From the Research
The incidence of serious postoperative bleeding in adult tonsillectomy is approximately 5.1%, with the majority of cases being secondary hemorrhage, as reported in a study of 685 adult patients undergoing tonsillectomy 1.
Incidence of Postoperative Bleeding
The incidence of postoperative bleeding in adult tonsillectomy patients can be broken down into primary and secondary hemorrhage.
- Primary hemorrhage occurs within the first 24 hours after surgery and affects a smaller percentage of patients.
- Secondary hemorrhage occurs between 24 hours and 2 weeks postoperatively and is more common, with a mean time lapse of 6.9 days (+/- 4.1) between tonsillectomy and bleeding, as seen in the study by 1.
Risk Factors
Several risk factors contribute to the increased risk of postoperative bleeding in adults, including:
- Male gender
- Older age
- Surgical technique, particularly hot techniques like electrocautery
- Perioperative NSAID use
- Certain medical conditions, such as hypertension or coagulation disorders These risk factors are attributed to greater tissue fibrosis, increased vascularity of the tonsillar bed, and potentially higher rates of occult bleeding disorders.
Management
Management of tonsillectomy patients should include:
- Careful preoperative assessment for bleeding risk factors
- Consideration of surgical technique
- Appropriate pain management that balances analgesia with bleeding risk
- Clear instructions to patients about warning signs of hemorrhage requiring immediate medical attention It is essential to note that while tranexamic acid has been studied as a potential agent to reduce post-tonsillectomy hemorrhage, the current evidence does not support its routine use for this purpose, as seen in the systematic review by 2.