[Hemorrhage after tonsillectomy. Analysis of 229 cases].

BACKGROUND: In Germany a hospital stay of 6 days following tonsillectomy is recommended. Our retrospective study aimed to evaluate the incidence of hemorrhage following tonsillectomy with regard to the safety of a shorter hospital stay. PATIENTS AND METHODS: 5474 patients of our clinic who underwent tonsillectomy between 1988 and 1998 were enrolled in our study. Additionally, 65 patients with hemorrhage following tonsillectomy elsewhere were included.
RESULTS: Postoperative hemorrhage occurred in 145 (2.65%) of our patients, 7 patients underwent recurrent treatment, in 97% suture ligation was sufficient. Primary bleeding (< 24 h) occurred in 79.7% of our patients. A 42-month old boy died at home due to massive bleeding 6 days following surgery. In this particular case, we strictly recommended postpone dismission because the boy had recurrent episodes of bleeding the days before. Postoperative hemorrhage after tonsillectomy performed elsewhere had to be treated in most cases 7-8 days postoperatively. Suture ligation of bleeding vessels was not sufficient in 21% and ligature of the external carotid artery mandatory. In these cases were usually found signs of deep necrosis.
CONCLUSION: Due to the risk of life-threatening bleeding tonsillectomy should be performed as an inpatient procedure. The time of hospital stay should be related to the results obtained by self-evaluation and definition of risk factors. Readmission of patients with hemorrhage after dismission should be recommended. The follow-up has to be extended as long as the healing process continues.