Revisits and postoperative hemorrhage after adult tonsillectomy

Abstract

Objectives/hypothesis: Determine revisits and reasons for revisits after adult tonsillectomy.

Study design: Cross-sectional analysis of multistate ambulatory surgery and hospital databases.

Methods: Ambulatory adult tonsillectomies performed as the sole procedure were extracted from the State Ambulatory Surgery databases for New York, Florida, Iowa, and California for 2010. Cases were linked to the State Emergency Department databases and the State Inpatient databases for visit encounters occurring 0 to 14 days after tonsillectomy. The number of revisits (including readmissions) was determined as well as the reason for revisit categorized as post-tonsillectomy bleeding, acute pain, or fever/dehydration. The overall rate of occurrence of and intervention rate for post-tonsillectomy bleeding was determined.

Results: A total of 7,748 adult tonsillectomies were examined (mean age, 29.2 years; 64.4% female). Overall, 11.6% of patients had a revisit after tonsillectomy (9.6% revisited the ambulatory surgery center, 78.8% the emergency department, and 11.6% to inpatient admission). The primary diagnoses at the first revisit were bleeding (41.3%), acute pain (22.1%), and fever/dehydration (13.2%). Overall, 2.1% of patients incurred a second revisit after adult tonsillectomy (10.7% of these to inpatient admission). Among all tonsillectomies, 4.8% of adult tonsillectomies presented with a bleeding diagnosis at a first revisit. Overall, 2.2% underwent a procedure to control bleeding at a first revisit.

Conclusions: The current data quantify at a multistate level revisits, revisit diagnoses, and procedural rates for post-tonsillectomy bleeding in the adult population. Interventions to offset revisits for acute pain and fever/dehydration should be explored to decrease adult tonsillectomy morbidity.

Level of evidence: 2b.

Keywords: Tonsillectomy; adult; dehydration; postoperative hemorrhage; readmission; revisit; safety; surgical complications.