Tonsillectomy is amongst the most common surgical procedures performed across the western world. For patients who report bleeding post-tonsillectomy, but have no clinical findings on examination, the management can be unclear. The accepted current management in most centres would be to admit and monitor, so in this study, the team from Boston aimed to understand the incidence and time course of subsequent haemorrhage, in the group of patients who report a history of bleeding at home but have a normal postoperative exam when evaluated in the emergency department. The patients were collected at a tertiary children’s hospital where approximately 1700 tonsillectomy procedures are performed annually.
Retrospective data were collected over a five-year period. Inclusion criteria were patients presenting to the emergency department who reported a history of bleeding at home but were found to have a postoperative exam without haemorrhage or fresh coagulum. 8860 tonsillectomies were performed, with 695 representing to the emergency department with postoperative bleeding.
The mean time from initial postoperative discharge to postoperative bleeding was 6.4 days. There were 337 readmissions with a history of haemorrhage, but with no clinical findings as described above. Of these, 38 (11.3%) subsequently had bleeding requiring cauterization. The mean time to subsequent bleeding during observation was 14.6 h and 32 (84%) of these bleeds occurred within 24 h. The team looked at a range of factors associated with the initial tonsillectomy, however none were statistically significant predictors of subsequent bleeding during the period of observation. We know that bleeding following tonsillectomy is not a minor issue and can result in significant morbidity. This study confirms what most departments would already consider as standard management, which is to admit and monitor patients who report bleeding post-tonsillectomy. With over 80% of patients that had a further bleed, doing so within the first 24 hours, then this seems a reasonable time course to follow.