• Stephanie Sarny, Guenther Ossimitz, Walter Habermann, and Heinz Stammberger.
• Department of General Otorhinolaryngology-Head and Neck Surgery, Medical University Graz, Austria. stephanie@sarny.at
• Laryngoscope. 2011 Dec 1;121(12):2553-60.

Objectives/HypothesisPostoperative hemorrhage as a serious complication after tonsillectomy (TE), tonsillotomy (TO), or adenoidectomy (AE) is covered in many studies, using rather inconsistent measurement methods. We introduce a new classification for the severity of postoperative hemorrhage and investigate risk factors for the frequency and severity of bleeding episodes.Study DesignProspective, multicenter cohort study.MethodsOur study is based on a prospective census recording all TEs, TOs, and AEs from October 1, 2009, to June 30, 2010, in Austria. Information concerning surgery indication, grade of surgeon, operation technique, and postoperative hemorrhage, classified as any bleeding episode after extubation according to severity, were collected.ResultsA total of 9,405 patients were included. Hemorrhage rate for TE ± AE was 15.0%, for TO ± AE was 2.3%, and for AE was 0.8%. Rate of return to the operating room for TE ± AE was 4.6%, for TO ± AE was 0.9%, and for AE was 0.3%. Minor bleeding episodes increased the risk of a subsequent severe bleeding episode (P < .001). Elevated hemorrhage rates were observed for adults (P < .001), TE ± AE (P < .001), and cold steel dissection combined with bipolar diathermy (P = .05). Multivariate logistic regression model for the frequency of post-TE hemorrhage showed significant odds ratios for males, children aged <6 years, children aged 6-15 years, abscess TE, and cold steel combined with bipolar diathermy. In addition, we found a significantly higher risk of severe bleeding episodes for children aged 6-15 years (P = .007), males (P = .02), and all bipolar operation techniques (P = .005).ConclusionsThe occurrence of a postoperative minor bleeding episode increases the risk of a subsequent severe bleeding episode.Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

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