title: Hemorrhage following tonsil surgery: a multicenter prospective study.
abstract: OBJECTIVE
  Postoperative hemorrhage as a serious complication after tonsillectomy (TE), tonsillotomy (TO), or adenoidectomy (AE) is covered in many studies, using rather inconsistent measurement methods. We introduce a new classification for the severity of postoperative hemorrhage and investigate risk factors for the frequency and severity of bleeding episodes.
  
  
  METHODS
  Prospective, multicenter cohort study.
  
  
  METHODS
  Our study is based on a prospective census recording all TEs, TOs, and AEs from October 1, 2009, to June 30, 2010, in Austria. Information concerning surgery indication, grade of surgeon, operation technique, and postoperative hemorrhage, classified as any bleeding episode after extubation according to severity, were collected.
  
  
  RESULTS
  A total of 9,405 patients were included. Hemorrhage rate for TE ± AE was 15.0%, for TO ± AE was 2.3%, and for AE was 0.8%. Rate of return to the operating room for TE ± AE was 4.6%, for TO ± AE was 0.9%, and for AE was 0.3%. Minor bleeding episodes increased the risk of a subsequent severe bleeding episode (P < .001). Elevated hemorrhage rates were observed for adults (P < .001), TE ± AE (P < .001), and cold steel dissection combined with bipolar diathermy (P = .05). Multivariate logistic regression model for the frequency of post-TE hemorrhage showed significant odds ratios for males, children aged <6 years, children aged 6-15 years, abscess TE, and cold steel combined with bipolar diathermy. In addition, we found a significantly higher risk of severe bleeding episodes for children aged 6-15 years (P = .007), males (P = .02), and all bipolar operation techniques (P = .005).
  
  
  CONCLUSIONS
  The occurrence of a postoperative minor bleeding episode increases the risk of a subsequent severe bleeding episode.
authors: Department of General Otorhinolaryngology-Head and Neck Surgery, Medical University Graz, Austria. stephanie@sarny.at
authors: Stephanie
authors: S
authors: Sarny
authors: Guenther
authors: G
authors: Ossimitz
authors: Walter
authors: W
authors: Habermann
authors: Heinz
authors: H
authors: Stammberger
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001317:Austria; D002675:Child, Preschool; D015331:Cohort Studies; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult