Abstract
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.
Key words: tonsillectomy, bleeding, post operative pain