(A903) A Scoping Review of Recurrent Post-Tonsillectomy Hemorrhage in Children

Introduction: Tonsillectomy, with or without adenoidectomy, is the most common major surgical procedure performed in children. The risk and incidence of primary and secondary post-tonsillectomy hemorrhage (PTH) have been well described. The goal of this review is to analyze the incidence, and the risk factors for recurrent PTH after tonsillectomy.

Methods: The study followed PRISMA-ScR guidelines. Databases searched included CINAHL, Cochrane Library, Embase, Google Scholar, and Ovid Medline. Three reviewers independently screened and analyzed studies, including those reporting the incidence of PTH and recurrent PTH in children.

Results: There were 229 recurrent PTH episodes described in the 11 manuscripts included in this analysis, with 7.1% of PTH cases re-bleeding (0.56% of total tonsillectomy cases). Management of recurrent PTH involved surgical intervention in 138 (62.4%) patients and observation in 83 (37.6%) patients. Oropharyngeal findings at the time of the first PTH, including active bleeding/blood clot (n=57/606) or a normal exam (n=65/926), were not associated with recurrent bleeding (p=0.11). Initial management strategy for PTH, including surgical intervention (n=65/935) vs. observation (n=141/1649), was not associated with increased odds of recurrent PTH (p=0.15). The indication for tonsillectomy (recurrent tonsillitis [n=22/480] vs. other indications [n=23/884], p=0.057), and the surgical technique (extracapsular [n=53/1,154] vs. intracapsular [n=2/73], p=0.7677) was not associated with increased risk for recurrent PTH.

Conclusions: The incidence of recurrent PTH is rare (0.56%), although 7.1% of patients presenting with PTH might be expected to re-bleed. No clear risk factors for recurrent PTH were identified.