Predictors of Occurrence and Timing of Post-Tonsillectomy He
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A Study was conducted to describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time. Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed.

Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression.

The institutional PTH rate of 1.9% included 124 patients;
15% were primary (less than 24?hours), with 50% occurring within 5?hours.
-(4 of 19) of primary PTH patients received operative intervention.
-(105 of 124) of all cases were secondary PTH, and (49) of those patients received operative intervention.
-Cold steel (OR 1.9) and Coblation (OR 1.9) techniques and tonsillectomy alone (OR 3.7) increased odds of PTH.
-Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0).

PTH was found to be associated with the use of cold steel and Coblation techniques and with tonsillectomy alone in a comprehensive case-control analysis for PTH. A PTH may be more likely to grow in patients with a postoperative respiratory incident and should be counselled accordingly. For an outpatient tonsillectomy, a PACU monitoring period of 4 hours is appropriate.