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Abstract
To date there exists no sensible way of classifying the intensity of haemorrhage following tonsillectomy, though this is a prerequisite when comparing the results presented in literature. We evaluated the incidence of post-operative haemorrhage according to our classification in 602 patients who underwent tonsillectomy at our department in 1999. In 21 patients a grade 1 (spontaneous cessation) bleeding occurred. One patient had a grade 2 (infiltration anaesthesia), 14 patients had a grade 3 bleeding (treatment under general anaesthesia) with one patient receiving a blood transfusion. Two patients had a grade 4 bleeding (ligature of the external carotid artery). There was no patient with grade 5 bleeding (lethal outcome). Grades 1 and 3 had the same incidence rates. Primary haemorrhage (<24 hours) can be expected in the majority of patients undergoing tonsillectomy. Secondary haemorrhage is rare and can be life-threatening.
Key words: Tonsillectomy, complications
Introduction
Tonsillectomies are one of the most frequently performed surgical procedures in otolaryngology to resolve upper airway obstruction and recurrent or chronic throat infections and to manage recurrent childhood ear disease. Despite numerous efforts, haemorrhage is the most common and significant complication following tonsillectomy, occurring in less than 10 per cent of cases, most often within 24 hours, although it can occur at any time during the first two weeks.1
Mainly for economic reasons, tonsillectomies are increasingly performed on an outpatient basis after careful patient selection.2-4 The AAO-HNS Pediatric Otolaryngology Committee published inpatient guidelines that may indicate overnight observation. Among these are age three years or less, abnormal coagulation values, peritonsillar abscess and obstructive sleep apnoea. 5
In the literature, classification of post-operative haemorrhage as primary (<24 hours) or secondary (>24 hours) has been well established, although the terms are used loosely with confusion and are mixed with the term reactionary haemorrhage (which can be intra-operative or primary haemorrhage) .6 Unfortunately there exists no common classification for the intensity of post-operative haemorrhage, which makes the results of studies difficult to compare. The rate of post-operative haemorrhage in studies where any incidence of bleeding has been registered will obviously be much higher than in those where bleeding was only registered if treatment under general anaesthesia was necessary. We conducted this study in order to evaluate the incidence rates of haemorrhage following...