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Objective: The purpose of this study was to identify pre- or intraoperative markers for post-tonsillectomy haemorrhage (PTH) that may help to define in-/outpatient tonsillectomy., Design: A retrospective case-control study of tonsillectomized patients., Setting: A tertiary referral university hospital., Methods: Twenty-three children with PTH were compared with 69 tonsillectomized age- and sex-matched children without bleeding. The cohort consisted of 559 individuals under 18 years old who were scheduled for tonsillectomy or adenotonsillectomy between 1996 and 2000., Main Outcome Measures: Physical and analytical variables were investigated, including blood pressure, haemoglobin and haematocrit levels, coagulation profile, American Society of Anesthesiology (ASA) physical status classification, indications for surgery, obstructive sleep apnea and snoring, surgical experience, addition of adenoidectomy, method of tonsillectomy, type of anaesthesia, method of haemostasis, and total surgical time. Statistical significance was calculated by the Mann-Whitney U test and Fisher's exact test., Results: The incidence of PTH was 4.11%, and all but one case were primary bleedings. Nineteen cases occurred within the first 8 hours. A possible risk marker identified was ASA class 2 (odds ratio = 5.69, p = .04). Other investigated factors were not significant., Conclusions: The ASA classification may be a predictor for PTH and could be used to select outpatients before tonsillectomy.

Objective: To identify pre or intraoperative risk factors that could indicate a higher risk for post-tonsillectomy hemorrhage (PTH) in children undergoing electrocautery dissection. SET-UP: Primary referral hospital., Design: A retrospective study of 163 post-tonsillectomy children comparing 7 cases of PTH with 156 cases with no PTH., Sample: This study includes children under the age of 18 that underwent tonsillectomy by dissection between 1997 and 2000., Outcome Parameters: Age, sex, height, weight, body mass index, hemoglobin level, hematocrit, platelet count activated partial thromboplastin time (APTT), fibrinogen, ASA index (physical state classification of the American Society of Anesthesiology) and type of hemostasis., Results: Prevalence of PTH was 4.29% in the cohort sample. The risk of PTH in children following tonsillectomy by electrodissection is significantly increased in patients over 15 years of age (OR = 8.46, p = 0.04) and when ligatures are used for hemostasis (OR = 8.62, p = 0.02). Activated partial thromboplastin time > or = 32 seconds is marginally significant (OR = 7.82, p = 0.05)., Conclusions: Our findings show that tonsillectomy by electrodissection has an increased risk of bleeding in older children and when ligatures are used for hemostasis.

Objective: To identify preoperative markers indicative of an increased risk of postoperative hemorrhage after tonsillectomy in adults., Setting: Tertiary referral hospital., Design: A retrospective 1:3 case-control study (19 post-tonsillectomy hemorrhage [PTH] cases versus a sample of 58 controls stratified by age and sex)., Subjects: Adults over 17 years of age who underwent tonsillectomy from 1989 to 1999 were included., Main Outcome Measurements: Height, weight, percentage of excess weight, body area, systolic and diastolic blood pressure, smoking, drinking, hemoglobin and hematocrit levels, platelet count, partial thromboplastin time, prothrombin activity, fibrinogen, ASA index (physical state classification of the American Society of Anesthesiology), and history of peritonsillar abscess., Results: The risk of PTH in adults was greater in patients with systolic blood pressure > or = 140 mm Hg (OR = 9.46, p = 0.01) and low hematocrit (< 37 for women and < 42 for men, OR = 3.46, p = 0.04). Hemoglobin levels < 12.5 also resulted in an increased risk of PTH in women (OR = 4.79, p = 0.058)., Conclusions: Our findings show that systolic hypertension and anemia may be significant risk factors for PTH in adults.