Avoidance of primary post-tonsillectomy hemorrhage in a teaching program.
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.
Conley
S F
SF
Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee, USA.
Ellison
M D
MD
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
D006490:Hemostatics; D009942:Organometallic Compounds; D005707:Gallic Acid; C002170:bismuth subgallate