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Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children
Phylannie K F Cheung1, Joanna Walton1, Megan L Hobson1
1Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, New South Wales, Australia.
Insights
Recurrent post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) is uncommon in children and difficult to predict. Both surgical and conservative management are reasonable for initial bleeding episodes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Hemorrhage Management
Background:
- Post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) is a common complication.
- Understanding risk factors for recurrent and delayed bleeding is crucial for pediatric care.
Purpose of the Study:
- To review experience with PTAH at a tertiary pediatric hospital.
- To evaluate management and risk factors for recurrent and delayed PTAH.
Main Methods:
- Retrospective chart review of pediatric patients with PTAH (July 2014 - June 2019).
- Subanalysis of patients with recurrent hemorrhage or bleeding after day 14.
Main Results:
- 11% of patients had recurrent hemorrhage; 4% had delayed bleeding (>14 days).
- 30% required surgical intervention; 3% received blood transfusions.
- No association found between coagulation profile, surgical indication, and delayed bleeding risk.
Conclusions:
- Recurrent or delayed PTAH is infrequent and unpredictable.
- Initial management (conservative or surgical) appears reasonable for PTAH.
- Preoperative counseling is vital for managing patient and family expectations regarding PTAH.
Objective:
To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14.
Methods:
A retrospective chart review was performed for all pediatric patients admitted to The Children's Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis.
Results:
Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage.
Conclusions:
Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.
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