Incidence, Risk Factors, and Management Approaches for Post-tonsillectomy Hemorrhage: A Systematic Review

Abstract

Context: Tonsils play an important role in the body's immune system. However, in the case of chronic infection, tonsillectomy is necessary. Objectives: Tonsillectomy causes complications such as bleeding after surgery, and the present study was conducted to systematically investigate the prevalence of bleeding and methods for its control. Methods: This study is a systematic review that was conducted during the years 2019 - 2024. Data were collected from the databases Scopus, PubMed, Web of Science, Google Scholar, Magiran, SID, and Irandoc. The search was conducted using the keywords prevalence, incidence, tonsillectomy, and bleeding, along with the operators "AND", "OR". In the next step, articles related to factors of bleeding after tonsillectomy were searched using the keywords tonsillectomy, bleeding, and risk factor with the operators "AND", "OR". The quality of selected articles with English abstracts was assessed using the STROBE tool. Results: Based on the initial search, 1680 studies were found, of which 29 studies were selected based on the criteria for the present study. The prevalence of post-tonsillectomy bleeding in these studies ranged from 1.3% to 83.3%. In the second search for factors associated with the control of post-tonsillectomy bleeding, of the 3541 articles found, 35 articles were identified as eligible for inclusion. The prevalence of post-tonsillectomy bleeding was 7.0% for those > 21 years using Daflon 500 mg tablets and 13.3% for those using the hospital protocol. In children < 19 years, the prevalence of post-tonsillectomy bleeding was reported to be 1.4% in ketorolac users and 1.7% in non-users. Conclusions: Pillar suturing technique, epinephrine and lidocaine injection, hydrogen peroxide, Daflon, and adrenaline injection with tramadol can reduce post-tonsillectomy bleeding, while ketorolac was not effective. Therefore, it is suggested that ENT surgeons should consider these methods to control or reduce post-tonsillectomy bleeding.