POSSIBLE RISK FACTORS AFFECTİNG POST-TONSİLLECTOMY BLEEDING
Dr. Ersin Akçam, MD* and Abdullah Belada MD
Objective: This study aims to identify the risk factors for post-tonsillectomy hemorrhage (PTH). Materials and Methods: A retrospective analysis was conducted on 776 patients (624 children, 152 adults; 425 males, 351 females) who underwent tonsillectomy at the Düzce University Faculty of Medicine ENT Clinic between 2013 and 2018. Patients were evaluated based on age, gender, indication for surgery, tonsil size, presence of chronic diseases, and preoperative hemoglobin, platelet, and INR levels. Tonsillectomies were performed under general anesthesia using the cold dissection technique, with hemostasis achieved via bipolar cautery and suture ligation. PTH was managed with conservative or surgical methods. Statistical analysis was performed using Pearson Chi-square, Fisher-Freeman-Halton, and Fisher Exact tests (p<0.05 was considered significant). Results: The overall PTH incidence was 2.7% (0.14% in children, 7.8% in adults). Among 21 patients with PTH, 3 (14.2%) had primary hemorrhage, and 18 (85.8%) had secondary hemorrhage. In adults, the PTH rate was significantly higher in males (12%) compared to females (2.9%) (p=0.037). No significant association was found between PTH and indication for surgery, tonsil size, chronic diseases, or hematological parameters. Conservative treatment was applied in 52.3% of cases, while 47.7% required surgical intervention. The mean time to presentation was 5.5 days. Conclusion and Recommmendations: Adult age and male gender are risk factors for PTH. Early diagnosis, hospitalization, intravenous access, and laboratory tests are critical in PTH management. Careful patient selection and postoperative follow-up are essential.
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