Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies.
OBJECTIVE
Tonsillectomy and adenoidectomy are the most common surgical procedures in otorhinolaryngology. The most serious complication is postoperative hemorrhage, with a 2-4% risk of substantial bleeding. The aim of this study was to evaluate the incidence of and possible predictive factors for postoperative hemorrhage requiring surgical revision in patients undergoing cold dissection tonsillectomy/adenoidectomy.


METHODS
We performed a single-institution retrospective study of 8388 patients who underwent tonsillectomy and/or adenoidectomy between 1994 and 2006. Tonsillectomy was performed using only cold-steel dissection with bipolar diathermy for hemostasis.


RESULTS
Hemorrhage occurred in 114 patients (1.78%) after tonsillectomy and in seven patients (0.35%) after adenoidectomy. After tonsillectomy 85.09% of the hemorrhages were secondary, occurring between the postoperative days 1 and 15, whereas in the adenoidectomy group 85.71% of the bleeding episodes were primary. Two patients (0.03%) required blood transfusions, none of the patients required an external carotid artery ligation, and there were no cases of death in our series. On the basis of logistic regression analysis, patient age was found to be a statistically significant risk factor (P = 0.007): the highest incidence was found in patients over 16 years of age (2.19%). At warmer times of year the incidence was higher (1.98%) than at colder times (1.63%). The resident surgeons caused a hemorrhage incidence of 1.75% and the consultant surgeons one of 1.84%. The incidence was significantly higher in male patients (2.2%) than in female patients (1.4%; P = 0.016).


CONCLUSIONS
Our data show that whereas adenoidectomy can be safely performed as a one-day procedure, tonsillectomy complications due to postoperative hemorrhages might be avoided only if patients were to stay in hospital until postoperative day 15, which would clearly be impractical for economic, organizational and social reasons. A crucial factor for increasing the safety of this procedure is the provision of meticulous education and information for the patient and/or parents.
Arnoldner
Christoph
C
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
Grasl
Matthäus Ch
MCh
Thurnher
Dietmar
D
Hamzavi
Jafar-Sasan
JS
Kaider
Alexandra
A
Brunner
Markus
M
Erovic
Boban M
BM
D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy / Q000009:adverse effects*