Watch-and-wait procedure after spontaneously stopped postoperative tonsillectomy haemorrhage triples the risk of recurrence

Post-operative bleeding after tonsillectomy is one of the most common emergencies in otolaryngology and ranges from discreet spotting to life-threatening situations. Depending on the severity of the bleeding, either a watch-and-wait procedure, a local treatment in the examination chair or surgical hemostasis under general anesthesia can be performed. The aim of this retrospective work was to find out whether one of these therapeutic strategies is superior to the others.

With the help of the hospital information system all inpatient cases with treatment of postoperative tonsillectomy haemorrhages from 2015 to 2020 were identified. This included bleedings after tonsillectomy in domo as well as externally pre-operated patients.

A total of 239 postoperative tonsillectomy haemorrhages were analyzed in 191 patients (78 internal, 113 external). In both groups the bleeding maximum was at the 6^th to 8^th postoperative day. 134 patients had a single bleeding event; 57 experienced this complication several times. In 31.0 %  the bleeding stopped spontaneously with no detectable source of bleeding. In 40.6 %  local measures ended the bleeding and in 28.5 %  a treatment under general anesthesia was performed. The risk of rebleeding after spontaneous stopping was significantly increased by 36.5 %  (p < 0.01). With the other procedures, the risk was lower at 13.4 % , and 11.8 % .

Without intervention, the risk of recurrent bleeding is more than three times higher. Therefore, even in such apparently mild cases of postoperative bleeding after tonsillectomy, inpatient monitoring is indicated. Although surgical treatment under general anesthesia offers more intervention options clinically, local measures are comparably effective if the patient is compliant.

Poster-PDF A-1090.pdf

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publication History

Article published online:
13 May 2021