Evaluation of Factors Associated with Post-Tonsillectomy Bleeding in Adults

Articles in Press

Document Type : Original

Authors

Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.

10.22038/ijorl.2026.93656.4108

Abstract

Introduction
Post-tonsillectomy hemorrhage is one of the most common and potentially life-threatening complications of tonsillectomy in adults and may result in readmission or reoperation. Adults are known to have a higher bleeding risk compared with children due to increased inflammation, comorbid factors, and surgical complexity. Identification of factors associated with postoperative bleeding is essential for optimizing surgical technique, postoperative care, and patient counseling.
Materials and Methods
This retrospective case–control study included adult patients (≥18 years) who underwent bilateral tonsillectomy at two tertiary referral hospitals between March 2021 and March 2023. Patients who developed post-tonsillectomy hemorrhage were compared with a matched control group without bleeding. Demographic characteristics, surgical indications, operative variables, and surgeon-related factors were evaluated. Post-tonsillectomy hemorrhage was defined as any postoperative pharyngeal bleeding confirmed by an otolaryngologist.
Results
Among 350 adult tonsillectomies, post-tonsillectomy hemorrhage occurred in 54 patients (15.4%), predominantly secondary bleeding. In multivariate analysis, halitosis (p<0.001), chronic recurrent tonsillitis (p=0.001), sleep disturbances (p=0.001), use of sutures during the primary procedure (p=0.002), and surgeon experience (p=0.013) were independently associated with post-tonsillectomy hemorrhage. Tonsillolith showed a borderline association (p=0.054), while body mass index was not significant (p=0.748). No significant differences were observed in age, sex, smoking status, tonsillar hypertrophy grade, or operative duration (p>0.05). Most bleeding episodes occurred spontaneously (59.3%), and bleeding resolved without surgical intervention in 66.7% of cases.
Conclusion
Several patient- and surgery-related factors were associated with post-tonsillectomy hemorrhage in adults. Recognition of these associations may aid in perioperative risk assessment and postoperative management.

Keywords

Main Subjects

References

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Iranian Journal of Otorhinolaryngology

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Available Online from 26 May 2026

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