Incidence and predictive factors of bleeding following tonsillectomy among pediatrics: A retrospective cohort study

To estimate the incidence of post tonsillectomy bleeding and to identify its predisposing factors among the pediatric population.

A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia between 2019 and 2020. The study sample was divided into 2 groups based on the development of postoperative bleeding and were compared using Chi-square test and independent t-test. Significant variables (p-value ≤0.05) were included in the logistic regression model to determine the predictors of bleeding following tonsillectomy.

The bleeding rate following tonsillectomy was 3.4% in 43 (95% confidence interval [CI] 2.4-4.5) patients. In the multivariable logistic regression model, the significant predictors of post tonsillectomy bleeding were age ≥12 years (odds ratio [OR]: 2.685, p=0.027), decreased postoperative oral intake (OR: 4.244, p=0.042), and single use of postoperative analgesia (OR: 53.124, p<0.001). Out of the 43 patients, 39 (90.7%) patients experienced secondary bleeding, and more than half of the patients who developed bleeding required surgical intervention 27 (62.8%).

Tonsillectomy is a safe and common surgical procedure but carries risks for postoperative bleeding. Age ≥12 years, poor postoperative oral intake, and the use of a single postoperative analgesic increase the risk of bleeding. We encourage healthcare providers to ascertain early resumption of oral intake and ensure effective pain management. We recommend a dual alternating analgesic regimen with weight-based dosing for optimal pain control. Furthermore, educating caregivers about the importance of adequate oral intake following tonsillectomy may improve patient outcomes.