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Updated: May 30, 2025
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Are More Adults Bleeding After Tonsillectomy Than in the Past?
Deepthi Akella1, Chloe Cottone2, Maya Raghavan2,3
1School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, Texas, USA.
Insights
Post-tonsillectomy hemorrhage (PTH) rates increased in adults over 15 years. This rise coincided with significant shifts in post-tonsillectomy pain management, warranting further investigation into the connection.
Area of Science:
- Otolaryngology
- Surgical Outcomes
- Public Health
Background:
- Post-tonsillectomy hemorrhage (PTH) incidence has risen in pediatric populations.
- The trend of PTH in adult populations remains less understood.
Purpose of the Study:
- To investigate the incidence of PTH in adults over a 15-year period.
- To analyze trends in analgesic use following tonsillectomy in adults.
Main Methods:
- Retrospective analysis of the TriNetX database (2008-2022).
- Inclusion of 72,232 adult patients who underwent tonsillectomy.
- Statistical analysis using the Mann-Kendall test for trend detection.
Main Results:
- PTH incidence increased from 4.1% in 2008 to 6.2% in 2022.
- The need for return to the operating room (RTOR) for PTH control rose from 0.7% to 2.4%.
- Significant shifts in analgesic prescribing patterns were observed, with decreased codeine use and increased use of NSAIDs and other opioids.
Conclusions:
- Adult post-tonsillectomy analgesia practices have evolved significantly.
- A concurrent increase in PTH incidence suggests a potential link requiring further research.
Objective:
Post-tonsillectomy hemorrhage (PTH) rates have increased in children over the last decade. This study aimed to determine whether PTH incidence in adults had also increased over the last 15 years.
Study Design:
Retrospective study.
Setting:
TriNetX database.
Methods:
A search was conducted using TriNetX for patients 18 years and older within the US Collaborative Network who had undergone tonsillectomy (CPT codes 42821 or 42826) and yielded 72,232 subjects. PTH diagnoses were identified using ICD-10 codes J95.830 or K91.840, and those who returned to the operating room (RTOR) to control PTH were identified using CPT 42962. PTH events that occurred and analgesics given following 14 days of tonsillectomy were tabulated annually from 2008 to 2022. Mann-Kendall test for monotonic trend examined significant trends in PTH and analgesic use.
Results:
Mean age at tonsillectomy was 32.8 years (SD = 13.8). 4.1% were diagnosed with PTH in 2008, compared with 6.2% by 2022 (p = 0.0030). In 2008, 0.7% required RTOR to control PTH, compared with 2.4% in 2022 (p < 0.0001). Use of codeine decreased from 6.9% in 2008 to 2.5% in 2022 (p = 0.0022). Use of ibuprofen, acetaminophen, ketorolac, and oxycodone increased from 1.6% to 23.4% (p = 0.0005), 36.1% to 78.6% (p < 0.0001), 1.5% to 11.9% (p < 0.0001), and 20.6% to 63.6% (p < 0.0001), respectively. No change was detected in use of hydrocodone.
Conclusion:
Post-tonsillectomy analgesia in adults has changed significantly over the last 15 years. Our study highlights a concurrent increase in PTH which bears more investigation.
Level Of Evidence:
3 Laryngoscope, 135:1958-1963, 2025.
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