Incidence and patterns of post-tonsillectomy hemorrhage in paediatric patients: a hospital-based study

M. Shafiqul Islam; Sazzadul Haque; M. Mamunur Rashid; M. Abul Kashem; M. Samiul Hasan

doi:10.18203/2320-6012.ijrms20262164

Authors

M. Shafiqul Islam Department of ENT, Dhaka Residential Model College Medical Centre, Dhaka Central International Medical College and Hospital, Dhaka, Bangladesh
Sazzadul Haque Department of ENT and Head-Neck Surgery, Monno Medical College Hospital, Manikganj, Bangladesh
M. Mamunur Rashid Department of ENT, Dhaka Central International Medical College and Hospital, Dhaka, Bangladesh
M. Abul Kashem Department of ENT, 250 Bedded General Hospital, Meherpur, Bangladesh
M. Samiul Hasan Department of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20262164

Keywords:

Bangladesh, Surgical complications, Risk factors, Secondary hemorrhage, Post-tonsillectomy hemorrhage, Pediatric tonsillectomy

Abstract

Background: Post-tonsillectomy hemorrhage (PTH) is a potentially serious complication in pediatric patients, contributing to increased morbidity, hospital readmission, and healthcare burden. Its incidence and clinical patterns vary depending on multiple patient- and procedure-related factors, particularly in developing healthcare settings. The aim of the study was to determine the incidence and patterns of PTH in pediatric patients and evaluate associated risk factors, timing, severity, and management outcomes.

Methods: This hospital-based observational study was conducted over 1 year in a tertiary care hospital in Bangladesh, including 220 pediatric patients who underwent tonsillectomy. Data were collected using a structured format covering demographic variables, type and timing of hemorrhage, severity, clinical presentation, management strategies, and associated risk factors. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26, with results expressed as frequency and percentage. A p≤0.05 was considered statistically significant.

Result: The mean age of patients was 8.6±3.2 years, with a male predominance (60.00%). Secondary hemorrhage (90.91%) was more common than primary hemorrhage (9.09%), most frequently occurring on days 5-10 (58.00%). Mild hemorrhage accounted for 46.36% of cases, while 10.91% required surgical intervention. Oral bleeding was present in 100.00% of patients, followed by blood-stained saliva (71.82%) and hematemesis (25.45%). Conservative management was sufficient in 46.36% of cases, whereas 12.73% required blood transfusion. Major associated risk factors included Diathermy technique (45.45%), infection (40.00%), and dehydration (32.73%).

Conclusion: Post-tonsillectomy hemorrhage is predominantly secondary in nature, with identifiable risk factors and varied clinical severity. Early recognition, improved surgical techniques, and effective postoperative care are essential to minimize complications and enhance pediatric patient outcomes.

References

Windfuhr JP, Chen YS. Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients. Ear Nose Throat J. 2002;81(9):626-34.

Handler SD, Miller L, Richmond KH, Baranak CC. Post‐tonsillectomy hemorrhage: incidence, prevention and management. Laryngosc. 1986;96(11):1243-7.

Tuhin MH, Islam GM, Hassan MF, Mahmud K, Faisal KA, Nashid NH et al. Incidence of Secondary Hemorrhage after Tonsillectomy by Dissection Method and Diathermy (Unipolar) Method. Insight. 2023;6(2):156-63.

Mohammadpour-Maleki A, Rasoulian B. Post-tonsillectomy hemorrhage: a seven-year retrospective study. Iran J Otorhinolaryngol. 2021;33(118):311.

Alsalamah S, Alraddadi J, Alsulaiman A, Alsalamah R, Alaraifi AK, Alsaab F. Incidence and predictors of readmission following tonsillectomy in pediatric population. Int J Pediatr Otorhinolaryngol. 2024;177:111859.

Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. 1998;118(1):61-8.

Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M. Risk factors for postoperative hemorrhage following tonsillectomy. Laryngosc. 2011;121(2):279-88.

Bhattacharya P, Shankar L, Manjila S, Chaturvedi S, Madhavan R. Comparison of outcomes of nonsurgical spontaneous intracerebral hemorrhage based on risk factors and physician specialty. J Stroke Cerebrovasc Dis. 2010;19(5):340-6.

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160:S1-42.

Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2017;156(3):442-55.

Ünsal N, Baldır EH, Bulut Çöbden S, Kantekin Y, Kaya A, Yaşar M, et al. Retrospective Analysis of Hemorrhage After Pediatric Tonsillectomy. Turk Arch Otorhinolaryngol. 2025;63(2):75-9.

Billings KR, Ghadersohi S, Fawcett AJ, Hazkani I. A Scoping Review of Recurrent Post-Tonsillectomy Hemorrhage in Children. Laryngoscope. 2026;136(5):2026-33.

Alenezi MM, Al-Harbi FA, Almoshigeh AN, Alruqaie SS, Alshahrani NM, Alamro AM, et al. Comparison of post-tonsillectomy hemorrhage rate after different tonsillectomy techniques: systematic review and meta-analysis. Clin Pract. 2025;15(5):85.

Windfuhr JP, Ulbrich T. Post-tonsillectomy hemorrhage: results of a 3-month follow-up. Ear Nose Throat J. 2001;80(11):790-802.

Chowdhury K, Tewfik TL, Schloss MD. Post-tonsillectomy and adenoidectomy hemorrhage. J Otolaryngol. 1988;17(1):46-9.

Kim MK, Lee JW, Kim MG, Ha SY, Lee JS, Yeo SG. Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol. 2012;269(3):977-81.

Walker P, Gillies D. Post-tonsillectomy hemorrhage rates: are they technique-dependent? Otolaryngol Head Neck Surg. 2007;136:S27-31.

Medikondu H, Chen A, Soliman D, Yellapragada S, Sadhasivam S, Visoiu M. Perioperative Pain Relief in Pediatric Tonsillectomy: Current Strategies and Future Directions. Children (Basel). 2025;12(12):1619.

Lee MS, Montague ML, Hussain SS. Post-tonsillectomy hemorrhage: cold versus hot dissection. Otolaryngol Head Neck Surg. 2004;131(6):833-6.