Abstract
Objective: 1) Assess risk factors for the frequency of postoperative hemorrhage. 2) Apply a new classification of postoperative hemorrhage using a clear definition and 7 grades depending on severity. 3) Assess multiple bleeding episodes after tonsil surgery.
Method: The study is based on a complete census of tonsillectomies (TE), tonsillotomies (TO), and adenoidectomies (AE) within 9 months in Austria. Postoperative hemorrhage was defined as every bleeding episode after extubation and classified in grades A1, A2, B1, B2, C, D, and E according to severity and the treatment needed.
Results: Included were 9,405 patients: 48.5% TE with or without (±) AE, 37.1% AE, and 14.0% TO ± AE. Postoperative hemorrhage was far more frequent for TE than for TO or AE (P < .001). A return to theater was necessary for 4.6% after TE. Adults had a significantly higher risk of postoperative bleeding than children for all types of surgeries (P < .05). Males had a significantly higher risk of postoperative bleeding episodes (P < .05). The “hot” operation techniques (bipolar diathermy or Coblation) showed a significantly increased risk of hemorrhage (P < .05). The evidence of a light bleeding episode increased the risk of a severe bleeding episode (P < .05).
Conclusion: Assessing all grades of postoperative hemorrhage offers a far more precise picture about postoperative bleeding. Risk factors for postoperative hemorrhage have been the type of surgery, age, and operation technique.
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