title: What lessons can be learned from the Austrian events?
abstract: BACKGROUND
  The death of 5 children in Austria below the age of 6 years due to posttonsillectomy haemorrhage in 2006 and 2007 led to an intensive discussion on the potential life-threatening risks of tonsil surgery. On this occasion, a consensus paper with clear recommendations for tonsil surgery was released by the Austrian Societies of Otorhinolaryngology, Head and Neck Surgery and Paediatrics followed by a nationwide multicentre study.
  
  
  METHODS
  All consecutive tonsillectomies, tonsillotomies and adenoidectomies performed in public hospitals in Austria within 9 months were assessed. Data on all participating patients were collected via an online questionnaire requesting patient characteristics, surgery details and postoperative haemorrhage. A strict definition for postoperative bleeding episodes with 7 severity grades was applied. Every bleeding episode after extubation was counted as postoperative bleeding event.
  
  
  RESULTS
  The study population - all younger than 18 years of age - consisted of 6,765 patients (tonsillectomy 2,080, 31%; tonsillotomy 1,292, 19%; adenoidectomy 3,393, 50%). Postoperative haemorrhage episodes were reported in 15% after tonsillectomy and in 2.3% after tonsillotomy, with the risk increasing parallel to age. Multiple bleeding episodes were recorded in one fourth of all tonsillectomy bleedings, but were rare after tonsillotomy. Surgical revision under general anaesthesia was necessary in 4.2% after tonsillectomy and in 0.9% after tonsillotomy.
  
  
  CONCLUSIONS
  As the incidence of tonsillectomy in children younger than 6 years has declined following the recommendations of the consensus paper issued in 2007, tonsillotomy has become more frequent in this age group. Overnight hospital admission and observation is suggested for all patients experiencing postoperative haemorrhage, as the occurrence of one minor bleeding doubled the risk of a second severe bleeding.
authors: Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University Graz, Graz, Austria. stephanie@sarny.at
authors: Stephanie
authors: S
authors: Sarny
authors: Walter
authors: W
authors: Habermann
authors: Guenther
authors: G
authors: Ossimitz
authors: Heinz
authors: H
authors: Stammberger
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D001317:Austria; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012307:Risk Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data