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Adult tonsillectomy—increased pain scores are correlated with risk of bleeding: a retrospective cohort study

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Abstract

Purpose

Tonsillectomy is among the most common surgical procedures performed worldwide, and post-tonsillectomy bleeding is a serious complication. This study aims to investigate the role of post-operative pain as a risk factor for bleeding in adults.

Methods

A retrospective cohort study of adults who underwent tonsillectomy in a tertiary referral center between 2015–2021. Medical records were reviewed for demographics, diagnoses, surgical technique, treatments, pain scores (measured by visual analogue scale 0–10), readmissions, and bleeding events. The primary outcome was return to the operating room for hemostasis, and secondary outcomes were bleeding events and consumption of additional analgesic doses.

Results

Of the 274 patients, 137 (50%) were males, the mean age was 30.3 ± 12 years (range 18–82), and 33 (12%) were smokers. Indications for tonsillectomy were recurrent throat infections in 213 (77.7%) patients and obstructive sleep apnea in 61 (22.3%). Surgical technique was cold dissection in 238 (86.9%) patients and electrocautery in 36 (13.1%). Primary post-tonsillectomy bleeding (< 24 h of surgery) occurred in 6 (2%) patients, and secondary bleeding (later than 24 h from tonsillectomy) in 43 (15.7%). A total of 19 (7%) patients necessitated surgical hemostasis. After controlling for technique and other confounders, high pain scores (VAS ≥ 5) on post-operative days 1 and 2 were associated with increased risk of bleeding that necessitated surgical hemostasis (adjusted odds ratio 6.9, 95% confidence interval 1.7–44.5). Other independent risk factors were male sex, age < 30 years, smoking, and recurrent throat infections.

Conclusions

Higher pain scores following tonsillectomy are correlated with bleeding episodes requiring surgical intervention in adults. Further studies may explore the role of different intensive pain regimens in minimizing the risk of bleeding.

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Data availability statement

Data generated/analyzed in this study will be made available to researchers upon reasonable request to the corresponding author.

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Funding

No funds, grants, or other support was received for conducting this study.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, 8 Ha’Aliya Street, 3109601, Haifa, Israel

    Roee Noy, Dmitry Ostrovsky & Yotam Shkedy

  2. Technion, Israel Institute of Technology, Haifa, Israel

    Roee Noy, Dmitry Ostrovsky & Yotam Shkedy

Authors
  1. Roee Noy
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  2. Dmitry Ostrovsky
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Contributions

RN: design, conduct, data collection, analysis, drafting the manuscript; DO: design, drafting the manuscript; YS: design, analysis, drafting the manuscript.

Corresponding author

Correspondence to Roee Noy.

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Conflict of interest

The authors declare no potential conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Ethics approval statement

This study was approved by the Institutional Review Board of the Rambam healthcare campus (0403-21-RMB-D).

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Not required.

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The manuscript was written and edited under The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for reporting cohort studies.

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Noy, R., Ostrovsky, D. & Shkedy, Y. Adult tonsillectomy—increased pain scores are correlated with risk of bleeding: a retrospective cohort study. Eur Arch Otorhinolaryngol 280, 3437–3444 (2023). https://doi.org/10.1007/s00405-023-07931-z

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  • DOI: https://doi.org/10.1007/s00405-023-07931-z

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