Postoperative bleeding after tonsillectomy–a risk factor study on 28,254 patients

Abstract

Background: Postoperative bleeding after tonsillectomy is a potentially serious complication. Cold techniques reduce bleeding risks, but hot techniques remain widely used, reflecting national variations in clinical practice. Aims/objectives: This study aimed to investigate postoperative bleeding rates after tonsillectomy and their correlation with demographic factors and surgical and haemostatic techniques, using data from national tonsil surgery registries in Norway and Sweden. Materials and methods: A prospective cohort study included 28,254 tonsillectomies (2017–2022), with patients completing a 30-day postoperative questionnaire. Data on indication for surgery, surgical and haemostatic technique and postoperative bleeding were analyzed using multivariate logistic regression. Results: Postoperative bleeding was reported in 7.2% of the patients, with higher rates in Norway (8.1%) compared to Sweden (6.3%). A hot + hot technique significantly increased the bleeding risk (OR 3.64), while the cold + cold technique had the lowest rate. Patients aged 19–24 years and males had higher bleeding risks. Conclusions and significance: The cold + cold technique significantly reduces postoperative bleeding, but the cold + hot technique remains the most utilized approach. Norway performed more surgeries in high-risk age groups and had less frequent use of the cold + cold technique compared to Sweden. Increased adoption of the cold + cold technique may improve outcome in tonsil surgery.