title: A devastating outcome after adenoidectomy and tonsillectomy: ideas for improved prevention and management.
abstract: OBJECTIVE
  To develop strategies that may assist the surgeon to prevent and manage severe bleeding complications after adenoidectomy and tonsillectomy.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Expert reports for malpractice lawsuits or professional boards were reviewed. The review was restricted to "deaths" and "permanent generalized neurological deficiencies."
  
  
  RESULTS
  Forty-three cases matched our search criteria, including 32 deaths. Adenoidectomy cases (2) were associated with immediate bleeding because of direct vascular injury resulting in one death. Tonsillectomy cases were associated with delayed and repeated episodes of bleeding resulting in 31 deaths, including 19 children. Autopsy verified predominantly aspiration and vascular injuries. An apallic syndrome prevailed in surviving patients.
  
  
  CONCLUSIONS
  Careful inspection of the nasopharynx immediately before adenoidectomy and curettage in a piecemeal fashion under visual control is helpful to prevent direct injury to aberrant arteries. Tonsillectomy cases are associated with delayed and episodic bleeding with spontaneous cessation and young age. Inpatient observation should be strongly considered in cases with repeated bleeding episodes to provide immediate treatment. The follow-up should be focused on disturbed wound healing. Outcome appears to be dependent on adequate airway management. Rigid instruments and tracheotomy in case of intubation failure are highly recommended to facilitate airway protection and ventilation.
authors.affiliation: Department of Otorhinolaryngology, St. Anna Krankenhaus, Duisburg, Germany.
authors.forename: Jochen P
authors.initials: JP
authors.lastname: Windfuhr
authors.forename: Georg
authors.initials: G
authors.lastname: Schloendorff
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Sesterhenn
authors.forename: Andreas
authors.initials: A
authors.lastname: Prescher
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult