Management of post tonsillectomy secondary haemorrhage: Flinders experience

Background: Secondary post tonsillectomy haemorrhage (sPTH) is a significant complication in Otolaryngology. Most studies have focussed on different risk factors associated with sPTH. However, few studies have reported on the outcomes of sPTH after presentation to a tertiary public hospital. We sought to present our experience with the management of sPTH. 

Methods: A retrospective review of all patients (n=145) presenting with a sPTH to Flinders Medical Centre (FMC) was analysed over a two-year period. The Stammberger grade for sPTH was applied and recorded in the case notes at presentation of all patients. 

Results: 59% of these patients were adults. Overall, 79% of patients were conservatively treated and discharged safely without returning to the operating theatre. Adults were marginally more likely to return to theatre (RTT) with a relative risk (RR) of 1.07 (CI 0.5-2.3). Patients who had coblation (COB) tonsillectomy had a higher RR of RTT (RR =1.45) compared to cold steel (CS) tonsillectomy. Patients who had a COB tonsillectomy (16.6%) were also more likely represent with a second bleeding episode compared to CS tonsillectomy (9.8%). The length of stay (LOS) was significantly longer (13 hours) in adults with Stammberger grade C sPTH (P<0.05) compared to grade A1 sPTH, with other factors having no significant effect on LOS. 

Conclusions: The overall risk of a second bleeding episode is low in patients with sPTH, and conservative management in the first instance is safe. Patients with a COB tonsillectomy are likely to present with multiple episodes of sPTH if initial management was conservative. Stammberger grade at initial sPTH presentation is not predictive of subsequent presentations.