Post-tonsillectomy Hemorrhage: A Seven-year Retrospective Study

Document Type : Original

Authors

Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Post-tonsillectomy hemorrhage (PTH) is a serious complication that sometimes requires immediate surgical interventions. The present study aimed to assess the association between patients’ age, the time of onset of PTH, and the need for surgery to control bleeding.
Materials and Methods:
All patients with PTH were retrospectively admitted to two tertiary hospitals in Mashhad, during 2012-2019. Hospital records were investigated to select eligible cases and retrieve their characteristics such as demographics, source and time of bleeding, and type of intervention. Chi-square, independent samples T-test, and binary logistic regression were used as research tools.
Results:
A total of 227 patients with PTH and a mean age of 14.99±10.34 years were studied, of whom 128 (56.4%) were male and 63 (27.8%) required surgery to control PTH. The mean onset of PTH was 8.14±3.47 days after the surgery and in 59 cases (26.5%) was the seventh day. Those patients aged 6 years or older in whom PTH occurred during the first postoperative week were significantly more likely to need surgery to control it (P= 0.034). Adult (OR= 4.032, 95%CI= 1.932-8.414,     p <0.001), bleeding from both tonsils (OR= 2.380, 95%CI= 1.032-5.487, P= 0.042), and receiving blood transfusion (OR= 7.934, 95%CI= 2.003-31.422, P= 0.002) were independent predictors of the need for surgical treatment to control PTH.
Conclusion:
PTH within the first postoperative week in patients older than 6 years, adults, bleeding from both tonsils, and receiving a blood transfusion is recommended to be considered as a potential predictor of the need for surgery.

Keywords


  1. Johnson LB, Elluru RG, Myer CM, 3rd. Complications of adenotonsillectomy. The Laryngoscope. 2002;112(8 Pt 2 Suppl 100):35-6.
  2. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2019;160(1_suppl):S1-s42.
  3. Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1998;118(1):61-8.
  4. Galindo Torres BP, De Miguel García F, Whyte Orozco J. Tonsillectomy in adults: Analysis of indications and complications. Auris, nasus, larynx. 2018;45(3):517-21.
  5. Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: who needs intervention? International journal of pediatric otorhinolaryngology. 2015;79(2):165-9.
  6. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2005;132(2):281-6.
  7. El Rassi E, de Alarcon A, Lam D. Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey. International journal of pediatric otorhinolaryngology. 2017;102:108-13.
  8. Wall JJ, Tay KY. Postoperative Tonsillectomy Hemorrhage. Emergency medicine clinics of North America. 2018;36(2):415-26.
  9. Taziki MH, Hosseini M, Fazli H. Prevalence of Post-Tonsillectomy Hemorrhage in Adults and Children. Journal of Clinical and Basic Research. 2020; 4(2):20-6.
  10. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative bleeding and associated utilization following tonsillectomy in children: a systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery. 2017;156(3):442-55.
  11. Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children? International journal of pediatric otorhinolaryngology. 2015;79(2):246-50.
  12. Attner P, Haraldsson PO, Hemlin C, Hessen Soderman AC. A 4-year consecutive study of post-tonsillectomy haemorrhage. ORL; journal for oto-rhino-laryngology and its related specialties. 2009; 71(5):273-8.
  13. Belyea J, Chang Y, Rigby MH, Corsten G, Hong P. Post-tonsillectomy complications in children less than three years of age: a case-control study. International journal of pediatric otorhinolaryngology. 2014;78(5):871-4.
  14. Evans AS, Khan AM, Young D, Adamson R. Assessment of secondary haemorrhage rates following adult tonsillectomy--a telephone survey and literature review. Clinical otolaryngology and allied sciences. 2003;28(6):489-91.
  15. Liu JH, Anderson KE, Willging JP, Myer CM, 3rd, Shott SR, Bratcher GO, et al. Posttonsillectomy hemorrhage: what is it and what should be recorded? Archives of otolaryngology--head & neck surgery. 2001;127(10):1271-5.
  16. Susaman N, Kaygusuz I, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk Factors For Post-Tonsillectomy Hemorrhage. ENT Updates. 2018;8(2):114-9.
  17. Ulualp SO. Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2012; 269(4):1269-75.
  18. Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N. Risk factors for post-tonsillectomy hemorrhage. Auris, nasus, larynx. 2014;41(4):376-9.
  19. Isaacson G. Tonsillectomy healing. The Annals of otology, rhinology, and laryngology. 2012; 121(10): 645-9.
  20. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. The Laryngoscope. 2011;121(12):2553-60.
  21. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. The Laryngoscope. 2011;121(2):279-88.
  22. Myssiorek D, Alvi A. Post-tonsillectomy hemorrhage: an assessment of risk factors. International journal of pediatric otorhinolaryngology. 1996;37(1):35-43.
  23. Akin RC, Holst R, Schousboe LP. Risk factors for post-tonsillectomy haemorrhage. Acta oto-laryngologica. 2012;132(7):773-7.
  24. Spektor Z, Saint-Victor S, Kay DJ, Mandell DL. Risk factors for pediatric post-tonsillectomy hemorrhage. International journal of pediatric otorhinolaryngology. 2016;84:151-5.
  25. Inuzuka Y, Mizutari K, Kamide D, Sato M, Shiotani A. Risk factors of post-tonsillectomy hemorrhage in adults. Laryngoscope investigative otolaryngology. 2020;5(6):1056-62.
  26. Gross JH, Lindburg M, Kallogjeri D, Molter M, Molter D, Lieu JE. Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study. Annals of Otology, Rhinology & Laryngology. 2020:0003489420978010.