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What lessons can be learned from the Austrian events?
Stephanie Sarny1, Walter Habermann, Guenther Ossimitz
1Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University Graz, Graz, Austria. stephanie@sarny.at
Insights
Post-tonsillectomy bleeding is a significant risk, especially in younger children. Overnight observation is recommended after any bleeding episode due to increased risk of severe recurrence.
Area of Science:
- Otorhinolaryngology
- Pediatric Surgery
- Public Health
Background:
- A 2007 consensus paper addressed life-threatening post-tonsillectomy hemorrhage risks in children.
- This led to a nationwide multicenter study assessing tonsil and adenoid surgeries.
Purpose of the Study:
- Evaluate the incidence and severity of postoperative hemorrhage after tonsillectomy, tonsillotomy, and adenoidectomy.
- Analyze risk factors and outcomes, including the need for surgical revision.
Main Methods:
- A 9-month prospective study assessed consecutive tonsillectomies, tonsillotomies, and adenoidectomies in Austrian public hospitals.
- Data collected via online questionnaire included patient demographics, surgical details, and postoperative bleeding events graded by severity.
Main Results:
- The study included 6,765 patients (tonsillectomy 31%, tonsillotomy 19%, adenoidectomy 50%).
- Postoperative hemorrhage occurred in 15% after tonsillectomy and 2.3% after tonsillotomy, increasing with age.
- Surgical revision was needed in 4.2% of tonsillectomy patients and 0.9% of tonsillotomy patients.
Conclusions:
- Tonsillotomy has increased in younger children following 2007 guidelines.
- Overnight hospital admission is advised for all postoperative hemorrhage cases due to a doubled risk of severe re-bleeding after a minor event.
Introduction:
The death of 5 children in Austria below the age of 6 years due to posttonsillectomy haemorrhage in 2006 and 2007 led to an intensive discussion on the potential life-threatening risks of tonsil surgery. On this occasion, a consensus paper with clear recommendations for tonsil surgery was released by the Austrian Societies of Otorhinolaryngology, Head and Neck Surgery and Paediatrics followed by a nationwide multicentre study.
Methods:
All consecutive tonsillectomies, tonsillotomies and adenoidectomies performed in public hospitals in Austria within 9 months were assessed. Data on all participating patients were collected via an online questionnaire requesting patient characteristics, surgery details and postoperative haemorrhage. A strict definition for postoperative bleeding episodes with 7 severity grades was applied. Every bleeding episode after extubation was counted as postoperative bleeding event.
Results:
The study population - all younger than 18 years of age - consisted of 6,765 patients (tonsillectomy 2,080, 31%; tonsillotomy 1,292, 19%; adenoidectomy 3,393, 50%). Postoperative haemorrhage episodes were reported in 15% after tonsillectomy and in 2.3% after tonsillotomy, with the risk increasing parallel to age. Multiple bleeding episodes were recorded in one fourth of all tonsillectomy bleedings, but were rare after tonsillotomy. Surgical revision under general anaesthesia was necessary in 4.2% after tonsillectomy and in 0.9% after tonsillotomy.
Discussion:
As the incidence of tonsillectomy in children younger than 6 years has declined following the recommendations of the consensus paper issued in 2007, tonsillotomy has become more frequent in this age group. Overnight hospital admission and observation is suggested for all patients experiencing postoperative haemorrhage, as the occurrence of one minor bleeding doubled the risk of a second severe bleeding.
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