Variation in management of post-tonsillectomy haemorrhage: a survey of Australian Society of Otolaryngology Head and Neck Surgery Consultants and Registrars

Timothy J. Lee, John Wood, Eng H. Ooi

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Abstract

Background: The objective of this study was to assess the management of post-tonsillectomy haemorrhage (PTH). 

Methods: An anonymous, online, cross-sectional survey of Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) Consultants and Registrars was conducted with re-distribution two weeks later. Treatment decisions regarding three clinical scenarios of post-tonsillectomy haemorrhage for patients aged less than and more than six years old were presented to respondents. For each scenario a list of treatment options was presented for selection. SPSS version 27 (IBM) was used for statistical analysis. 

Results: One hundred and sixty-three out of the 565 members responded to our survey (29% respondent rate). The commonly selected options were obtaining bloods (78%), intravenous access (86%), intravenous fluids (60%), tranexamic acid (TXA) (59%), antibiotics (49%) and hydrogen peroxide gargles (31%), all of which were more likely to be used with severe bleeding. Respondents from Queensland were less likely to obtain bloods (42%) for patients presenting with no clot or active bleeding. However, clinicians from Queensland and Western Australia were more likely to use TXA (81% and 73% respectively) compared to the rest of the nation (49%). Registrars were more likely than consultants to take bloods and obtain intravenous access for those not actively bleeding but were less likely to prescribe antibiotics and suction tonsillar fossa clots. 

Conclusions: The findings from this study have demonstrated the common management options used by ASOHNS Consultants and Registrars for three scenarios of adult and paediatric patients presenting with PTH. Some findings are potentially due to local protocols. Responses demonstrate that there is variability in the management of PTH around Australia. The results could be used for the future development of an Australian or statewide consensus guideline regarding management of PTH.

Original languageEnglish
Article number21
Number of pages9
JournalAustralian Journal of Otolaryngology
Volume5
DOIs
Publication statusPublished - Aug 2022

Keywords

  • Adult
  • Pediatrics
  • Postoperative hemorrhage
  • Surveys and questionnaires
  • Tonsillectomy

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