Inpatient Observation of Post-tonsillectomy Bleed Patients Who Are Hemostatic on Arrival

Sunday, October 12, 2025

2:42 PM - 2:48 PM EDT

Location: 233-234

Disclosure(s):

Micah K. Harris, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Allison C. Rollins, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

David H. Chi, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Many providers have a low threshold to admit post-tonsillectomy bleed patients for observation, even if hemostatic on arrival. Decisions are highly variable and guided primarily by clinical characteristics and provider preference. Our goal was to investigate bleed trajectory and admission timing of post-tonsillectomy bleed patients who are hemostatic on arrival.

Methods: A retrospective review was performed of patients who presented to the emergency department (ED) with post-tonsillectomy bleed. Initial evaluation was done by the ENT resident or attending. Patients who presented with an active bleed were excluded from further analysis.

Results: A total of 125 hemostatic post-tonsillectomy bleeds presented to the ED from January to December 2023. Of these, 72 (57.6%) had no visible clot, 43 (34.4%) had a unilateral clot, and 10 (8%) had bilateral clots. Most (97.6%) were admitted for observation. Of those admitted, 4 (3.2%) required OR, with an average time from arrival to OR of 24.8 ± 25.7 hours (range: 3.1-62). In patients with no visible clot (vs. visible clot) on arrival, there was no significant difference in OR (1.4% vs. 5.7%, P>0.05) or readmission (1.4% vs.5.7%, P>0.05). Notably, all 4 readmissions returned >24 hours after discharge (88.4 ± 59.8 hours, range: 31-169), outside the window of a reasonable inpatient stay. The average admission was 21.7 ± 12.6 hours (range: 0.95-87.9). Patients with no visible clot on arrival had a shorter inpatient stay (18.5 ± 9.2 vs. 25.6 ± 15.5 hours, P=0.004), with no additional bleeds (excluding the 1 patient requiring OR) . In patients with minimal bleeding prior to arrival (defined as scant to < 3 tablespoons), none required OR intervention or had additional bleeds, regardless of whether clot was present or not on admission.

Conclusions: In our cohort, the rate of OR return following resolved post-tonsillectomy bleed was low, which may reflect a low threshold for evaluation. Patients with no clot on arrival and/or additionally report minimal bleeding prior to arrival may be considered for ED discharge. A 24-hour observation period may be appropriate for those with clots on arrival.

Presenting Author(s)

MH

Micah K. Harris, MD

Resident, Department of Otolaryngology
University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery
pittsburgh, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Allison C. Rollins, MD

Otolaryngology Resident
University of Pittsburgh, Department of Otolaryngology/Head and Neck Surgery
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Anthony J. Tang, BS

Medical Student
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
Natasha R. Mayer, BS

Medical Student
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
NH

Nanki Hura, MD

Resident Physician
University of Pittsburgh Medical Center - Medical Education Program
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.

Co-Author(s)

EK

Eugene A. Kim, MM

University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

DC

David H. Chi, MD

Professor
Childrens Hosp of Pittsburgh
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.