Posttonsillectomy hemorrhage: what is it and what should be recorded?

Objectives: To report on our incidence of posttonsillectomy hemorrhage and to define what constituted posttonsillectomy bleeding.

Design: Retrospective study.

Setting: Tertiary care children's hospital and a local satellite facility.

Patients: A series of 1438 consecutive patients who had undergone either tonsillectomy or adenotonsillectomy between January 1, 1999, and December 31, 1999.

Intervention: During this period, parents were instructed to return with their children for clinical evaluation if any blood was seen in the postoperative period.

Main Outcome Measures: Postoperative day of evaluation, age, sex, location of bleeding, management strategy, length of hospital admission, and any bleeding disorders were noted for each patient.

Results: A total of 112 patients underwent evaluation 134 times. Of these patients, 96 required only 1 evaluation and 16 required more than 1 evaluation. All patients who had more than 1 evaluation required intervention. The total number of children requiring intervention for posttonsillectomy hemorrhage was 51 (3.5%) of the 1438 patients. Female patients were more likely than male patients to return for evaluation. Patients who were 12 years and older were the most likely and those 3 years and younger were the least likely to have posttonsillectomy hemorrhage. The most common time from surgery to initial evaluation for hemorrhage was 6 days.

Conclusions: By reviewing our own criteria for defining and recording posttonsillectomy hemorrhage, we conclude that posttonsillectomy hemorrhage is defined differently in the literature. This supports the need for a standard definition to allow for direct comparisons.