A Scoping Review of Recurrent Post-Tonsillectomy Hemorrhage in Children

Tonsillectomy, with or without adenoidectomy, is the most common major surgical procedure performed in children. The risk and incidence of primary and secondary post-tonsillectomy hemorrhage (PTH) have been well described. The goal of this scoping review is to analyze the incidence and risk factors for recurrent PTH, and to map existing evidence to identify knowledge gaps.

CINAHL, Cochrane Library, Embase, Google Scholar, and Ovid Medline.

The study followed PRISMA-ScR guidelines. Three reviewers independently screened studies, including those reporting the incidence of PTH and recurrent PTH in children.

There were 229 recurrent PTH episodes described in the 11 manuscripts included in this analysis, with 7.1% of initial PTH cases re-bleeding (0.33% of total tonsillectomy cases). Management of recurrent PTH involved surgical intervention and observation. Oropharyngeal findings at the time of the initial PTH and management strategy for the initial PTH were not associated with increased recurrence rates. The indication for tonsillectomy, NSAID usage, and surgical technique were not associated with recurrent PTH when reported. Across studies, there was wide heterogeneity in how recurrent bleeding was defined, and inconsistent reporting of timing and outcomes. The predictive value of laboratory screening for occult coagulopathies in children with multiple bleeds was unclear.

No clear risk factors for recurrent PTH were identified from the pooled analysis. This scoping review highlights major research gaps, including the need for standardized definitions and severity grading, prospective multicenter data to clarify predictors of recurrence, and systematic evaluation of hematologic screening protocols.