Standardization of reporting post-tonsillectomy bleeding

Abstract

Objectives: Postoperative bleeding is a well-recognized complication after tonsillectomy. We believe significant variation exists in how bleeding following tonsillectomy is reported and that a standardized system is needed. Our goal was to develop such a system.

Methods: Relevant literature was found on Ovid Medline. Studies published from 1996 to 2009 involving post-tonsillectomy bleeding were analyzed, and data were collected on the basis of strict criteria. A standardized system for reporting post-tonsillectomy bleeding was then developed.

Results: A review of the literature found variation in the reporting of post-tonsillectomy bleeding and found that categorization systems for reporting bleeding are often not used. The following standardization system is proposed. Type I is bleeding, historical or observed, that does not require any intervention or control of the bleeding (except for oral rinses or intravenous administration of fluids). Type II is bleeding that requires control with local measures under topical or local anesthesia. Type III is bleeding that requires control with local measures, suture ligation, and/or aggressive cauterization in the operating room. Type IV is bleeding that requires control that includes external carotid artery ligation or embolization. Type V is bleeding that leads to the patient's death. The postoperative day on which the bleeding occurs is also reported.

Conclusions: The literature on tonsillectomy varies greatly in describing and reporting post-tonsillectomy bleeding. We propose a system to standardize the reporting of post-tonsillectomy bleeding.