Tonsillectomy in Adults -- Increased Pain Scores are Correlated with
Risk of Bleeding
Objective: Tonsillectomy is one of the most common surgeries worldwide,
mostly indicated for recurrent throat infections and sleep-disordered
breathing. The most significant complication is post-tonsillectomy
bleeding. Although several risk factors for post-tonsillectomy bleeding
in adults have been described, the role of post-operative pain as a risk
factor for hemorrhage has not been described in this patient population.
Design: Retrospective cohort study of adult patients (18 years and
older) who underwent tonsillectomy in a tertiary referral center.
Multi-variable logistic regression model was used to test correlation
between the independent variables and post-tonsillectomy bleeding.
Results: 305 patients (male to female ratio 1:1) with a mean age of 30.5
years old (18-82, ± 12). Mean body mass index was 26.6 (16-42, ±5) and
13% of patients were current smokers. Post-tonsillectomy pain on
post-operative day 1 and 2 was associated with increased risk of
bleeding (adjusted odds ratio 2.18, 95% confidence interval 1.73-2.44).
Other factors that were associated with increased risk of
post-tonsillectomy bleeding were male sex, young age (18-30 years old),
smoking, recurrent throat infections as an indication for surgery and
the usage of hot technique (p < 0.05). Conclusions: Increased
post-operative pain following tonsillectomy is associated with increased
risk of bleeding in adults. Other factors such as younger age group,
males, smoking, previous throat infections and using hot dissection
technique are also associated with risk of post-tonsillectomy bleeding.
Further studies should explore the effect of strict pain control
regimens on post-tonsillectomy bleeding in adults.