criteria for final analysis. These comprised of retrospective single-center analyses. The pooled prevalence of PTB was 6.65% (95% C.I. 4.01-9.81), and the return-to-theatre rate was 2.35% (95% C.I. 1.48-3.37). There was no difference in PTB rate between unilateral and bilateral tonsillectomy. However, the bipolar technique was associated with a higher PTB rate compared to cold steel dissection. The overall quality of the body of evidence was moderate. Our study highlights the complications associated with abscess tonsillectomy. These findings contribute valuable insights into this potential treatment option for quinsy. N/A Laryngoscope, 2024.

The relationship between posttonsillectomy bleeding to hemogram and coagulation parameters.

Tonsillectomy is a common surgery performed for indications such as chronic tonsilitis, tonsil hypertrophy and obsructive sleep apnea. Although posttonsillectomy bleeding (PTB) is rare and can be controlled with simple interventions in many patients, it is one of the most feared complications of tonsillectomy surgery. In our study, we investigated the effects of changes in hemogram and coagulation values and seasonal effects on PTB. Pediatric and adult patients who underwent tonsillectomy with cold knife method between August 2020 and August 2023 in our clinic were retrospectively reviewed. Demographic data, hemogram and coagulation values of the patients in the control and study groups were recorded and the differences between the two groups in terms of these parameters were evaluated. Our study included 991 patients aged 1-51years. The rate of PTB was calculated as 2.82%. No patient with primary PTB was found. The duration of bleeding development was 7.03days. Age, WBC and neutrophil values were statistically significantly higher in the study group. There were no significant differences between two groups in terms of gender, season and other hemogram and coagulation parameters. Age, high WBC and neutrophil levels were determined as possible risk factors for PTB. Seasonal and gender distribution, aPTT and INR values were similar in the two groups. In order to prevent and predict bleeding, detailed infection investigation should be performed and the risk of bleeding should be considered to increase with increasing age.

A comparative study of BiZact™ tonsillectomy versus cold steel dissection technique in adults: Analysis of operating time, intraoperative blood loss, postoperative bleeding rate and pain.

To analyse operating time, intraoperative blood loss, postoperative bleeding rate and pain when using the relatively new BiZact™ tonsillectomy device compared to the commonly used cold steel dissection technique with bipolar cautery in adults. Retrospective case control study. Parameters analysed for significant association with technique were operating time, intraoperative blood loss, wound pain on postoperative days 1-4 and rate of post-tonsillectomy bleeding (PTB). Monocentric study at a department of otolaryngology and head and neck surgery at a tertiary centre in Germany. A total of 183 patients who underwent a bilateral tonsillectomy with either the BiZact™ tonsillectomy device or the cold dissection technique with bipolar cautery for haemostasis. Operating time, intraoperative blood loss, postoperative pain on the first to fourth postoperative day (numeric rating scale: 0-10) (PTB, primary bleeding ≤24 h, secondary bleeding >24 h postoperative; Stammberger scale). The BiZact™ tonsillectomy device leads to a significant shorter operating time with less intraoperative blood loss compared to cold steel dissection with bipolar haemostasis. No benefits with regards to PTB or postoperative pain could be observed. The use of the BiZact™ device provides major benefits in clinical routine and stands up to conventional tonsillectomy techniques.

Post-tonsillectomy bleeding rate decreases with limitation in maximum post-operative ibuprofen dosage: A quality improvement study

ObjectiveThe objective of this study is to investigate the effect of a reduction in the prescribed post-operative ibuprofen dosage on frequency of post-tonsillectomy bleeding. MethodsA quality improvement study was conducted at a single tertiary care pediatric hospital with patients weighing >40 kg undergoing tonsillectomy. The intervention was limiting the post-operative ibuprofen dosage to a maximum of 400 mg per dose. Data was collected on all patients returning to the hospital with bleeding after tonsillectomy. The primary outcome was the rate of post-tonsillectomy bleeding. Statistical analysis was conducted using nonparametric comparisons and a run chart. ResultsA total of 199 tonsillectomy patients >40 kg were included in the study. There were 119 (59.8 %) females and 80 (40.2 %) males total. The pre-intervention group had a total of 56 patients while the post-intervention group had a total of 143 patients. There was no statistical difference in age, weight, or sex between the pre- and post-intervention groups (p > .05). The post-tonsillectomy hemorrhage rate was 11/56 (19.6 %) before the intervention, and 11/143 (7.7 %) after the intervention (p = .016). Children who experienced a bleeding event were significantly older (mean 15.9 years, 95 % CI 14.5–17.3) than those who did not (13.5 years, 95 % CI 12.9–14.1; p = .011). The run chart revealed that the intervention resulted in a nonrandom decrease in rate of post-tonsillectomy bleeding. ConclusionsPost-tonsillectomy bleeding rate decreased with a ceiling post-operative ibuprofen dose of 400 mg/dose in this quality improvement study. Further research is warranted.

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored. To use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event. This retrospective cohort study used data from the Pediatric Health Information System for all pediatric (<18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children's hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023. Revisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy. Of the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%. This retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

Tonsillectomy in regional Australia: management and outcomes

: Post-tonsillectomy bleeding (PTB) is a potentially life-threatening complication of patients undergoing tonsillectomy. Rates of haemorrhage vary between studies and to date there are no studies investigating outcomes in a contemporary regional Australian setting. This study aims to determine the rate of PTB and to identify risk factors associated with PTB in a large regional centre in New South Wales, Australia. A retrospective review was conducted of all patients who underwent tonsillectomy performed at Wagga Wagga Base Hospital (WWBH) from January 2014 until June 2018. The demographics, type of operation, indication, primary operator and postoperative medications, were collected for all cases. In PTB cases we identified rates of primary and secondary bleeding, transfer time and method, subsequent management and geographical distance from WWBH. Multivariate logistic regression of the data was performed to identify risk factors. A total of 1,209 patients underwent tonsillectomy over the study period. Forty-five patients (4.0%) represented with PTB. The rate of primary and secondary bleeding was 1.0% (n=9) and 3.0% (n=36) respectively. A total of 3 patients (0.2%) required a return to the operating theatre and two patients required blood transfusion. Rates of PTB were not affected by sex, primary operator, operative technique, post-operative antibiotic, opiates or steroids. Multivariable analysis revealed increased risk of PTB with increasing age (OR =1.03; 95% CI: 1.01–1.06), larger tonsil size (OR =5.87; 95% CI: 1.31–26.3) and use of perioperative tranexamic acid (TXA) (OR =7.15; 95% CI: 2.36–21.6). The median time to transfer of patients presenting outside of Wagga Wagga was 4.1 hours. There was no increased risk of haemorrhage or complications when patients lived ≥100 km from WWBH. This study provides data on contemporary regional Australian practice and provides preliminary data on the safety of regional and remote management of post tonsillectomy bleeding in geographically spare health areas.

Comparison of celecoxib and acetaminophen for pain relief in pediatric day case tonsillectomy: A randomized double-blind study.

ObjectivePost‐tonsillectomy pain is a common morbidity in children. The aim of this study was to compare the efficacy of celecoxib with acetaminophen on pain relief in pediatric day‐case tonsillectomy.MethodsWe compared the analgesic effect of celecoxib (99 patients) with acetaminophen (100 patients) for the management of post‐tonsillectomy pain. Post‐tonsillectomy pain score was evaluated three times a day for 7 days. In addition, the incidence of post‐tonsillectomy bleeding and the rate of patients who returned to regular diet were evaluated.ResultsIn the first day, we observed lower mean pain score in the celecoxib group, than the acetaminophen group (P =  0.013). The overall pain score in other days was not significantly different between the two groups. In the celecoxib group, more patients resumed regular amount of oral intake within the first 3 days. Also, the rate of post‐tonsillectomy bleeding in the two groups was not statistically different.ConclusionWe recommend celecoxib as a more suitable choice than acetaminophen for post‐tonsillectomy pain management in the first day and resuming regular diet within 3 days.Level of Evidence: 1b.

Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis.

Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia. This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors. A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate (P = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; P = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; P = .006). This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.

Comparison of three tonsillectomy techniques in children.

Tonsillectomy is still one of the most common surgical procedures worldwide performed by otorhinolaryngologists. This single-blind randomized study aimed to compare cold dissection tonsillectomy, coblation tonsillectomy, and harmonic scalpel tonsillectomy in pediatric patients in respect of intraoperative blood loss, operating time, and postoperative pain and bleeding. This single-blind randomized clinical trial evaluated 82 pediatric patients aged 3-16years (mean age: 7.23 ± 3.26years) applied with tonsillectomy between April 2017 and March 2020. Harmonic scalpel tonsillectomy was applied to 33 (40.2%) patients, the cold knife technique to 25 (30.5%), and coblation tonsillectomy to 24 (29.3%). There was no statistically significant difference between the three techniques in respect of postoperative pain levels and post-tonsillectomy bleeding rates. The intraoperative bleeding rate and mean operating time were determined to be significantly lower in the harmonic scalpel group (p < 0.05). Harmonic scalpel tonsillectomy is associated with a shorter operating time and lower intraoperative bleeding rates and similar postoperative pain score and postoperative bleeding rates compared with coblation tonsillectomy and cold dissection tonsillectomy. Harmonic scalpel tonsillectomy is a fast, safe, and effective method for tonsillectomy in children.

Post-Tonsillectomy Bleeding: Ibuprofen Versus Acetaminophen

Source: Diercks GR, Comins J, Bennett K, et al. Comparison of ibuprofen vs acetaminophen and severe bleeding risk after pediatric tonsillectomy: a noninferiority randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2019; 145(6): 494– 500; doi: 10.1001/jamaoto.2019.0269Investigators conducted a multicenter, randomized, double-blind, noninferiority trial to compare the effect of ibuprofen to that of acetaminophen on post-tonsillectomy bleeding (PTB) in children. Children aged 2–18 years who presented to 1 of 4 study institutions for extracapsular tonsillectomy for sleep-disordered breathing or obstructive sleep apnea, adenotonsillar hypertrophy, or infectious tonsillitis were eligible. Children with known personal or family history of a bleeding disorder were excluded.Participants were randomized to receive either 15 mg/kg of acetaminophen every 6 hours or 10 mg/kg of ibuprofen every 6 hours for the first 9 postoperative days for analgesia. Participants, parents, and clinicians were all blinded to treatment, with acetaminophen and ibuprofen prepared in identical packaging, of equal volume, and as grape flavored. Participants completed daily postoperative study medication dosage questionnaires to track their compliance, as well as a questionnaire about PTB in the 14 days after their tonsillectomy, which was supplemented by medical record review. PTB was categorized by severity: type 1 was bleeding observed at home or evaluated in the ED, type 2 was bleeding requiring readmission for observation, and type 3 was bleeding requiring return to the operating room for control of hemorrhage.The primary outcome was type 3 PTB. The investigators conducted an intention-to-treat analysis to assess whether the rate of type 3 PTB differed between the 2 treatment groups. The noninferiority margin was set at 3%, which required that the ibuprofen group have no more than a 3% absolute increase over the acetaminophen group in the rate of type 3 PTB (and the upper limit of the 97.5% CI) to be considered noninferior to acetaminophen.There were 688 participants included in analyses: 345 in the ibuprofen group and 343 in the acetaminophen group. Overall, 44% of participants had missing postoperative dosage data on their daily questionnaires. In the ibuprofen group, 38 participants had PTB, including 10 (26.3%) with type 3. In the acetaminophen group, 27 participants had PTB, including 4 (14.8%) with type 3. Overall, the type 3 PTB rate was 1.2% in the acetaminophen group and 2.9% in the ibuprofen group (difference, 1.7%; 97.5% CI upper limit, 3.8%).The investigators conclude that ibuprofen did not meet the criteria for noninferiority with acetaminophen and, therefore, may increase the risk of severe bleeding after tonsillectomy.Dr Chung has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Tonsillectomy is a common surgical procedure performed in children. The results of the current study are a reminder that ibuprofen and other NSAIDs interfere with platelet aggregation and may pose a risk for postoperative bleeding. Although the risk of PTB is low, with a mean rate of 4.5%, severe bleeding occurs in some children.1 Whether ibuprofen poses an increased risk for PTB has been studied previously. The most recent Cochrane review on this subject concluded that there was insufficient evidence to exclude an increased risk of PTB.2 Stokes et al3 demonstrated a significantly increased OR of 1.38 for PTB associated with ibuprofen use when compared to other analgesics and placebos.In 2017, the US Food and Drug Administration deemed codeine to be contraindicated as an analgesic and antitussive agent in all children <12 years after earlier reports of an increased risk of life-threatening events and death associated with use of codeine after tonsillectomy in patients who were ultra-rapid metabolizers.4 Today, ibuprofen is widely available over-the-counter, and clinicians and parents alike commonly use this agent. The investigators in the current study compared ibuprofen 10 mg/kg per dose with acetaminophen 15 mg/kg per dose every 6 hours and allowed for supplemental use of oxycodone. However, they provide information neither about pain control nor use of oxycodone among the comparison groups, nor do they provide information about post-tonsillectomy nausea and vomiting, symptoms found less commonly with use of ibuprofen than with use of other analgesics or placebo.5 Such information would have been useful for readers interested in weighing the risk-benefit ratio of using ibuprofen over acetaminophen. This study, nonetheless, is a well-designed, randomized, double-blind trial across multiple centers. The investigators conclude that use of ibuprofen when compared to acetaminophen may increase the risk of severe bleeding.Use caution when determining which analgesic to use after tonsillectomy because there may be an increased risk of severe bleeding in children receiving ibuprofen when compared to that in those receiving acetaminophen.

Does Surgical Technique Significantly Change the Rate of Post-Tonsillectomy Hemorrhage?

Aim: Tonsillectomy is one of the most common surgical procedures in the pediatric population, as well as one of the first operations learned during otolaryngology residency. This study aims to evaluate the effect of surgical technique on the occurrence of post-tonsillectomy hemorrhage.Material and Methods: This prospectively-designed clinical trial was conducted in a tertiary referral center between May 2012 and April 2015. A total of 608 patients had tonsillectomies performed by a single surgeon with three different surgical techniques used during the study period. Patients in group one were operated on using cold dissection; group two comprised patients who underwent bipolar cautery; group three had the posterior pillar mucosal suturing technique performed.Results: 608 patients met inclusion criteria; 165 of them in group one, 274 in group two, and 169 in group three. The median age was 5 (2-14) years old. A total of five patients (0.82%) experienced post-operative bleeding. One of these patients (from group one) experienced primary hemorrhage. The four others were considered secondary hemorrhage; two from each the bipolar cautery and posterior pillar mucosal suturing groups. The rates of post-operative hemorrhage in each group were 0.61%, 0.73% and 1.18%, respectively (p=0.861). Only one of the five patients necessitated a return to the operating room to control the bleeding.Conclusion: Our study findings suggest that the choice of surgical technique does not affect the post-tonsillectomy bleeding rate. There were no significant differences in bleeding rates between subgroups.

Rate of post-tonsillectomy haemorrhage in different tonsillectomy techniques: Retrospective study, Dubai hospital experience in 16-Month period

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed. Haemorrhage has been divided into two broad categories; primary, occurring 24 h post-operation although commonly 5–10 days after the operation. Objectives: This study was conducted to determine the rate of post-tonsillectomy bleeding in our hospital, to review the rate of bleeding between different methods of tonsillectomy and to encourage surgeons with high bleeding rate to change to different techniques. Methods: It was a retrospective study conducted at the Department of Otolaryngology (ENT), Dubai Hospital, Dubai, United Arab of Emirates. It was conducted from 1st June 2014 to 30th September 2015. Study population were 554 patients who underwent tonsillectomy or adenotonsillectomy during this period. The patients were grouped into four groups according to the tonsillectomy technique. Results: Twenty-two patient presented with bleeding (3.97%). Out of these, one was primary post-tonsillectomy bleeding and 21 were secondary post-tonsillectomy bleeding. The highest rate of secondary post-tonsillectomy bleeding was in bipolar tonsillectomy group (8.98%), while the lowest rate was in radiofrequency group. The primary bleeding was encountered in one patient in cold dissection group while no primary bleeding was encountered in other groups. 40.9% of cases were managed surgically, while 59.1% were managed medically. Conclusion: Post-tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Radiofrequency tonsillectomy has the lowest bleeding rate. Our hospital rate of bleeding stand in the international range and we are going to be better regarding secondary bleeding, but we are one of the best regarding primary.

Reduced post-tonsillectomy bleeding rates through a refined technique

Reduced post-tonsillectomy bleeding rates through a refined technique

Comparison between Post-tonsillectomy Bleeding of Three Different Techniques in Children

Introduction: Post-tonsillectomy bleeding remains the most serious complication of tonsillectomy. The rate of post tonsillectomy bleeding varies with different technique. The common used techniques are the bipolar, monopolar and cold. Methods: This was a retrospective case series study based on chart review of children under 14 years who underwent tonsillectomy during the period between January 2010 to December 2011 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia – ENT department. The charts of all the patients were reviewed by the student and the data form filled for included patients for the age, gender, indications for tonsillectomy, previous surgery, medications, admission type, technique used which are the bipolar, monopolar and cold technique and complications. Results: Out of 60 patients reviewed, post tonsillectomy bleeding was reported in 16 (27%). Indications for tonsillectomy were six indications and most common one was recurrent adenotonsillitis in 27 (46%). Intraoprative bleeding was 8 cases (13%) which was the most common type of bleeding and there was no significant difference in post tonsillectomy bleeding between the three techniques (p=0.62). Conclusion: The result showed that there was no significant difference in post tonsillectomy bleeding between the three techniques.

Healthcare disparities in revisits for complications after adult tonsillectomy

ObjectiveDetermine if disparities exist for revisit complications after adult tonsillectomy. MethodsCases of adult tonsillectomy were extracted from the state ambulatory surgery databases and linked to the state emergency department databases and inpatient databases for California, Iowa, Florida and New York for 2010 and 2011. Revisits within 14days for diagnoses of: post-tonsillectomy bleeding, acute pain and nausea/vomiting/dehydration were determined and analyzed for associations of these complications with age, sex, race, median household income and comorbidity score. ResultsAmong 17,836 tonsillectomies (63.7% female; mean age, 29.0years), revisit rates for post-tonsillectomy bleeding, acute pain and fever/dehydration were 5.1, 2.8 and 1.5%, respectively. On multivariate analysis, only female sex was associated with a lower post-tonsillectomy bleeding rate (odds, 0.48, p<0.001). Decreasing household income, female sex, black and Hispanic race were associated with increased revisits for acute pain (odds, 1.21, 1.49, 2.03 and 1.32, p≤0.002). Female sex was associated with an increased odds of a revisit for FNVD (odds, 1.94, p<0.001). ConclusionsSignificant disparities with respect to income and race exist in the incidence of revisits and potentially avoidable complications after adult tonsillectomy.

Coblation adenotonsillectomy in children.

To determine re-admission rate for post-tonsillectomy pain; the primary and secondary post-tonsillectomy bleeding rate; the percentage requiring control of post-tonsillectomy bleeding in children undergoing coblation tonsillectomy. A descriptive study. Royal Hospital for Sick Children (Yorkhill Hospital) between 2004 and 2006. All patients who underwent tonsillectomy with or without adenoidectomy by coblation technique. Patients were identified from operation theatre log book and electronic data base of theatre activity. The hospital case notes were reviewed retrospectively to collect data, regarding demographics, indication and type of surgery, grade of operating surgeon, duration of hospital stay, re-attendance and re-admission, and management of complications. A total of 106 children; males (n = 53, 50%), females (n = 53, 50%) with a mean age 6.3 years underwent surgery using coblation technique. Thirty-one percent had a tonsillectomy while 69% underwent an adenotonsillectomy. Of these, 48% had history of recurrent tonsillitis, 43% had obstructive sleep apnoea and 9% suffered predominantly from obstructive symptoms. Eighty-two percent of patients were discharged on the first postoperative day. Only one patient had primary bleeding requiring re-operation. After discharge, 7 patients (6.7%) were re-admitted with secondary bleeding, 3 (2.8%) of whom were taken back to theatre to control the bleeding under general anaesthesia. Coblation tonsillectomy is a useful technique in having a low primary and secondary bleeding rates in children undergoing tonsillectomy and adenotonsillectomy.

Difference of delayed post-tonsillectomy bleeding between children and adults

Objective To analyze the characteristics of post-tonsillectomy bleeding and its management comparing with adults. Methods A retrospective chart review of 1489 patients who underwent tonsillectomy in our institution (June 2003–June 2006). Results Post-tonsillectomy bleeding rate was 3.1%, 2.5% and 10.8% in younger children (age ≤ 11 years), older children (12 ≤ age ≤ 15 years) and adults (age > 15 years), respectively. Although adults showed an unimodal peak time for onset of post-tonsillectomy bleeding, children showed a bimodal peak time. In the younger child group, all of the 28 bleeders had spontaneous hemostasis. However, in the older child group, there was no spontaneous hemostasis. Bleeding was controlled under local anesthesia in 3 patients and 2 patients required general anesthesia for bleeding control. In the adult group, spontaneous cessation of bleeding occurred in 25 patients (60.9%) and hemostasis under local or general anesthesia was performed in 16 (39.1%) patients. Conclusions Post-tonsillectomy bleeding occurred more frequently in adults than in children. Spontaneous hemostasis was more prevalent in children than in adults. Post-tonsillectomy bleeding in the younger child group was controlled with close observation alone.

Post-tonsillectomy bleeding: How much is too much?

Complication rates become important in discussions for informed surgical consent and for quality assurance purposes. In an attempt to quantify literature-based rates for post-tonsillectomy bleeding, a MEDLINE search was carried out. Of 4,610 papers 63 reported post-tonsillectomy bleeding rates. The weighted mean, standard deviation and 95% confidence intervals were calculated for those papers. The mean (4.5%) plus 2 standard deviations (9.4%) suggests a maximum "expected" sustained bleeding rate of 13.9%. In the literature, which should reflect optimum results, there were 3 reports of bleed rates in the 18-20% range. These data may be useful for quality assurance committees and individual clinicians.

Post-tonsillectomy bleeding: a regional hospital experience

Post-tonsillectomy bleeding (PTB) is still one of the most common complications of tonsillectomy. The rate of PTB varies with different methods. We retrospectively reviewed all charts of patients who underwent tonsillectomy in a regional hospital. Post-tonsillectomy bleeding occurred in 33 patients (6.68%); 3 experienced primary haemorrhage and 30 had secondary haemorrhage. The rate of PTB was higher in males and in the over 15-year group (9.41%). The commonest surgical techniques used were cold steel dissection with bipolar diathermy for haemostasis (55.87%). The lowest PTB was observed with 'cold steel and ties technique' (3.14%). Operations which used bipolar diathermy throughout had the highest level of haemorrhage (8.47%). In conclusion, the overall risk of bleeding is related to surgical technique. A 'hot' technique had a higher risk of bleeding than 'cold' technique.

Post-tonsillectomy Bleeding as a Stochastic Process

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.