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Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children?
P Achar1, R K Sharma1, S De1
1Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.
Insights
Post-tonsillectomy bleeding is a concern. This study found higher secondary hemorrhage rates in obstructive sleep apnea (OSA) patients compared to recurrent tonsillitis patients, challenging previous assumptions.
Area of Science:
- Otolaryngology
- Surgical Complications
- Pediatric Surgery
Background:
- Post-tonsillectomy bleeding, particularly secondary hemorrhage, is a significant surgical risk.
- The causes of secondary hemorrhage are not fully understood, with infection traditionally implicated.
- Limited data exist comparing bleeding rates between obstructive sleep apnea (OSA) and recurrent tonsillitis indications for tonsillectomy.
Purpose of the Study:
- To evaluate and compare secondary post-tonsillectomy hemorrhage rates in patients undergoing surgery for obstructive sleep apnea (OSA) versus recurrent tonsillitis.
- To investigate the influence of the primary indication for tonsillectomy on secondary bleeding rates.
Main Methods:
- Retrospective review of 568 patients presenting with post-operative complications within 4 weeks of tonsillectomy or adenotonsillectomy (2008-2013).
- Analysis of 222 patients who presented with secondary post-operative bleeding.
- Electronic case records were used to determine the primary indication for surgery (OSA vs. recurrent tonsillitis).
Main Results:
- The rate of secondary hemorrhage was approximately 4.9% for recurrent tonsillitis and 15.6% for OSA.
- Patients undergoing tonsillectomy for OSA had a significantly higher risk of secondary bleeding (relative risk 0.31 compared to recurrent tonsillitis).
- The incidence of bleeding correlated with the primary indication for surgery each year.
Conclusions:
- Contrary to expectations, the secondary bleeding rate for obstructive sleep apnea (OSA) was substantially higher than for recurrent tonsillitis.
- The primary indication for tonsillectomy is a critical factor influencing the rate of secondary post-operative bleeding.
Introduction:
A significant risk in tonsillectomy that causes concern to surgeon and patient is post-tonsillectomy bleed. Secondary haemorrhage is mainly post-operative bleed presenting at or 24h after surgery. Classical teaching indicates infection as the cause. There are not enough published data to evaluate the post-tonsillectomy bleed rates in patients operated for obstructive sleep apnoea versus recurrent tonsillitis. We suspected secondary bleed rates to be higher in patients with recurrent tonsillitis.
Methods:
A retrospective review of case-notes of patients presenting to Accident & Emergency department within 4 weeks of tonsillectomy or adeno-tonsillectomy was performed. 568 patients presented with post-operative complications over the 5-year period 2008-2013. Of these, 222 presented with post-operative secondary bleed. Electronic case records were used to identify indication of operation and matched with coding data. These coded data were also used to identify number of operations and primary indications over the 5-year period.
Results:
The proportion of OSA patients receiving tonsillectomy or adenotonsillectomy surgery increased over the 5-year period. Secondary haemorrhage rate for recurrent tonsillitis surgery was around 4.9% and for OSA surgery was around 15.6%. Comparison of recurrent tonsillitis against OSA for post-operative bleed showed a relative risk of 0.31 (CI 0.24-0.41). The incidence of bleeding mirrored primary indication for each year.
Conclusion:
The bleed rate for OSA was unexpectedly higher than for recurrent tonsillitis. The primary indication for tonsillectomy affects secondary bleeding rate.
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