title: Postoperative hemorrhage following adenoidectomy.
abstract: OBJECTIVE
  To examine postoperative hemorrhage following adenoidectomy.
  
  
  METHODS
  Prospective multicenter observational study.
  
  
  METHODS
  The Surgical Instrument Surveillance Programme (SISP) was established in 2003 to monitor tonsil and adenoid surgery in all hospitals in Wales. Data were examined between April 1, 2003 and June 30, 2008, for risk factors that may contribute to primary (R1) or secondary (R2) postoperative hemorrhage from the adenoid bed, of a severity sufficient to require a return to the operating room.
  
  
  RESULTS
  There were 5,588 procedures included, of which 4,225 included simultaneous tonsillectomy. The study included 2,903 (52%) males with a median age of 5.8 years (interquartile range [IQR], 4.5-7.7 years) and 2,685 (48%) females with a median age of 6.5 years (IQR, 5.0-9.1 years). There were 22 patients (0.4%; confidence interval [CI], 0.2-0.6) who returned to the operating room with a postoperative hemorrhage arising from the adenoid bed. These were exclusively R1 hemorrhage; there were no instances of R2 hemorrhage (0.0%; CI, 0.0-0.1). No specific risk factors for R1 hemorrhage could be identified. There were 38 patients in the adenotonsillectomy group who returned to operating room with a postoperative hemorrhage arising from the tonsil bed (0.5%; CI, 0.3-0.8). R1 was seen in 22 patients (0.5%; CI, 0.3-0.8) and R2 in 16 patients (0.4%; CI, 0.2-0.6).
  
  
  CONCLUSIONS
  Adenoidectomy appears to be primarily a procedure performed in childhood. The rate of R1 hemorrhage following adenoidectomy is one in 200 (0.5%) and is similar to the R1 hemorrhage rate for tonsillectomy. R2 hemorrhage following an adenoidectomy appears to be extremely rare. In children, the risk of a serious primary hemorrhage following an adenotonsillectomy is double that of either procedure when performed alone.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Hospital Wales, Cardiff, United Kingdom. tomkinsona@cardiff.ac.uk
authors.forename: Alun
authors.initials: A
authors.lastname: Tomkinson
authors.forename: Wendy
authors.initials: W
authors.lastname: Harrison
authors.forename: David
authors.initials: D
authors.lastname: Owens
authors.forename: Samuel
authors.initials: S
authors.lastname: Fishpool
authors.forename: Mark
authors.initials: M
authors.lastname: Temple
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom