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Published on: November 6, 2019
High Bleeding Rates After Tonsil Surgery in Denmark and Opportunities for Quality Improvement
Martin Mølhave1,2,3, Nina M Lyhne3, Susanne H Nielsen4
1Department of Otorhinolaryngology, Head & Neck Surgery, Gødstrup Hospital, University Clinic for Flavour, Balance and Sleep, Herning, Denmark.
Objectives:
To examine postoperative bleeding rates and associated patient and surgical factors after tonsil surgery in Denmark and identify targets for quality improvement.
Design:
Multicentre cohort study using prospectively collected registry data.
Setting:
Five Danish ENT departments contributing to the Danish Tonsil Database, 2018-2024.
Participants:
Children, adolescents and adults undergoing tonsillectomy, adenotonsillectomy, tonsillotomy, adenotonsillotomy or acute tonsillectomy for benign indications.
Main Outcome Measures:
Clinically confirmed postoperative bleeding within 30 days. Modified Poisson regression with robust standard errors estimated adjusted relative risks (RRs).
Results:
Among 6145 procedures, postoperative bleeding occurred after 14% of tonsillectomies, 9.9% of adenotonsillectomies, 10% of acute tonsillectomies, 1.7% of tonsillotomies and 2.6% of adenotonsillotomies. Among bleeding events, 51% required general anaesthesia, 32% local anaesthesia and 17% resolved spontaneously. After tonsillectomy, male sex (adjusted RR 1.69, 95% CI 1.44-2.00) and resident surgery (adjusted RR 1.25, 95% CI 1.04-1.51) were associated with higher risk, while patients aged < 12 years (adjusted RR 0.53, 95% CI 0.37-0.74) and 12-17 years (adjusted RR 0.57, 95% CI 0.43-0.76) had lower risk than adults. Cold dissection with cold haemostasis tonsillectomy had the lowest crude bleeding rate (9.8%), but operative technique was not independently associated with bleeding after adjustment. No deaths occurred.
Conclusions:
Bleeding rates after tonsillectomy were higher than those reported in several international cohorts, while rates after tonsillotomy were low. Cold dissection with cold haemostasis tonsillectomy had the lowest observed rate, although adjusted analyses were not statistically significant. These findings support structured quality-improvement work and continued monitoring.
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