Post-Tonsillectomy and post-adenoidectomy Hemorrhage in Children

Tonsillectomy (removal of the tonsils) and adenoidectomy (removal of the lymphoid tissue in the back of the nose) are two of the most common surgeries in Pediatric Otolaryngology (Ear, Nose, Throat Surgery). Both are relatively simple surgical procedures conducted under general anesthesia. However, complications can arise in the form of bleeding either immediately post-operation or up to 9 days post-operation. The incidence of post-operation bleed then becomes a crucial factor in deciding where to have the operation.

A Clinical Audit was conducted to establish the rate of post-operative hemorrhage, both primary (directly from operation) and secondary (not directly from operation), in pediatric tonsillectomies and adenoidectomies over a ten-year period from January 1998 to December 2007. The audit revealed 2,104 consecutive tonsillectomy cases and 1,174 consecutive adenoidectomy cases.

A low post-operative hemorrhage rate of 0.95% for tonsillectomy and 0.93% for adenoidectomy were observed. Of the 2,104 tonsillectomies, there were 20 cases of hemorrhage, of which 12 were primary hemorrhage and eight were secondary hemorrhage. Of the 1,174 adenoidectomy cases, there were 11 cases of hemorrhage.

The over-all hemorrhage rates for both pediatric tonsillectomy and adenoidectomy is vastly lower than that reported in other similar audits and studies (Local and Western: 1.5% to 3.9%). This could be due to advanced surgical equipments, high level of competency of the surgeons and medical staff, as well as good post-operative management and follow-ups.

References

Ranjit, S, RH Brett, PKS Lu, CY Aw. "The Incidence and Management of Post-Tonsillectomy Haemorrhage: A Singaporean Experience." Singapore Medical Journal 40(1999)

Granell, J, P Gete, M Villafruela, C Bolaños, JJ Vicent. "Safety of outpatient tonsillectomy in children: a review of 6 years in a tertiary hospital experience." Otolarnygology Head and Neck Surgery 131(2004): 383-7.

Kendrick D, Gibbon K. “An audit of the complications of paediatric tonsillectomy, adenoidectomy and adenotonsillectomy.” Clinical Otolaryngology 1993; 18:115-7.

Lalakea , ML, I Marquez-Biggs, AH Messner. "Safety of pediatric short-stay tonsillectomy." Arch Otolarnygology Head and Neck Surgery 125(1999): 749-52.