Skip to main content

Hemorrhage after adenotonsillectomy in children: tertiary center experiences

Hämorrhagie nach Adenotonsillektomie bei Kindern: Erfahrungen eines Zentrums der Tertiärversorgung

Summary

Background

Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively, is one of the most serious complications.

Objective

To determine the frequency of hemorrhage in children after adenotonsillectomy and to compare postoperative hemorrhage with regard to age and sex.

Methods

A cross-sectional longitudinal study was conducted at the Ear, Nose, and Throat Clinic, University Clinical Center Tuzla, and included all children of both sexes, aged 3 to 15 years, who underwent adenotonsillectomy during a 1.5-year period.

Results

A total of 201 children aged 3–15 years underwent adenotonsillectomy, 113 males and 88 females, which corresponds to a ratio of 1.28: 1. Adenotonsillectomy was performed in 147 (73.1%) patients and adenoidectomy in 54 (27%). In the overall sample, there were 19 (9.5%) subjects with postoperative hemorrhage. Primary hemorrhage occurred in 9 subjects (47%) and secondary hemorrhage in 10 subjects (53%). Significantly more female subjects had postoperative hemorrhage. In the group of subjects with hemorrhage, the mean age (standard deviation) was 8.45 (3.3) years. Tonsillar lodges are common sites of hemorrhage.

Conclusion

The frequency and causes of hemorrhage after adenotonsillectomy in our study are partially comparable to the world data.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160(1):S1–S42. https://doi.org/10.1177/0194599818801757.

    Article  PubMed  Google Scholar 

  2. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;28(11):1–25.

    Google Scholar 

  3. Johnston J, McLaren H, Mahadevan M, Douglas RG. Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children. Int J Pediatr Otorhinolaryngol. 2019;116:177–80. https://doi.org/10.1016/j.ijporl.2018.11.004.

    Article  PubMed  Google Scholar 

  4. Achar P, Sharma RK, De S, Donne AJ. Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children? Int J Pediatr Otorhinolaryngol. 2015;79(2):246–50. https://doi.org/10.1016/j.ijporl.2014.12.022.

    CAS  Article  PubMed  Google Scholar 

  5. Perkins JN, Liang C, Gao D, Shultz L, Friedman NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope. 2012;122(10):2311–5.

    Article  Google Scholar 

  6. Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970–2005. Otolaryngol Head Neck Surg. 2009;140(6):894–901.

    Article  Google Scholar 

  7. Johnson LB, Elluru RG, Myer CM. Complications of adenotonsillectomy. Laryngoscope. 2002;112:35–6.

    Article  Google Scholar 

  8. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope. 2011;121(12):2553–60.

    Article  Google Scholar 

  9. Windfuhr JP. Serious complications following tonsillectomy: how frequent are they really? Orl J Otorhinolaryngol Relat Spec. 2013;75(03):166–73.

    Article  Google Scholar 

  10. Arora R, Saraiya S, Niu X, Thomas RL, Kannikeswaran N. Post tonsillectomy hemorrhage: who needs intervention? Int J Pediatr Otorhinolaryngol. 2015;79(2):165–9.

    Article  Google Scholar 

  11. Ordemann AG, Hartzog AJ, Seals SR, Spankovich C, Stringer SP. Is weight a predictive risk factor of postoperative tonsillectomy bleed? Laryngoscope Investig Otolaryngol. 2018;3(3):238–43.

    Article  Google Scholar 

  12. Cote C, Lerman J, Anderson B. A practice of anesthesia for infants and children. 6th ed. Elsevier; 2018.

    Google Scholar 

  13. Attner P, Haraldsson PO, Hemlin C, Hessen Soderman AC. A 4‑year consecutive study of post-tonsillectomy haemorrhage. ORL J Otorhinolaryngol Relat Spec. 2009;71(5):273–8.

    Article  Google Scholar 

  14. Kurtović D. Utjecaj barometarskog tlaka na učestalost krvarenja nakon tonzilektomije na području srednje Dalmacije. Zagreb: Medicinski fakultet, Magistarski rad; 2001. pp. 1–37.

    Google Scholar 

  15. Windfuhr JP, Chen Y‑S. Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients. Ear Nose Throat J. 2002;81(9):626–8.

    Article  Google Scholar 

  16. Prim MP, De Diego JI, Jimenez-Yuste V, Sastre N, Rabanal I, Gavilan J. Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2003;67:341–4.

    CAS  Article  Google Scholar 

  17. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005;132:281–6.

    CAS  Article  Google Scholar 

  18. Østvoll E, Sunnergren O, Stalfors J. Increasing readmission rates for hemorrhage after tonsil surgery: a longitudinal (26 years) national study. Otolaryngol Head Neck Surg. 2018;158:167–76.

    Article  Google Scholar 

  19. McKeon M, Kirsh E, Kawai K, Roberson D, Watters K. Risk factors for multiple hemorrhages following tonsil surgery in children. Laryngoscope. 2019;129:2765–70.

    Article  Google Scholar 

  20. Sakki A, Mäkinen LK, Roine RP, Nokso-Koivisto J. Changing trends in pediatric tonsil surgery. Int J Pediatr Otorhinolaryngol. 2019;118:84–9.

    Article  Google Scholar 

  21. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative bleeding and associated utilization following tonsillectomy in children: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017;156(3):442–55.

    Article  Google Scholar 

  22. Susaman N, Kaygusuz I, Karlıdag T, Keles E, Yalcın S, Cilibas RE. Risk factors for post-tonsillectomy hemorrhage. ENT Update. 2018;8(2):114–9.

    Article  Google Scholar 

  23. Mohammadpour-Maleki A, Rasoulian B. Post-tonsillectomy hemorrhage: a seven-year retrospective study. Iran J Otorhinolaryngol. 2021;33(118):311–8. https://doi.org/10.22038/ijorl.2021.54962.2882.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Blomgren K. A prospective study on pros and cons of electro-dissection tonsillectomy. Laryngoscope. 2001;111:478–82.

    CAS  Article  Google Scholar 

  25. Blakely BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg. 2009;140:288–90.

    Article  Google Scholar 

  26. Kim MK, Lee JW, Kim MG, Ha SY, Lee JS, Yeo SG. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol. 2012;269(3):977–81.

    CAS  Article  Google Scholar 

  27. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope. 2011;121(2):279–88.

    Article  Google Scholar 

  28. Spektor Z, Saint-Victor S, Kay DJ, Mandell DL. Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol. 2016;84:151–5. https://doi.org/10.1016/j.ijporl.2016.03.005.

    Article  PubMed  Google Scholar 

  29. Windfuhr JP. Excessive post-tonsillectomy hemorrhage requiring ligature of the external carotid artery. Auris Nasus Larynx. 2002;29(2):159–64. Erratum in: Auris Nasus Larynx 2002; 29 (3): 317–8.

    Article  Google Scholar 

  30. Vestergaard H, Wohlfahrt J, Westergaard T, Pipper C, Rasmussen N, Melbye M. Incidence of tonsillectomy in Denmark, 1980 to 2001. Pediatr Infect Dis J. 2007;26(12):1117–21. https://doi.org/10.1097/INF.0b013e31814536ba.

    Article  PubMed  Google Scholar 

  31. Jensen-Fangel S, Mohey R, Johnsen SP, Andersen PL, Sorensen HT, Ostergaard L. Gender differences in hospitalization rates for respiratory tract infections in Danish youth. Scand J Infect Dis. 2004;36:31–6.

    Article  Google Scholar 

  32. Peterson J, Losek JD. Post-tonsillectomy hemorrhage and pediatric emergency care. Clin Pediatr (Phila). 2004;43(5):445–8.

    Article  Google Scholar 

  33. Bhattacharyya N, Shapiro NL. Associations between socioeconomic status and race with complications after tonsillectomy in children. Otolaryngol Head Neck Surg. 2014;151(6):1055–60.

    Article  Google Scholar 

  34. Kshirsagar R, Mahboubi H, Moriyama D, Ajose-Popoola O, Pham NS, Ahuja GS. Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy. Int J Pediatr Otorhinolaryngol. 2016;84:119–23.

    Article  Google Scholar 

  35. Schwaab M, Hansen S, Gurr A, Dazert S. Significance of blood tests prior to adenoidectomy. Laryngorhinootologie. 2008;87(2):100–6.

    CAS  Article  Google Scholar 

  36. Urík M, Bartoš M, Šikolová S, et al. Risk factors for postoperative bleeding after adenoidectomy. Children. 2021; https://doi.org/10.3390/children8030242.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding source was involved in this study and there are no financial or other relationships that could be perceived to influence the manuscript.

Author information

Authors and Affiliations

Authors

Contributions

Alma Jahić Čampara wrote the main manuscript, critically reviewed the manuscript, participated in the treatment of patients from the study. Selmira Brkić wrote the main manuscript and critically reviewed the manuscript. Anis Cerovac wrote the main manuscript, critically reviewed the manuscript, and is corresponding author. Mirza Kovačević critically reviewed the manuscript, gave some suggestions for improvements of the paper, and wrote some additions. All authors met the criteria of authorship and have rights on intellectual content

Corresponding author

Correspondence to Anis Cerovac MD phD candidate.

Ethics declarations

Conflict of interest

A.J. Čampara, S. Brkić, A. Cerovac, and M. Kovačević declare that they have no competing interests.

Ethical standards

The ethics committee of the UCC Tuzla approved the research. We obtained the required ethics committee permission.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Čampara, A.J., Brkić, S., Cerovac, A. et al. Hemorrhage after adenotonsillectomy in children: tertiary center experiences. Wien Med Wochenschr (2022). https://doi.org/10.1007/s10354-022-00945-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10354-022-00945-y

Keywords

  • Anesthesiology
  • Palatine tonsil
  • Pediatrics
  • Postoperative complications
  • Surgery