Large Study IDs Risk Factors for Hemorrhage After Tonsillectomy

What are the main risk factors associated with postoperative hemorrhage following tonsillectomy?

Background: The most serious risk associated with tonsillectomy is postoperative hemorrhage, with previous reports linking it to operative technique. Many past studies, however, have been small or not well designed.

Study design: Prospective multicenter observational study.

Setting: Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff; Communicable Disease Surveillance Centre, National Public Health Services for Wales, Temple of Peace and Health, Cardiff, United Kingdom.

Synopsis: Utilizing data from 17,480 tonsillectomy and adenotonsillectomy procedures conducted in all hospitals in Wales between April 1, 2003 and June 30, 2008, the authors used binary logistic regression to determine risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage of a severity sufficient to require a return to the operating room. They found that patients aged ≥12 years were 1.5 and three times more likely to experience R1 and R2 complications, respectively. There were 2.5 times as many females as males aged ≥12 who underwent tonsillectomy, but males were almost twice as likely to experience R1 or R2 postoperative hemorrhage. There was a 1.9-fold likelihood of R1 with the most junior surgeon and no relationship of R2. All techniques that used heat had a significantly greater adjusted odds of R2 as compared with cold dissection, with odds ranging from 2.7 for dissection plus bipolar diathermy and ties to 13.0 with coblation when used with other techniques. No additional risk was associated with specified single-use instruments.

Bottom line: The age and sex of the patient and the operative technique determine the risk and timing of serious postoperative hemorrhage, with the grade of the surgeon contributing to the risk of complications occurring on the day of surgery. The use of heat has a strong association with the occurrence of secondary hemorrhage, and single-use instruments were as safe as reusable instruments.

Citation: Tomkinson A, Harrison W, Owens D, et al. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope. 2011;121(2):279-288.

—Reviewed by Sue Pondrom