High Rates of Post-Tonsillectomy Hemorrhage in Children With von Willebrand Disease

Though tonsillectomies are commonly performed in children, the rate of post-tonsillectomy hemorrhage in those with von Willebrand disease (VWD) is unknown.

To determine the rate of post-tonsillectomy hemorrhage in children with VWD.

We performed a retrospective analysis of individuals 0-18 years with VWD who underwent tonsillectomy and received a hemostatic agent on the day of procedure between October 2015 and September 2023 via the Pediatric Health Information Systems (PHIS) database. The primary outcome was the rate of hemorrhage within 14 days of tonsillectomy. Secondary outcomes included the rate of postoperative emergency department (ED) visits and subsequent surgical procedures for hemorrhage. Data on demographics, setting (inpatient vs. outpatient), and tonsillectomy indication were collected.

A total of 753 individuals with VWD underwent tonsillectomy. Postoperative bleeding occurred in 17.5% (n = 132). A total of 4.5% (n = 34) presented to the ED with hemorrhage following tonsillectomy, with repeat surgery in 5.0% (n = 38). Individuals whose perioperative hemostatic regimen included only an antifibrinolytic had an increased bleeding rate (24.2%; n = 31) compared to desmopressin (14.5%; n = 8) or VWF replacement alone (2.4%; n = 1; p = 0.004). Older age was associated with bleeding (p = 0.006), as those 6-18 years had a bleeding rate of 22% compared to 4.3%-12.8% in the younger age groups.

Our study represents a nine-fold increased rate of post-tonsillectomy hemorrhage in children with VWD compared to the general pediatric population. This suggests the need for aggressive preventive management with normalizing of VWF levels around the time of tonsillectomy and close clinical supervision to prevent hemorrhagic complications.