What happens if you bleed after tonsillectomy

Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. Bleeding after tonsillectomy is considered an emergency due to the close proximity of major arteries to the tonsils. However, many people have their tonsils removed every day in the United States and most do just fine.

That said, the frequency of postoperative bleeding can vary greatly depending on the technique used and the nature of the procedure. Complications from a tonsillectomy vary with the worst complication being death. Tonsillectomies are among the most common surgeries in the world. Bleeding afterward is rare, so it should be taken seriously. Bleeding after tonsillectomy is most likely to occur right after surgery or about a week later when the scabs come off. Bleeding can also occur at any point in the recovery process , which takes around 2 weeks.

You may hear your healthcare provider refer to primary hemorrhage or secondary hemorrhage. All this refers to is the length of time that passed before bleeding occurred:.

If there is significant bleeding immediately after surgery, you may return back to the OR to have additional cauterization. If significant bleeding occurs or your healthcare provider suspects bleeding problems, you may be kept in the hospital overnight. However, a tonsillectomy rarely requires hospitalization and is usually considered an outpatient procedure.

If you suspect any of the signs listed above, you may wish to look at the tonsil beds. You can do this using a flashlight and a tongue depressor or popsicle stick. Depending on how long it's been since you had surgery, your tonsil beds should look white or dark brown. If your tonsil beds are covered with bright red blood or you see bright red streaks running down the back of your throat, you should seek medical attention immediately. It is not uncommon to swallow blood during a tonsillectomy and then vomit old blood the day of surgery.

If this happens, use the method above to take a look at the tonsil beds. Post-tonsillectomy management: A Framework. Post tonsillectomy Haemorrhage. Clinical Guideline. Princess Margaret Hospital for Children. Royal College of Paediatrics and Child Health. Evidence Statement: Major Trauma and the use of tranexamic acid in children. November Napolitano et al. Tranexamic Acid in Trauma: How should we use it? Vol 74 6. Date last published: 17 September This document is only valid for the day on which it is accessed.

Please read our disclaimer. Starship clinical guidelines. Despite the acceptance of electrocautery for the control of postoperative bleeding, few studies have examined the effect of electrocautery dissection on postoperative tonsillectomy hemorrhage.

The prospective study of Weimert et al 13 compared cold knife and electrocautery dissection tonsillectomies and concluded that electrocautery dissection was more rapid, decreased blood loss, and significantly decreased primary hemorrhage rates, the most frequent cause of posttonsillectomy mortality.

Weimert et al reported a postoperative hemorrhage rate of 1. Szeremeta et al, 2 in a retrospective comparison of cold knife and electrocautery dissection techniques, found hemorrhage rates of 3.

All patients in our study underwent electrocautery dissection and suction electrocautery for hemostasis. In this study, we defined evaluation for posttonsillectomy hemorrhage as any bleeding incident that results in clinical evaluation of the patient, whether in the clinic, emergency department, or operating room. This inclusive definition allows all subclassifications of hemorrhages to be compared from a known baseline. Like Handler et al, 11 we include all bleedings reported by parents and hospital staff, regardless of examination findings or eventual management and, thus, can assess all bleeding incidents whether managed without intervention or hospital admission, hospital admission for hour observation, emergency department intervention, or operative evaluation and intervention.

It is important to include patients with benign examination and those patients who require neither hospital admission nor intervention because of these incidents, while not emergency situations, are stressful for the affected child and family and require a considerable commitment of time and resources from the medical system.

Parents in our practice are informed to return to the emergency department for any postoperative hemorrhage, the severity of which cannot be determined without clinical evaluation. Not only those patients who are seen with frank hemorrhage, but also those who report blood-tinged sputum and vomitus should be included for these are among the more common posttonsillectomy hemorrhage presentations. Overall, our study produced a total posttonsillectomy hemorrhage evaluation rate of 7.

Our primary hemorrhage evaluation rate, or evaluation rate for bleeding within the first 24 hours after surgery, was 0. Thirty-two patients Operative intervention was definitive in all but 1 of the total of 20 patients requiring surgical control; the 1 patient who returned for further evaluation required no intervention. If reporting only those patients requiring intervention in any clinical location, our significant bleeding rate is 3.

This study also identified hemorrhage rates and management issues in patients who presented with multiple bleeding episodes. Sixteen of the patients had more than 1 evaluation for hemorrhage; 11 had 2 episodes, 4 had 3, and 1 had 4. All eventually required emergency department 6 patients or operative 10 patients intervention.

Thus, it is reasonable to return to the operating room for evaluation and intervention on the second presentation. A return to the operating room also can be justified if the patient is too uncooperative to allow a thorough examination in the emergency department. A significantly greater number of female patients 9. However, although the percentage of female patients with significant bleeding events was higher than that of males 4.

This value contradicts the findings of Kristensen and Tveteras 3 that males have a greater hemorrhage rate but agrees with the study findings by Breson and Diepeveen 8 and Carmody et al. Those children who were 3 years old or younger in our study were the least likely to have posttonsillectomy bleeding. This is consistent with previous studies that show that older patients are more likely to bleed than younger ones. In evaluating a patient who reports posttonsillectomy hemorrhage, certain historical facts must be established.

The postoperative day should be determined. Primary hemorrhages tend to occur prior to postoperative discharge, but secondary hemorrhage has been reported up to 21 days after surgery. A history of frank hemorrhage does not always correlate with examination findings. On physical examination, vital signs, presence of frank bleeding, oozing, clot, and eschar including position on tonsillar fossa should be recorded.

In our study, the inferior tonsillar pole was found to be the most likely location of a posttonsillectomy hemorrhage, unlike the findings of Conley and Ellison 5 that the superior pole was most likely to bleed.

Coagulation studies, including bleeding time, and a complete blood cell count, should be obtained with hematologic consultation if study results are abnormal.

All patients should receive intravenous fluid hydration while being evaluated. We recommend adhering to the strategy elucidated by Cressman and Myer 1 in a survey of pediatric otolaryngology fellowship programs in determining the need for hospital admission. If only a stable eschar is seen on examination, without clot or active bleeding, and the patient is hemodynamically stable with an otherwise normal recovery course, then discharge home is acceptable. Clot requiring suctioning, frank bleeding or oozing requiring emergency department or operative intervention, or a history of dehydration or poor recovery necessitates hospital admission.

Clot suctioning, silver nitrate cautery, or direct pressure hemorrhage control in the emergency department generally requires hospital observation, although the clinical situation determines when discharge is appropriate. This time course often applies to operative candidates as well. Traditionally, diagnosis of a bleeding disorder has been a relative contraindication for tonsillectomy.

The use of electrocautery and laser tonsillectomy has begun to challenge this position. Of the patients who presented with hemorrhage, 2 received a preoperative hematologic diagnosis of a nonspecific anticoagulant characterized by a prolonged partial thromboplastin time; one required direct pressure in the emergency department for hemostasis and the other was evaluated and discharged home. Both patients had a family history of bleeding disorders.

A third patient was found to have a prolonged bleeding time in posthemorrhage coagulation studies. Hematologic evaluation diagnosed a non—von Willebrand platelet disorder with normal prothrombin time, partial thromboplastin time, and fibrinogen level. This patient had 2 bleeding episodes—the first required silver nitrate cautery in the emergency department on postoperative day 7 and the second on postoperative day 9 required silver nitrate cautery followed by definitive operative electrocautery.

Therefore, 3 0. Two of the 3 patients had family histories that would warrant preoperative evaluation. This illustrates the lack of cost-effectiveness for screening all patients undergoing tonsillectomy or adenotonsillectomy preoperatively with laboratory studies to ascertain the existence of bleeding disorders. We have presented criteria for reporting posttonsillectomy hemorrhage rates that are inclusive of all hemorrhage evaluations, whether or not there is a final diagnosis of actual or significant bleeding.

Knowing the number of patients who are evaluated but do not require intervention places the actual hemorrhage rate in perspective compared with the incidence of patient presentations for evaluation. This definition provides a baseline against which actual hemorrhage rates and intervention modalities can be compared between researchers.

All patients who report any bleeding after tonsillectomy should return for clinical evaluation. A patient who requires intervention with direct pressure or electrocautery in the clinic, emergency room, or operating room should be recorded as having a significant posttonsillectomy hemorrhage.

Patients 12 years old and older, regardless of the sex, are the most likely to have significant posttonsillectomy bleeding. Admission to the hospital for observation is suggested and evaluation in the operating room may be warranted when patients present more than once for evaluation of posttonsillectomy hemorrhage. We thank Theodore F.