Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children?

Abstract

Introduction: A significant risk in tonsillectomy that causes concern to surgeon and patient is post-tonsillectomy bleed. Secondary haemorrhage is mainly post-operative bleed presenting at or 24h after surgery. Classical teaching indicates infection as the cause. There are not enough published data to evaluate the post-tonsillectomy bleed rates in patients operated for obstructive sleep apnoea versus recurrent tonsillitis. We suspected secondary bleed rates to be higher in patients with recurrent tonsillitis.

Methods: A retrospective review of case-notes of patients presenting to Accident & Emergency department within 4 weeks of tonsillectomy or adeno-tonsillectomy was performed. 568 patients presented with post-operative complications over the 5-year period 2008-2013. Of these, 222 presented with post-operative secondary bleed. Electronic case records were used to identify indication of operation and matched with coding data. These coded data were also used to identify number of operations and primary indications over the 5-year period.

Results: The proportion of OSA patients receiving tonsillectomy or adenotonsillectomy surgery increased over the 5-year period. Secondary haemorrhage rate for recurrent tonsillitis surgery was around 4.9% and for OSA surgery was around 15.6%. Comparison of recurrent tonsillitis against OSA for post-operative bleed showed a relative risk of 0.31 (CI 0.24-0.41). The incidence of bleeding mirrored primary indication for each year.

Conclusion: The bleed rate for OSA was unexpectedly higher than for recurrent tonsillitis. The primary indication for tonsillectomy affects secondary bleeding rate.

Keywords: Indications for tonsillectomy; Paediatric tonsillectomy; Secondary haemorrhage.