(1017) Does the Primary Indication for Pediatric Tonsillectomy Influence Posttonsillectomy Hemorrhage Risk?

Introduction: Tonsillectomy is one of the most common pediatric surgical procedures. The most feared sequela of a tonsillectomy is post-tonsillectomy hemorrhage (PTH). The incidence of PTH varies considerably, ranging from 2% to 10% in the literature. Previous studies have typically used a small sample size of children with PTH. To our knowledge, the largest study to date included around 200 patients. The literature also suggests that patients receiving a tonsillectomy for recurrent tonsillitis (RT) may have a higher risk of PTH than those receiving a tonsillectomy for sleep-disordered breathing (SDB). A better understanding of the rates of PTH will allow for improved perioperative patient counseling.

Methods: We utilized TriNetx, a large database of de-identified EHR data, to query pediatric patients who received a tonsillectomy. We stratified the data using ICD-10 and CPT codes into 2 groups: (1) patients who received tonsillectomies for SDB only and (2) patients who received them for RT only. We then determined rates of PTH in each group.

Results: Of 365,022 pediatric patients who received tonsillectomy, 9,565 (2.62%) had PTH. In the sleep-disordered breathing subgroup, 4,974 out of 172,404 patients (2.885%) had PTH. In the RT subgroup, 1,523 out of 43,310 patients (3.517%) experienced PTH. The RR for the RT subgroup was 1.34 (95% CI: 1.27 - 1.42; p < 0.001), so patients with RT are ~34% more likely to experience PTH than the overall cohort. The RR of the SDB group was 1.1 (95% CI: 1.06 - 1.14; p < 0.001), so patients with SDB are ~10% more likely to experience PTH than the overall cohort. The RR of RT compared to SDB is 1.22 (95% CI: 1.15 - 1.29; p < 0.001), so patients with RT are ~22% more likely to have PTH than patients with SDB.

Conclusions: This is the largest study of patients who have experienced PTH to date. This highly powered study also provides updated rates of PTH. For all patients, the rate is 2.62%, whereas for children receiving a tonsillectomy for RT and SDB, the rates are 2.89% and 3.52%, respectively. These results are invaluable to providers and parents, as they will allow for improved perioperative counseling and decision-making.