Risk factors for postoperative hemorrhage following tonsillectomy

Objectives/hypothesis: To identify the main risk factors associated with postoperative hemorrhage following tonsillectomy.

Study design: Prospective multicenter observational study.

Methods: The Surgical Instrument Surveillance Programme (SISP) was established in 2003 to monitor tonsil and adenoid surgery and the associated complications in all hospitals in Wales. Data were examined between April 1, 2003, and June 30, 2008, by using binary logistic regression, for risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage of a severity sufficient to require a return to the operating theater.

Results: A total of 17,480 procedures were included. Patients aged ≥12 years were 1.5 (1.0-2.1; P < .05) and 3 times (2.2-4.9; P < .0001) more likely to experience R1 and R2 complications, respectively. There were 2.5 times as many females as males aged ≥12 years who underwent tonsillectomy, but males were almost twice as likely to experience R1 (1.4-2.8), P < .0001, or R2 (1.2-2.5), P < .001, postoperative hemorrhage. There was a 1.9-fold increased likelihood of R1 (1.1-3.3), P < .05, with the most junior surgeon, and no relationship with R2. All techniques that used heat had a significantly greater adjusted odds of R2 as compared with cold dissection, with odds ranging from 2.7 (1.5-4.7), P < .001, for dissection plus bipolar diathermy and ties, to 13.0 (5.8-29.1), P < .0001, with coblation when used with other techniques. No additional risk was associated with specified single-use instruments.

Conclusions: Patient age and sex and operative technique were the most significant factors affecting the risk and timing of serious postoperative hemorrhage, with no additional risk associated with the use of specified single-use instruments.