Tonsillectomy in regional Australia: Management and outcomes

Abstract

Post-tonsillectomy bleeding (PTB) is a potentially life-threatening complication of patients undergoing tonsillectomy. Rates of haemorrhage vary between studies and to date there are no studies investigating outcomes in a contemporary regional Australian setting. This study aims to determine the rate of PTB and to identify risk factors associated with PTB in a large regional centre in New South Wales, Australia. A retrospective review was conducted of all patients who underwent tonsillectomy performed at Wagga Wagga Base Hospital (WWBH) from January 2014 until June 2018. The demographics, type of operation, indication, primary operator and postoperative medications, were collected for all cases. In PTB cases we identified rates of primary and secondary bleeding, transfer time and method, subsequent management and geographical distance from WWBH. Multivariate logistic regression of the data was performed to identify risk factors. A total of 1,209 patients underwent tonsillectomy over the study period. Forty-five patients (4.0%) represented with PTB. The rate of primary and secondary bleeding was 1.0% (n=9) and 3.0% (n=36) respectively. A total of 3 patients (0.2%) required a return to the operating theatre and two patients required blood transfusion. Rates of PTB were not affected by sex, primary operator, operative technique, post-operative antibiotic, opiates or steroids. Multivariable analysis revealed increased risk of PTB with increasing age (OR =1.03; 95% CI: 1.01.1.06), larger tonsil size (OR =5.87; 95% CI: 1.31.26.3) and use of perioperative tranexamic acid (TXA) (OR =7.15; 95% CI: 2.36.21.6). The median time to transfer of patients presenting outside of Wagga Wagga was 4.1 hours. There was no increased risk of haemorrhage or complications when patients lived ≥100 km from WWBH. This study provides data on contemporary regional Australian practice and provides preliminary data on the safety of regional and remote management of post tonsillectomy bleeding in geographically spare health areas.