- Design
- Single-centre retrospective cohort, 2015–2024
- Population
- 945 patients having tonsillectomy (86% children)
- Primary outcome
- Post-tonsillectomy haemorrhage needing medical evaluation
- Effect
- 2.65% overall; adults 7.4% vs children 1.9%; adjusted OR 2.93 (1.17–7.36)
This ten-year retrospective cohort included 945 tonsillectomies at a Lebanese tertiary centre (mean age 8.7 years; 86% children). Bleeding requiring medical evaluation occurred in 25 patients, 2.65% (95% CI 1.7–3.9).
Ninety-two per cent of bleeds were secondary, usually around postoperative day 7, and five of the 25 patients needed transfusion. Adults bled more often than children (7.4% vs 1.9%), and adult age was the only independent predictor (adjusted OR 2.93, 1.17–7.36). Sex, operative time, operating surgeon, concurrent procedures, histology and routine preoperative laboratory values were not associated with bleeding.
Two things follow for practice. Adults need to be counselled with their own, higher risk rather than paediatric figures. And because most bleeds happen a week after discharge, patients and families — and the general practitioners they see first — need to know that any bleeding in the second week needs same-day ENT assessment. The finding that routine preoperative coagulation tests did not predict bleeding also supports not ordering them without a clinical indication. This is a single-centre retrospective study with few events.
- Quote adults a bleeding risk several times higher than for children during consent
- Tell every patient that bleeding is most likely around day 5 to 10
- Give written instructions to attend immediately for any fresh bleeding, however small
- Make sure adults can reach a hospital with ENT cover during the second postoperative week
- Take a bleeding history rather than relying on routine coagulation screens
Why it matters
Most bleeds happen at home a week later, and adults carry the greatest risk.
Don't overread it
One centre and 25 bleeds — the absence of association with surgeon or technique does not show those factors are irrelevant.
The statistics, in plain English
An adjusted odds ratio of 2.93 with an interval from 1.17 to 7.36 is clearly above 1 but imprecise, because there were only 25 bleeds. With so few events, the study could miss real but modest effects of other factors such as surgical technique.
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