title: Avoidance of primary post-tonsillectomy hemorrhage in a teaching program.
abstract: OBJECTIVE
  To determine the incidence of primary post-tonsillectomy hemorrhage in a teaching institution by using a uniform technique, including a 3-minute relaxation of retraction before case termination and the use of bismuth subgallate.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary care academic pediatric center.
  
  
  METHODS
  A 7-year retrospective study was performed by using the medical records of 1286 children without a bleeding abnormality who underwent tonsillectomy (with or without adenoidectomy). A uniform technique, proposed to reduce hemorrhage, was used for 705 children and was not used for 581 children.
  
  
  RESULTS
  No episodes of primary hemorrhage (onset < or = 24 hours after surgery) occurred, and the incidence of delayed hemorrhage (onset >24 hours after surgery) was 1.1% in the study group. The primary hemorrhage rate of the study group was significantly lower (P = .007) than the rate for the reference group (0.0% vs 1.0%), as was the total hemorrhage rate (1.1% vs 4.1%) and the delayed hemorrhage rate (1.1% vs 3.1%).
  
  
  CONCLUSIONS
  A uniform technique including the use of bismuth subgallate and reassessment of the tonsillar fossae after a 3-minute observation period reduces the incidence of primary tonsillar hemorrhage in a teaching institution setting.
authors: Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee, USA.
authors: S F
authors: SF
authors: Conley
authors: M D
authors: MD
authors: Ellison
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005707:Gallic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009942:Organometallic Compounds / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*; D014922:Wisconsin
chemical_list: D006490:Hemostatics; D009942:Organometallic Compounds; D005707:Gallic Acid; C002170:bismuth subgallate