Post-Tonsillectomy and -Adenoidectomy Hemorrhage in Nonselected Patients

Abstract

This retrospective study was undertaken to evaluate the incidence of hemorrhage in nonselected patients requiring surgical treatment after adenoidectomy (group 1; 7,785 patients) or tonsillectomy with or without adenoidectomy (group 2; 6,794 patients). Postoperative bleeding from the tonsillar fossae occurred in 200 patients (2.94%). Primary hemorrhage (< 24 hours) clearly prevailed in groups 1 (86%) and 2 (78%). There was 1 case with a lethal outcome following tonsillectomy (0.007%). Bleeding from the epipharynx occurred in 17 patients of group 1 (0.21%). A total of 5 patients received blood transfusions, all of them belonging to group 2 (0.07%). The latest bleeding occurred 6 days (adenoidectomy) and 18 days (tonsillectomy) after surgery. Hemorrhage following both procedures is a rare complication predominantly occurring several hours after surgery and in nonselected patients. Male gender, age over 70 years, infectious mononucleosis, and a history of recurrent tonsillitis were found to be risk factors for posttonsillectomy hemorrhage.

Hemorrhage Risk After Quinsy Tonsillectomy

“…Similar observations were found in previous studies on tonsillectomies. 6,16 The male gender effect might result from a less strict following of the postoperative instructions regarding rest and diet.…”

Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

“…However, in a number of previous studies the secondary hemorrhage rate was much higher in comparison with our study. Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing hemostasis [10,19]. The bleeding was less in ITPL method probably due to dealing with offending bleeders by competent and secured way of hemostasis which was the ligation, this phenomenon seen also by others.…”

Complicações pós-operatórias em tonsilectomias

“…Estes resultados foram comparáveis ao de outros serviços, em outros países. 3,4,5 Durante a primeira semana após a cirurgia, 5 pacientes (3,4%) apresentaram episódios de sangramento, que foram leves e melhoraram com conduta expectante. Não tivemos nenhum caso de sangramento após a primeira semana.…”

“…Consideramos seguro a alta hospitalar dos pacientes submetidos a tonsilectomias após um período de observação clínica de no mínimo 6 horas, prática esta utilizada de rotina em nosso serviço, barateando consideravelmente o custo do procedimento cirúrgico, já que quando ocorre hemorragia ela é muito mais freqüente no pós-operatório imediato 5 .…”

“…Podemos classificá-la como sendo primária (<24 horas) ou secundária (>24 horas) 3 . A maioria dos estudos atesta que a hemorragia primária é muito mais freqüente que a secundária 5,6 , sendo que este tipo de evento ocorre entre 6 e 8 horas de pós-operatório na maioria das vezes (76-89% dos casos) 2 . Outras complicações pós-operatórias comuns são náuseas, vômitos, febre, inabilidade para ingerir alimentos sólidos ou líquidos, otalgia e dor 2,7 .…”