title: Population-based analysis of tonsil surgery and postoperative hemorrhage.
abstract: Although tonsil surgery is one of the most frequent otorhinolaryngological procedures, not many population-based regional or country-wide studies are published on the incidence of postoperative bleeding and its risk factors. 2,216 patients underwent tonsil surgery in 2012 in Thuringia, a federal state in Germany. Most frequent indications were recurrent tonsillitis (44 % of all cases), tonsillar abscess (27 %), and tonsillar hyperplasia (20 %). 29 % of the patients were <10 years of age. Most frequent methods of surgery were tonsillectomy (73 %) and tonsillotomy (19 %). 215 patients (10 %) had 221 events of a postoperative hemorrhage. Re-surgery for hemostasis was necessary in 137 patients (6 %). The interval to re-surgery was 4.4 ± 4.6 days. The re-surgery rate was 8, 0.2, and 15 % after tonsillectomy, tonsillotomy, and radical tonsillectomy, respectively. In cases of recurrent tonsillitis, male gender (p < 0.001), age >24.78 years (median; (p = 0.018), and waiving of perioperative antibiotics (p = 0.029) were independent factors associated with hemorrhage. In cases of tonsillar hyperplasia tonsillectomy instead of tonsillotomy, the only significant risk factor was postoperative hemorrhage (p = 0.005). The overall incidence of tonsillar surgery was 87.6/100,000. The highest incidence was seen for patients 3-4 years of age with 862.7/100,000. In children <10 years, the incidence was always higher for boys than for girls. Throughout all age groups, a reverse gender relation was only seen, if surgery was indicated for recurrent tonsillitis. We recommend establishing national guidelines for indication of tonsil surgery, especially of tonsillectomy, including recommendations for perioperative care to decrease variations in tonsil surgery rates and minimize postoperative complications.
authors.affiliation: Department of Otorhinolaryngology, University Hospital Jena, Lessingstrasse 2, 07740, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Mueller
authors.affiliation: Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Boeger
authors.affiliation: Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Buentzel
authors.affiliation: Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Esser
authors.affiliation: Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hoffmann
authors.affiliation: Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Jecker
authors.affiliation: Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mueller
authors.affiliation: Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Radtke
authors.affiliation: Department of Otorhinolaryngology, University Hospital Jena, Lessingstrasse 2, 07740, Jena, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Geißler
authors.affiliation: Department of Otorhinolaryngology, University Hospital Jena, Lessingstrasse 2, 07740, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bitter
authors.affiliation: Department of Otorhinolaryngology, University Hospital Jena, Lessingstrasse 2, 07740, Jena, Germany. orlando.guntinas@med.uni-jena.de.
authors.forename: O
authors.initials: O
authors.lastname: Guntinas-Lichius
mesh_terms: D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006488:Hemostasis, Surgical; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D007223:Infant; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000473:pathology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D014068:Tonsillectomy; D014069:Tonsillitis / Q000601:surgery; D055815:Young Adult
keywords: Bleeding; Complication; Epidemiology; Health services research; Outcome; Surgery; Tonsil