Frequency of post‐tonsillectomy hemorrhage relative to time of day

Abstract

Objectives Postoperative hemorrhage is a serious complication of tonsillectomy, with secondary bleeding rates affecting up to 0.8% to 3% of patients. Although these bleeds are anecdotally perceived as occurring more frequently at night, the occurrence of hemorrhage relative to the time of day has not been investigated. We measured the frequency of post‐tonsillectomy hemorrhage onset relative to the time of day. Methods We reviewed electronic medical records of all patients who experienced postprocedural hemorrhage (International Classification of Disease, Ninth Edition [ICD‐9] 998.11, ICD‐10 J95.830 at two hospitals within a tertiary academic health system in a 10‐year period). Patient demographics, time of bleed onset, emergency room [ED] arrival time, and management (operating room vs. observation) were abstracted. Patients without a recorded bleeding time were excluded. Time of bleed onset was categorized as morning (6:01 am–12 pm), afternoon (12:01 pm–6 pm), evening (6:01 pm–12 am), or overnight (12:01 am–6 am). Chi‐square goodness of fit test was used to assess the distribution of hemorrhage timing (P ≤ 0.05). Results A total of 7,396 patients underwent tonsillectomy May 2008 through May 2018, among whom 121 (2%) post‐tonsillectomy hemorrhage patients were identified. Among the 104 patients with ED arrival times, 29 (28%) arrived in the morning; 15 (14%) arrived in the afternoon; 40 (38%) arrived in the evening; and 20 (19%) arrived overnight (P = 0.003). Sixty patients (mean age 17.1 years, standard deviation 16.6) had a recorded timing of bleed onset. Bleed onset occurred most commonly overnight (24, 40%), followed by evening (21, 35%), afternoon (11, 18%), and morning (4, 7%) (P = 0.0007). Conclusion In this cohort, post‐tonsillectomy hemorrhage occurred most frequently between midnight and 6 am. Our findings confirm anecdotal experience and provide data in setting caregiver expectations. Level of Evidence 4 Laryngoscope, 130:1823–1827, 2020

Post-Tonsillectomy Bleeding: A National Perspective

“…For example, one study by Hopkins reported a hemorrhage rate between 0.8 and 3%. 24 However, this study, like most currently found in literature on post-tonsillectomy hemorrhage, focused on two tertiary institutions with a limited amount of surgeons. Contrarily, our study is a composite of national data and includes the rates of various types and levels of institutions and their surgeons nationwide.…”

Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children

“…While it is widely accepted that PTAH can occur up to 14 days after the initial operation, previous studies have found that postoperative hemorrhage most commonly occurred between 5 and 10 days after the initial operation. 11,[15][16][17][18] Our study found that 18% of our cohort had postoperative bleeding after day 10, and 4% presented after day 14. Few studies report on these delayed presentations, particularly the delayed PTAH of 14 to 28 days.…”

Frequency of epistaxis by months and daytime hours

“…This phenomenon is partly due to hematological parameters including blood viscosity and clotting factors peaking in the morning hours displaying circadian rhythm (25). In a study by Kim et al which examined the variation of bleeding frequency in the day in post-tonsillectomy found that bleeding was observed more frequently at night (26). In our study, the high prevalence of epistaxis occurrence in the evening hours in patients with comorbid conditions such as diabetes mellitus, hemophilia, antiaggregant -anticoagulant medication usage, leukemia and chronic renal failure was found to be statistically significant.…”