Hemorrhage risk after quinsy tonsillectomy.
BACKGROUND
The goal of the study was to evaluate the incidence and possible predictive factors of post-tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy.


METHODS
A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon's experience, procedure duration, intra- and postoperative anti-inflammatory medications, and side of bleeding were analyzed.


RESULTS
Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant (P = 0.02). Male gender (P = 0.042), smoking (P = 0.009), and aspirin intake (P = 0.008) were statistically significant factors associated with an increased PTH risk.


CONCLUSIONS
The risk of bleeding following abscess tonsillectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo-tonsillar infections, aspirin intake, and clinical improvement after initial drainage and antibiotherapy.


METHODS
C.
Giger
Roland
R
Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland. Roland.Giger@hcuge.ch
Landis
Basile Nicolas
BN
Dulguerov
Pavel
P
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D000039:Peritonsillar Abscess / Q000175:diagnosis / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome