Avoidance of Primary Post-tonsillectomy Hemorrhage in a Teaching Program
Stephen F. Conley, MD;
Matthew D. Ellison, MD
Arch Otolaryngol Head Neck Surg. 1999;125:330-333.
Objective To determine the incidence of primary post-tonsillectomy hemorrhage in a teaching institution by using a uniform technique, including a 3-minute relaxation of retraction before case termination and the use of bismuth subgallate.
Design Case series.
Setting Tertiary care academic pediatric center.
Patients A 7-year retrospective study was performed by using the medical records of 1286 children without a bleeding abnormality who underwent tonsillectomy (with or without adenoidectomy). A uniform technique, proposed to reduce hemorrhage, was used for 705 children and was not used for 581 children.
Results No episodes of primary hemorrhage (onset ≤24 hours after surgery) occurred, and the incidence of delayed hemorrhage (onset >24 hours after surgery) was 1.1% in the study group. The primary hemorrhage rate of the study group was significantly lower (P=.007) than the rate for the reference group (0.0% vs 1.0%), as was the total hemorrhage rate (1.1% vs 4.1%) and the delayed hemorrhage rate (1.1% vs 3.1%).
Conclusion A uniform technique including the use of bismuth subgallate and reassessment of the tonsillar fossae after a 3-minute observation period reduces the incidence of primary tonsillar hemorrhage in a teaching institution setting.
From the Departments of Otolaryngology and Human Communication (Drs Conley and Ellison) and Pediatrics (Dr Conley), Medical College of Wisconsin, Milwaukee.
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Liu et al.
Arch Otolaryngol Head Neck Surg 2001;127:1271-1275.
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