Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort.

OBJECTIVES

Traditionally secondary post-tonsillectomy haemorrhage has been thought to be due to post-operative infection and as such is treated with broad-spectrum antibiotics. The aim of this study was to identify clinical evidence of infection in patients with secondary post-tonsillectomy haemorrhage that might justify the use of antibiotics in these patients.

DESIGN

Prospective data collection.

SETTING

Tertiary University Teaching Hospital.

PARTICIPANTS

Adult patients admitted with post-tonsillectomy haemorrhage over a 2-year period.

MAIN OUTCOME MEASURES

Temperature, white cell count, Neutrophil count and C-reactive protein.

RESULTS

47 patients were admitted with secondary post-tonsillectomy haemorrhage. Fifteen out of 47 patients (32%) had an elevated white cell count but in them the other indicators of temperature and C-reactive protein were extremely variable: none of these 15 patients was pyrexial (> 37.6 C). An elevated C-reactive protein was found in 55% of patients but none had an elevated white cell count. The elevated C-reactive protein may have been influenced by the recent surgery rather than infection. Overall there was no clear interrelation between the indicators of infection in the patients and none had the three main indicators of infection (pyrexia, increased white cell count and elevated C-reactive protein).

CONCLUSIONS

Our results suggest that clinical signs of infection are lacking in patients with secondary tonsillectomy bleeding. Correspondingly the routine use of antibiotics should be questioned for secondary tonsillectomy haemorrhage.