Article
Risk factors for post-tonsillectomy hemorrhage
Risikofaktoren für Blutungen nach Tonsillektomie
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Authors
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Jochen Windfuhr
- Klinik für HNO-Heilkunde, Plastische Chirurgie, Duisburg, Germany
| Published: | September 7, 2006 |
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Outline
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Patients and methods: To evaluate potential risk factors as described in the literature and the incidence of bleeding following tonsillectomy, with or without adenoidectomy requiring surgical treatment under general anesthesia in a retrospective chart review of 16.918 patients who underwent surgery at our institution.
Results: TE, with or without adenoidectomy was performed in 7999 patients to treat recurrent tonsillitis, peritonsillar abscess, selected cases of infectious mononucleosis or tonsillar remnants. 72% of bleeding episodes did occur on the day of surgery. Primary bleeding (<24h) occurred in 180 patients (2,25%) whereas only 56 patients (0,7%) experienced secondary bleeding (>24h). Ligature of the external carotid artery was required in 7 patients with excessive hemorrhage including one case with lethal outcome. Post-tonsillectomy hemorrhage (PTH) appears to be an age related phenomenon. Moreover, patients of male gender were found to be significantly at risk for post-tonsillectomy hemorrhage. In contrast to patients with infectious mononucleosis, immediate abscess-tonsillectomy was not associated with an increased risk of bleeding. The current literature indicates that surgical have an impact on the rate of PTH suggesting to avoid electrosurgical means. Local anesthesia seems to be associated with an increased risk for PTH. Unidentified coagulation disorders are extremely rare and therefore statistical significance is not given. Concerning postoperative morbidity, postoperative infection and administration of non-steroidal antiinflammatory drugs (NSAID) do not contribute to an increased risk for PTH.
Conclusions: Hemorrhage following T and A is rare and predominantly occurs early after surgery. Male patients, age > 70 years, infectious mononucleosis and a history of recurrent tonsillitis were identified as risk factors for post-tonsillectomy hemorrhage. Delayed hemorrhage has the potential to be life-threatening. The current literature indicates that surgical techniques have a significant impact on postoperative morbidity including PTH and further studies are required to find the best surgical method.
Keywords: tonsillectomy; adenoidectomy; postoperative hemorrhage, fatalities, outpatient surgery
