Management of post tonsillectomy secondary haemorrhage: Flinders experience

Abstract

Background: Secondary post tonsillectomy haemorrhage (sPTH) is a significant complication in Otolaryngology. Most studies have focussed on different risk factors associated with sPTH. However, few studies have reported on the outcomes of sPTH after presentation to a tertiary public hospital. We sought to present our experience with the management of sPTH. Methods: A retrospective review of all patients (n=145) presenting with a sPTH to Flinders Medical Centre (FMC) was analysed over a two-year period. The Stammberger grade for sPTH was applied and recorded in the case notes at presentation of all patients. Results: 59% of these patients were adults. Overall, 79% of patients were conservatively treated and discharged safely without returning to the operating theatre. Adults were marginally more likely to return to theatre (RTT) with a relative risk (RR) of 1.07 (CI 0.5-2.3). Patients who had coblation (COB) tonsillectomy had a higher RR of RTT (RR =1.45) compared to cold steel (CS) tonsillectomy. Patients who had a COB tonsillectomy (16.6%) were also more likely represent with a second bleeding episode compared to CS tonsillectomy (9.8%). The length of stay (LOS) was significantly longer (13 hours) in adults with Stammberger grade C sPTH (P<0.05) compared to grade A1 sPTH, with other factors having no significant effect on LOS. Conclusions: The overall risk of a second bleeding episode is low in patients with sPTH, and conservative management in the first instance is safe. Patients with a COB tonsillectomy are likely to present with multiple episodes of sPTH if initial management was conservative. Stammberger grade at initial sPTH presentation is not predictive of subsequent presentations.

Post-tonsillectomy haemorrhage rates at Nelson Hospital

“…The management of patients who presented to Nelson ED with bleeding is consistent with that as described by Alvo et al and Dharmawardana et al 4,7 All patients who present to Nelson are admitted onto the ENT ward and observed overnight. Alvo et al had a return to theatre rate of 28% in their Auckland cohort, which closely matches our rate of 24%.…”

“…Dharmawardana et al had a rate of 21% in their Australian cohort 7. Comparison of Nelson cohort and Auckland cohort 4.…”

Reference rate for post-tonsillectomy haemorrhage in Australia—A 2000–2020 national hospital morbidity database analysis

“…In Australia, a survey study conducted in 2005 found that the hot technique of monopolar diathermy has been the preferred technique for tonsillectomy [ 37 ]. It is unknown how this practice has changed since the study, but the use of the other hot technique Coblation (also known as radiofrequency ablation) has been increasingly mentioned in Australian studies [ 10 , 38 , 39 ]. Whilst advocates of the use of Coblation offers less post-operative pain and faster return to normal diet following surgery, a systematic review has showed there is currently a lack of quality evidence to support these claims [ 40 ].…”

Risk factors for secondary post tonsillectomy hemorrhage

“…For every increase in age by one year, the risk of bleeding post-operatively significantly increased by 1.1 times [8] . Kim et al, [9] , who made a study on 60 patients with post-tonsillectomy haemorrhage, and they reported that, the mean age of patients was 17.1 years. Also, Subha et al, [10] , reported that, there is a significant association between age group and post-tonsillectomy haemorrhage.…”