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Sean M. Demars, MD; Wayne J. Harsha, MD; James V. Crawford, MD

Arch Otolaryngol Head Neck Surg. 2008;134(8):811-814.

Objective  To evaluate the rate of posttonsillectomy hemorrhage and any change that smoking causes in patients who undergo tonsillectomy.

Design  Retrospective chart review.

Setting  Military tertiary referral center.

Patients  The study included 1036 adult patients who underwent tonsillectomy either alone or in conjunction with another procedure.

Main Outcome Measures  The rate of postoperative hemorrhage was reviewed in all patients who underwent tonsillectomy at our medical center, and an investigation was conducted to determine whether smoking caused any alteration in this rate.

Results  A total of 1010 patients were included in the study, with a total bleeding rate of 6.7%. There was a significant increase in the rate of bleeding in all patients when they were divided into smokers and nonsmokers (10.2% and 5.4%, respectively; P = .01). The large difference was found by subset analysis to be attributable to a marked increase in postoperative hemorrhage in the patients who underwent uvulopalatopharyngoplasty (10.9% in smokers vs 3.3% in nonsmokers; P = .006) and remained significant when they were further subdivided by sex. Men who underwent tonsillectomy alone also bled significantly more than women (11.2% and 5.4%, respectively; P = .02). All other subsets analyzed did not reach statistical significance.

Conclusions  Smoking does appear to increase the rate of posttonsillectomy hemorrhage in patients who undergo uvulopalatopharyngoplasty with tonsillectomy, but not in those who undergo tonsillectomy alone. This modifiable risk factor may help clinicians further counsel their patients before surgery, but further study is needed to ascertain that these findings apply to a broader patient base.

Author Affiliations: Departments of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington (Drs Demars, Harsha, and Crawford), and Mayo Clinic Arizona, Phoenix (Dr Harsha).

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