Adults bleed more after tonsillectomy, and later

Design

Single-centre retrospective study (2015 to 2024) with multivariable regression

Population

945 tonsillectomy patients (85.7% paediatric)

Primary outcome

Prevalence of and risk factors for post-tonsillectomy haemorrhage

Effect

2.65% overall; adults 7.4% vs children 1.9%; adult age adjusted odds ratio 2.93 (95% CI 1.17-7.36)

Post-tonsillectomy haemorrhage is the complication that defines consent and aftercare for this common operation. This single-centre review of 945 tonsillectomies over ten years quantified how often it happens and who is at risk.

Haemorrhage occurred in 2.65% of patients (95% CI 1.7 to 3.9), and 92% were secondary, clustering around postoperative day 7. The clear risk marker was age: adults bled far more than children (7.4% vs 1.9%), and adult age was the only independent predictor (adjusted odds ratio 2.93, 95% CI 1.17 to 7.36). Sex, operative time, the operating surgeon, concurrent procedures and routine preoperative labs showed no independent association. One in five of those who bled needed a transfusion.

The practical message is to counsel and watch adults more closely. Warn every patient that secondary bleeding typically comes around a week out, when they are home, and give clear return instructions, with a lower threshold for review and admission in adult patients.

• Single-centre review of 945 tonsillectomies: haemorrhage in 2.65%, and 92% were secondary.
• Secondary bleeds clustered around postoperative day 7, after discharge.
• Adults bled far more than children (7.4% vs 1.9%); adult age was the only independent predictor (adjusted odds ratio 2.93).
• Sex, operative time, surgeon, concurrent procedures and routine labs were not independent predictors.
• Counsel all patients about day-7 bleeding and watch adults more closely.

Why it matters

It sharpens consent and aftercare by pinning the risk to adult age and the second postoperative week, when the patient is already home.

Don't overread it

This was a single-centre retrospective study with relatively few adult patients, so the exact adult risk estimate is imprecise.

The statistics, in plain English

The adult odds ratio of 2.93 with an interval from 1.17 to 7.36 is significant but wide, reflecting few adult bleeds in a mostly paediatric cohort, so the size of the adult excess is uncertain even though its direction is clear.

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