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Recurrent post-tonsillectomy bleeding in pediatric patients

Kathleen R Billings1, Sydney J Sachse2, Saied Ghadersohi1

  • 1Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.

International Journal of Pediatric Otorhinolaryngology
|January 13, 2026
PubMed

Insights

The risk of recurrent post-tonsillectomy hemorrhage (R-PTH) is low at 0.2%, but patients experiencing initial bleeding have a 5.4 times higher risk of R-PTH. No clear risk factors were identified, though R-PTH patients had higher healthcare utilization.

Area of Science:

  • Pediatric Otolaryngology
  • Surgical Complications
  • Health Services Research

Background:

  • Post-tonsillectomy hemorrhage (PTH) is a significant risk following tonsillectomy.
  • Recurrent PTH (R-PTH) represents a subset of these bleeding events with potential implications for patient management and healthcare resource utilization.

Purpose of the Study:

  • To analyze the incidence rate of recurrent post-tonsillectomy hemorrhage (R-PTH).
  • To identify potential risk factors associated with R-PTH.
  • To assess healthcare utilization patterns in patients experiencing R-PTH.

Main Methods:

  • Retrospective cohort study involving patients under 18 years old who underwent tonsillectomy.
  • Comparison of risk factors between patients with R-PTH and those with a single bleeding episode.
  • Analysis of healthcare utilization metrics (primary care, otolaryngology, telemedicine, ED visits) unrelated to PTH.

Main Results:

  • The overall incidence of PTH was 2.0%, with R-PTH occurring in 11.0% of these cases (0.2% overall risk).
  • Patients with R-PTH had a 5.4 times higher relative risk of experiencing recurrent bleeding after an initial PTH.
  • No statistically significant risk factors for R-PTH were identified, although a higher proportion of R-PTH patients had a history of chronic tonsillitis.
  • Patients with R-PTH demonstrated significantly higher healthcare utilization (2.5 vs. 1.8 occurrences, p=0.023).

Conclusions:

  • The incidence of R-PTH is low, but the relative risk for patients with initial PTH is substantially elevated.
  • Current analysis did not identify specific risk factors predicting R-PTH.
  • Patients experiencing R-PTH exhibit increased healthcare utilization, suggesting a need for targeted monitoring or management strategies.
Abstract

Keywords:
Pediatric patientsPost-tonsillectomy hemorrhageRecurrent post-tonsillectomy hemorrhageTonsillectomy

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