[Austrian tonsil study part 3: surgical technique and postoperative haemorrhage after tonsillectomy]

Risk factors for postoperative haemorrhage after tonsillectomy are discussed controversy. In the past years surgical techniques were considered a determining factor for post-tonsillectomy bleedings in several studies.

In a prospective, multicentre study 9,405 patients--of whom 4,437 underwent tonsillectomy and were focused in this article--were evaluated during study -period of 9 months (1st October 2009 till 30th June 2010). Postoperative haemorrhage was defined as any bleeding episode after extubation and classified according to a 7 grade scheme.

Postoperative haemorrhage occurred in 14.4% (637/4,437) patients with 4.6% (204/4,437) requiring a return to theatre and 9.8% (433/4,437) experiencing minor bleedings. Bipolar techniques (with or without cold steel dissection) showed a haemorrhage risk of 16.8% (62/370). Severe bleedings occurred significantly more often with the use of bipolar techniques (8% compared to 4.6% severe bleedings for all operation techniques, p=0.003). In addition, Coblation® technique had a higher postoperative haemorrhage rate (23.5%, 12/51). However, minor bleedings occurred in the majority of patients operated with Coblation® technique (20% compared to 9.8% minor bleedings for all operation techniques, p<0.017).

Following the strict definition of postoperative haemorrhage, we found higher postoperative haemorrhage rates for bipolar techniques and Coblation® technique. The proportion of severe bleedings is higher for bipolar methods, whereas the proportion of minor bleedings is higher for Coblation® technique.