Post-tonsillectomy hemorrhage: cost-benefit analysis of prolonged hospitalization

Abstract

Background: Prolonged hospitalization after tonsillectomy up to three nights was implemented to decrease mortality due to post-tonsillectomy hemorrhage.

Aims: To assess if extension of postoperative inpatient observation time from one to three nights results in potential benefits following tonsillectomy.

Subjects and methods: Patients who stayed only one night post-tonsillectomy between 1994 and 2006 (Group A) were compared to 1570 patients who stayed three nights postoperatively between 2008 and 2016 (Group B). Complication rate and expense of hospitalization were compared.

Results: Published data show that 114 (1.78%) out of 6400 patients in group A had post-tonsillectomy hemorrhage. In this patient group 75.4% (n = 86) of all bleedings occurred after discharge from hospital. However, in group B post-tonsillectomy hemorrhage occurred in 70 (4.5%) and of those only 0.38% (n = 6) developed bleeding episodes on the second or third postoperative day (POD). As observed in group A, the majority of hemorrhage (n = 57; 81.4%) was observed after discharge. Cost analysis reveals a difference of approximately 6 million €for all 32 ENT departments per year in Austria.

Conclusions and significance: Extending postoperative hospitalization from one to three nights reveals no benefit after tonsillectomy. Comparison reveals substantial increase of costs for an extended 3 nights inpatient stay.

Chinese abstract

背景：扁桃体摘除术后延长住院时长至三晚, 以降低扁桃体摘除术后出血所致的死亡率。

目的：评估扁桃体切除术后将住院病人的观察时间从一晚延长到三晚是否有潜在的益处。

研究对象和方法：将1994年至2006年在扁桃体切除术后仅住院一晚的患者（A组）与1570名在2008年至2016年之间术后住三晚的患者（B组）进行比较。比较并发症发生率和住院费用。

结果：已发表的数据显示, A组的6400例患者中有114例（1.78％）发生扁桃体切除术后出血。在该患者组中, 所有出血患者中有75.4％（n¼86）在出院后发生。然而, B组扁桃体切除术后出血发生于70个（4.5％）患者, 其中只有0.38％（n¼6）在术后第二天或第三天发生出血。正如在A组中所观察到的, 大多出血发生在出院后（n¼57； 81.4％）。成本分析显示, 奥地利所有32个ENT部门每年约有600万e的差额。

结论和意义：扁桃体摘除术后将住院时间从一晚延长至三晚并无益处。通过比较表明, 延长住院三晚的费用会大幅增加。

Keywords:

• Post-tonsillectomy hemorrhage
• cost-benefit analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical considerations

The Medical University of Vienna Ethics Committees approved the study (1816/2017). All procedures were in accordance with the Declaration of Helsinki of 1975. This work was not funded and the authors declare no conflict of interest.