Risk of post-tonsillectomy hemorrhage by clinical diagnosis

Obstructive sleep apnea (OSA) has been associated with upregulation of prothrombotic factors. We hypothesize that diagnosis of OSA may be protective against postoperative hemorrhage. This study investigates the relationships between preoperative clinical diagnosis and postoperative hemorrhage.

Seven-year retrospective case-control study.

Medical records of tonsillectomy subjects with and without hemorrhage were reviewed for demographics, clinical diagnosis, and treatment. Clinical diagnoses included OSA confirmed by polysomnogram, sleep-disordered breathing (SDB), chronic tonsillitis, and a mixed group.

A total of 9,023 tonsillectomy patients were identified (52.0% male, 48.0% female; mean age, 6.9 years). Of these, 2.4% (n = 212) presented with hemorrhage. There were 48 (22.6%) primary and 164 (77.4%) secondary hemorrhages. The control group consisted of 1,488 nonhemorrhage patients. A multivariate logistic regression analysis compared the two groups controlling for age, sex, and clinical diagnosis. OSA patients were half as likely to hemorrhage compared to chronic tonsillitis patients (P = .04). SDB patients also had a lower chance of hemorrhage compared to chronic tonsillitis patients; this result was not significant (P = .09). Patients older than 6 years had a higher hemorrhage rate (P < .001).

This study demonstrates that patients with OSA may be less likely to have postoperative hemorrhage than patients with chronic tonsillitis. Younger age was associated with fewer hemorrhages.