Late posttonsillectomy haemorrhage, differences in unilateral versus bilateral tonsillectomy, a retrospective epidemiological multicentric study

Abstract

Tonsillectomy (TE) is one of the most performed head and neck surgeries. Patients range from children to seniors, and there is a wide range of indications and various complications related to TE. The most feared complication is post-tonsillectomy haemorrhage (PTH). Multicentric retrospective study, conducted between 2014 and 2018, includes data from 8166 patients who underwent TE. Among these patients, 3889 were men (47.62%) and 4277 were women (52.28%), with a mean age of 29.06 years. For this study, we analysed a total of 14,030 unilateral tonsillectomies (resected tonsils), of which 2,302 were performed primarily as unilateral surgeries, while 11,728 were part of bilateral procedures. Late post-tonsillectomy haemorrhage (LPTH) was significantly associated with the type of surgery performed (unilateral versus bilateral procedure; p < 0.0001). In the unilateral group, bleeding occurred in 217 cases (9.43%), while in the bilateral group, it was noted in 1062 cases (18.11%). When analysing the total sample (14030 unilateral tonsillectomies), the incidence of LPTH was found to be 9.12%. The occurrence of bleeding in our sample was influenced by several factors, including hospital choice, age, and gender (p < 0.0001). Additionally, the use of anticoagulants was associated with bleeding (p = 0.0449), as was antiplatelet medication (p = 0.0160). However, factors such as the spectrum of indications, surgical technique, surgeon experience, and the use of electrocoagulation during surgery did not impact LPTH. The severity of bleeding was linked to the use of anticoagulants (p = 0.0002) and antiplatelet medication (p = 0.0404). Our study highlighted the importance of methodology when studying LPTH as the outcome of unilateral and bilateral TE procedures. LPTH occurrence was most influenced by the choice of hospital and the patient's age and gender. The severity of bleeding was affected by the use of anticoagulants and antiplatelet agents. The manner in which LPTH was treated did not affect the likelihood of LPTH recurrence.