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Surgical techniques and post-tonsillectomy haemorrhage

Sergio Motta, Domenico Testa, Brillante Ferrillo, Eva Aurora Massimilla, Roberto Varriale, Teresa Barrella3, Giovanni Motta, Gaetano Motta

Purpose: Some controversies have recently arisen regarding the frequency of post-operative haemorrhagic complications in relation to the surgical procedures adopted for tonsillectomy. The authors set out to verify the relationship between different surgical techniques and postoperative haemorrhage based on the analysis of data derived from multi-centric studies appeared in the last fifteen years. Materials and methods: Multi-centric English and Italian studies pertaining to the frequency of post-tonsillectomy haemorrhage secondary to different surgical techniques published between 2000 and 2015 were selected. The data relevant to post-surgical haemorrhagic complications were elaborated by ANOVA test. Results: Eight multi-centric studies were analysed. The mean frequency of post-tonsillectomy haemorrhage was: 1.13% for primary haemorrhage, 5.37% for secondary haemorrhage and 6.5% as overall for cold dissection and cold haemostasis; 0.99% for primary haemorrhage, 2.91% for secondary haemorrhage and 3.9% as overall for cold dissection with hot haemostasis; 1.31% for primary haemorrhage, 7.38% for secondary haemorrhage and 8.69% as overall for hot dissection with hot haemostasis. Statistical comparison did not show significant differences between the frequencies of post-tonsillectomy primary, secondary and total haemorrhage in relation to the surgical techniques employed. Conclusion: A great variability in the frequency of haemorrhagic complications reported in the selected articles was found, regardless of the surgical technique employed. These findings, together with lack of a statistically significant difference in post-tonsillectomy haemorrhage between the techniques employed, must be carefully considered by professionals involved in health organization in clinical wards and the relative problems linked to medical liability.