Adults bled four times as often as children after tonsillectomy, mostly around day 7

Design

Retrospective single-centre cohort

Population

945 tonsillectomy patients, 85.7% children

Primary outcome

Post-tonsillectomy haemorrhage

Effect

2.65% overall; adults 7.4% vs children 1.9%; adjusted OR 2.93 (1.17 to 7.36)

This retrospective study reviewed all 945 tonsillectomies at a Lebanese tertiary centre from 2015 to 2024, most in children (mean age 8.7 years). Haemorrhage needing medical evaluation occurred in 2.65% (95% CI 1.7 to 3.9). Nearly all bleeds (92%) were secondary, typically around the seventh postoperative day.

Adults bled more than children (7.4% vs 1.9%), and adult age was the only independent predictor (adjusted OR 2.93, 1.17 to 7.36). Sex, operative time, surgeon, concurrent procedures, histology and routine preoperative blood tests showed no association. One in five patients who bled needed transfusion.

The practical lesson is that routine coagulation screening did not predict bleeding, while age did. Adults need specific counselling about the day-5-to-10 window and a clear route back to hospital.

• Counsel adults that their bleeding risk is several times that of children
• Warn all patients that most bleeds happen around day 7, after they are home
• Give a written plan: any fresh bleeding means return to hospital immediately
• Routine preoperative blood tests did not predict bleeding in this cohort
• GPs seeing post-tonsillectomy patients should refer any bleed, however small

Why it matters

The risk peaks after discharge, when the patient's understanding decides how fast they return.

Don't overread it

A single-centre retrospective series with only 25 bleeds; the risk factor analysis has limited power.

The statistics, in plain English

An adjusted odds ratio of 2.93 with an interval of 1.17 to 7.36 is wide because there were few bleeds; adult risk is clearly higher, but by how much is uncertain.

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