A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital

Abstract

Introduction Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants ( p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage ( p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.

Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis

“…Several authors have reported that the risk of post-tonsillectomy bleeding depends on the skill level of the surgeon, with the risk of bleeding increasing when procedures are performed by trainees. 10,26 In the current study, there was no association between the surgeon’s skill level and post-tonsillectomy bleeding which in keeping with other previous studies. 9,31 However, a surgeon’s inexperience and dissection in the wrong plane results in more post-tonsillectomy bleeding.…”

“…Furthermore, the operation time is increased, leading to a greater loss of blood. 10 In present study, post-tonsillectomy bleeding was not found to be significant correlated with comorbidity, syndrome, or the history of recurrent tonsillitis which in line with other previous study. 32 No previous studies have found an impact of syndromes on postoperative bleeding.…”

“…Similarly, another study unconcealed that the surgeon's level of expertise was additionally considerable related to post-tonsillectomy bleeding. 10 Tonsillectomies performed by trainee-level surgeons had more risk of post-tonsillectomy bleeding compared to senior consultants. One study compared the techniques of tonsillectomy and found that the risk of post-tonsillectomy hemorrhage was higher in patients undergoing bipolar diathermy compared to the cold dissection technique.…”

Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal

“…Post-tonsillectomy haemorrhage (PTH) has been considered one of the potentially life-threatening complications an ENT surgeon might face during surgical practice. 8 Tonsillectomy is one of the initial procedures learnt by the beginners, and although viewed as a relatively low-risk procedure, it can be potentially harmful because of the chance of post-tonsillectomy haemorrhage. 8 In a study done at Dhulikhel Hospital of Nepal, PTH was seen in 12.6% with one out of 15 PTH returning to the operation theatre.…”

“… 8 Tonsillectomy is one of the initial procedures learnt by the beginners, and although viewed as a relatively low-risk procedure, it can be potentially harmful because of the chance of post-tonsillectomy haemorrhage. 8 In a study done at Dhulikhel Hospital of Nepal, PTH was seen in 12.6% with one out of 15 PTH returning to the operation theatre. 9 In the studies conducted in different centres and countries, the PTH varies from 3.3% to 13.9%.…”