Post Tonsillectomy Bleeding among Children in a Tertiary Hospital in the Kingdom of Bahrain: Two Years Experience

Background: Palatine tonsils are part of the immune system located within the Waldeyer’s ring, they are prone to infections, hypertrophy or both. These conditions are known as tonsil diseases that usually require surgical removal through tonsillectomy. Tonsillectomy is one of the most common procedures done for children but it is challenged by the occurrence of complications, especially post tonsillectomy bleeding (PTB). In the current study, the incidence of post tonsillectomy bleeding in children younger than 14 years undergoing tonsillectomy in Salmaniya Medical Complex is evaluated and their demographic data and risk factors are assessed. Method: Pediatric patients who are younger than 14 years with postoperative tonsillectomy bleeding that were treated in Salmaniya Medical Complex between the period of January 2018 and December 2019 were retrospectively studied for risk factors. Results: A total of 1161 patients within the age range of 2 - 13 years old underwent tonsillectomy in Salmaniya Medical Complex from the period of January 2018 to December 2019. Twenty-eight pediatric patients had post-tonsillectomy bleeding (PTB) during the study period with an incidence of 2.4% of the total number of pediatric tonsillectomies done in our institute. The majority were male patients and the mean age was 6.2 years. The main indication of tonsillectomy for those with bleeding was recurrent tonsillitis. A second surgery was needed in 64.5% to control the bleeding. The size of the tonsil, the level of the surgeon and the season at which the tonsillectomy was done did not seem to have any effect on the incidence of post-tonsillectomy bleeding (PTB). Conclusion: The incidence of post tonsillectomy bleeding (PTB) in Salmaniya Medical Complex is 2.4%, which makes it a common complication for a common surgery irrelevant to any patient, surgeon or climate related factors.

Incidence of Hemorrhage after ENT Procedures and Seasonal Variation: A Retrospective Study and Literature Review

Background: Ear, nose, throat procedures are the most performed procedures for adults and children per year. Doctors might have noticed that at certain times of the year, there would be an increase in admissions of post tonsillectomy bleeding or epistaxis after nasal surgeries. Objectives: To determine whether a correlation exists between season and the rate of hemorrhage presentation after ear, nose, throat procedures. Methods: A 12-year retrospective review from January of 2003 to June of 2015, involving 1032 patients who developed secondary hemorrhage following ear, nose, throat related surgeries. We analyzed the presentation of hemorrhage in relation to the month of admission. Meteorological data were obtained from the Meteorological directorate of Bahrain. Results: Post-Operative Hemorrhage occurred in (1032) patients. The season and air temperature had a significant influence on secondary post-tonsillectomy hemorrhage and post-septoplasty epistaxis according to the age with a significant increase in their rate during the summer months (p < 0.05). Conclusion: The incidence of hemorrhage showed monthly and seasonal variations. This is clearly a multi-factorial problem. However, in patients at high risk of bleeding, consideration should be given to performing surgeries at a time of year of lower rates.