Time between First and Second Posttonsillectomy Bleeds

OBJECTIVE To determine the time between first and recurrent posttonsillectomy hemorrhages (PTHs) and find factors related to multiple PTHs. METHODS Retrospective chart review. RESULTS Of 112 patients, 91 had one PTH, while 21 had recurrent PTHs. Patients with recurrent bleeds had significant differences (P < 0.05) in indication for tonsillectomy (47.6% had recurrent tonsillitis), prior cardiac conditions (28.6%), transfusions (9.5%), and hematology consults during the initial PTH visit (19%). Bleeding occurred at a mean of 6.1 (range 1-13) days for the first episode and 10 (range 9-18) days for the second episode as compared to 6.65 (range 1-18) days for those who bled once. Recurrent PTH patients were less likely to have had surgical control of the initial bleed (P < 0.05). Patients who bled at 7 days or later were more likely to bleed again within one day (OR 23.0, RR 12). Regression analysis showed that age, failure to have operative control of PTH, and surgical indication were most important in predicting recurrent PTH. CONCLUSIONS Operative control of PTH is associated with a better outcome than monitoring alone. Patients with PTH within 7 days of tonsillectomy are likely safe to discharge soon after treatment; those who bleed after 7 days should be monitored longer.