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A Scoping Review of Recurrent Post-Tonsillectomy Hemorrhage in Children
Kathleen R Billings1,2, Saied Ghadersohi1,2, Andrea J Fawcett3
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Recurrent post-tonsillectomy hemorrhage (PTH) in children lacks identified risk factors. Further research is needed for standardized definitions and predictive screening protocols for this common surgical complication.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Hemorrhagic Disorders
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Post-tonsillectomy hemorrhage (PTH) is a known complication.
- Recurrent PTH incidence and risk factors require further investigation.
Purpose of the Study:
- To analyze the incidence and risk factors for recurrent post-tonsillectomy hemorrhage (PTH) in children.
- To map existing evidence and identify knowledge gaps regarding recurrent PTH.
Main Methods:
- A scoping review following PRISMA-ScR guidelines.
- Included studies reporting incidence of primary and recurrent PTH in pediatric tonsillectomy cases.
- Data synthesized from 11 manuscripts detailing 229 recurrent PTH episodes.
Main Results:
- Recurrent PTH occurred in 7.1% of initial PTH cases (0.33% of all tonsillectomies).
- No clear associations found between oropharyngeal findings, initial management, tonsillectomy indication, NSAID use, or surgical technique and recurrent PTH.
- Significant heterogeneity in recurrent bleeding definitions and outcome reporting was noted.
Conclusions:
- No definitive risk factors for recurrent post-tonsillectomy hemorrhage were identified.
- Major research gaps include the need for standardized definitions, severity grading, and prospective multicenter data.
- Systematic evaluation of hematologic screening protocols for recurrent bleeding is warranted.
Objective:
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.
Data Sources:
CINAHL, Cochrane Library, Embase, Google Scholar, and Ovid Medline.
Review Methods:
The study followed PRISMA-ScR guidelines. Three reviewers independently screened studies, including those reporting the incidence of PTH and recurrent PTH in children.
Results:
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.
Conclusions:
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.
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