Tonsillectomy: Post-Operative Hemorrhage Reduction Strategy in Jos, North Central Nigeria

Post-tonsillectomy hemorrhage (PTH) is one of the more life-threatening /lethal complications and the leading malpractice claims/convictions in Oto-laryngological practice.

A Study on PTH reduction strategy in Jos, North Central Nigeria.

Prospective Cohort Study.

Participants who met the criteria under GA had dissection Tonsillectomy ± Adenoidectomy between August 1, 2017-July 31, 2019 at the Jos University Teaching Hospital, Nigeria, were enrolled. Data analysis was by SPSS version 21.0 Chicago, IL, USA.

We studied 96 participants with a M:F = 1.7:1. Age range was 9months-51years with a Median = 3.0years. Snoring-83(86.5%), Nasal obstruction - 71(74.0%), Mouth breathing -18(18.8), OSA(S) - 17(17.7%) were main features. Seventy-Eight (81.2%) were Grade III & IV and 71(75.0%) had Adenoid Nasopharyngeal Ratio >0.5. Mean INR was 1.22 ± 0.24 where 28(29.2%) were abnormal. Post-operative blood loss was 10ml - 250ml with Median = 35ml. There was a correlations between the Brodsky's grading with Tonsil volume and between Tonsil grade with volume of blood loss. An estimated 76.0% had the surgery within 60mins. We practice 'awake' extubation. Incidence of Primary PTH of 3.1% with no secondary PTH or mortality.

We established that blood loss was directly proportional to the tonsil size which brings new insights in PTH prevention. Our use of specific agents for GA, technique/ expertise, pillar infiltration with Lignocaine, 'awake extubation, liberal post-operative analgesia with systemic antibiotics may be responsible for the low incidence of PTH in this series.