Post-operative haemorrhage after acute bilateral tonsillectomy in patients with peritonsillar abscess: prevalence, treatment, risk factors, and side of bleeding

Abstract

Background: Bilateral quinsy tonsillectomy (QT) in patients with peritonsillar abscess (PTA) is associated with the risk of post-tonsillectomy haemorrhage (PTH) and current literature finds a significantly higher risk of PTH contralaterally to the quinsy.

Aims: To determine the prevalence of PTH in a large cohort of patients undergoing QT, explore risk factors for PTH, describe our methods of treatment, and evaluate if contralateral haemorrhage is more common than ipsilateral haemorrhage.

Materials & methods: All patients undergoing QT at Aarhus University Hospital in the period 2001–2017 were included in the study.

Results: One hundred sixteen of 1671 (6.9%) QT patients were admitted with PTH. PTH patients were significantly more frequently males (66%) and infected with Streptococcus group A (GAS) (31%) compared to QT patients without PTH (53% and 18%, respectively) (p = .005 and p = .002, respectively). Haemostasis was obtained in general anaesthesia (n = 61) or local anaesthesia (n = 28) and stopped spontaneously in 25 patients. The side of PTH was not associated with the side of PTA (ipsilateral (n = 41), contralateral (n = 43), and bilateral PTH (n = 23), p = .93).

Conclusions and significance: Our findings question if unilateral QT is preferable to bilateral QT when the PTA does not respond to conservative treatment, especially in males with GAS-positive PTA.

Chinese abstract

背景：对扁桃体周围脓肿（PTA）患者行双侧昆西扁桃体切除术（QT）带有扁桃体切除术后出血（PTH）风险。目前的文献发现, 与昆西扁桃体相反, PTH的风险明显更高。

目的：确定QT患者中PTH的发生率, 探讨PTH的危险因素, 描述我们的治疗方法, 并评估对侧出血是否比同侧出血更常见。

材料与方法：所有2001-2017年在奥胡斯大学医院接受QT的患者均被纳入本研究。

结果：1671例QT患者中116例（6.9%）发生PTH。发生PTH的QT患者与没有发生PTH的QT患者相比, 男性更常见（66%）, 且更易感染A组链球菌（31%）；后者的相应比率为53%和18%（P=.005；P=.002）。在全身麻醉（n=61）或局部麻醉（n=28）时止血, 并有25例患者自行止血。PTH侧与PTA侧无相关性（同侧（n=41）、对侧（n=43）、双侧（n=23）, p=0.93）。

结论和意义：根据我们的发现, 我们提出这一疑问：当PTA对保守治疗没有反应时, 单侧QT是否优于双侧QT, 尤其是在A组链球菌阳性的PTA男性中。

Keywords:

• Post-tonsillectomy haemorrhage
• acute tonsillectomy
• peritonsillar abscess
• quinsy
• microbiology
• risk factors

Disclosure of interest

No potential conflict of interest was reported by the authors.