1. Introduction
Tonsillectomy is one of the most common surgical procedures worldwide.
According to the most recent National Health Statistics Report,
published in 2017, over 390,000 tonsillectomies were performed in United
States, 102,000 of them were in ages 15-44 years old [1]. The most
common indications for tonsillectomy in adults are recurrent throat
infections (with or without suppurative complications such as
peritonsillar abscess), sleep-disordered breathing and obstructive sleep
apnea (OSA) [2].
Tonsillectomy can be performed through several techniques; Cold
dissection techniques uses sharp dissector with a tonsil knife, scalpel
and scissors, while hot dissection make use of cautery. Hot techniques
may be associated with increased postoperative pain and longer healing
times [3-4]. Radiofrequency ablation (i.e, coblation) is a technique
which uses lower temperatures giving rise to less thermal injury and
potentially less postoperative pain. A Cochrane review of 9 trials that
compared coblation with other techniques found no significant
differences in pain and speed of recovery between the different
techniques [5].
The most common post-tonsillectomy complications are nausea and
vomiting, dehydration, pain and bleeding. Post-tonsillectomy bleeding
(PTB), the most significant complication, usually occurs in 0.28% to
20% of cases [6] and may rarely lead to suffocation, airway
obstruction, hemorrhagic shock and death [7]. Primary PTB occurs
within the first 24 hours and is usually related to surgical technique,
while delayed bleeding occurs later, usually within the first 10
days—most commonly on the sixth or seventh day and is attributed to
the slough of eschar [8].
Studies suggested that risk factors for PTB are indication for surgery,
obesity, surgical technique and smoking status, amongst others
[9-18]. However, only a few of these studies were conducted in the
adult population.
Post-operative pain was shown in the pediatric population to be
associated with increased PTB risk [20-24]. There have been no
studies examining this correlation in the adult population. The aim of
our study was to delineate the risk factors for PTB in the adult
population, with special emphasis on post-operative pain scores.