Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy

Introduction: Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate postoperative setting. Methods: The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. The records of patients aged less than 18 years undergoing tonsillectomy (T) or adenotonsillectomy (AT) were extracted using relevant ICD-9 diagnosis codes. The association between hemorrhage and obesity, OSA, AH, CT, PTA, and patients' demographics among surgeries performed in the outpatient setting was evaluated. Results: A total of 138,998 procedures, 22,478 Ts and 116,520 ATs, were performed during 2005-2011, of which 3.0% were performed on obese children. Hemorrhage occurred in 156 cases (0.1%), and was associated with an age from 9 to 18 years (p = 0.01), and obesity (p = 0.02). There was no association between hemorrhage and gender (p = 0.8), OSA (p = 0.6), ATH (p = 0.5), CT (p = 0.35), PTA (p = 0.47), or T versus AT (p = 0.3). Multivariate analysis revealed that hemorrhage was about 2.3 times more likely to occur in obese children (odds ratio [OR] = 2.3; 95% Confidence Interval: 1.1-5.1; p = 0.03). Conclusions: Obesity and older age are associated with an increased risk of immediate post-operative hemorrhage following tonsillectomy with or without adenoidectomy in the outpatient setting. Gender, OSA, ATH, CT, PTA, and T versus AT did not alter the risk of post-operative hemorrhage. (C) 2016 Elsevier Ireland Ltd. All rights reserved.