Post-tonsillectomy bleeding: an evaluation of risk factors.

While tonsillectomy is usually a safe operation, it is always accompanied by the risk of immediate postoperative bleeding. Despite continued efforts to eliminate this problem, it remains a persistent risk. In reviewing 775 consecutive cases of tonsillectomy, immediate postoperative bleeding occurred in 21 (2.7%). Diagnostic, demographic, hematologic, hemodynamic and surgical management factors were evaluated. The role of local anesthesia for tonsillectomy was also examined. Postoperative bleeders were more likely to have abnormal preoperative clotting studies, greater elevations of their mean postoperative blood pressures, and unusual surgical indications. Local anesthetic cases were shorter, had less intraoperative bleeding and were not associated with greater postoperative bleeding. We conclude that local anesthesia is safe and efficient and that identifiable factors are associated with primary post-tonsillectomy bleeding. An awareness of these factors can help identify potential postoperative bleeders.