(1007) Comparative Analysis of a Conservative Approach Versus Surgical Intervention for Pediatric Posttonsillectomy Hemorrhage

Introduction: This study evaluates a conservative approach to post-tonsillectomy hemorrhage (PTH), specifically, admitting children who present with a clot in their tonsillar fossa with no active bleeding. The purpose is to evaluate whether it is a safe and effective way of managing PTH in children.

Methods: In this pre/post-intervention single institution cohort study, we compare outcomes before (2013-2016) and after (2019-2022) the implementation of the conservative management algorithm for PTH. The conservative approach is to admit patients for 24-hour observation if they presented with a clot in the tonsillar fossa and no active bleeding. Inclusion criteria were children who underwent tonsillectomy and presented to the emergency room for PTH between 1 and 15 days post-surgery. Patients in the pre (n = 86) and postimplementation (n = 134) groups were evaluated for rate of OR utilization, length of stay, and 15-day revisit rate.

Results: The conservative PTH protocol evaluated in this study yielded a 51% decrease in OR utilization for patients presenting with bleeding symptoms (pre: 54.65%, post: 26.87%, p < 0.0001). Despite fewer operative interventions, patients were 42% less likely to return for a second ED visit with a conservative approach, though not at statistical significance (pre: 12.79%, post: 7.46%, p = 0.2403). Demographic characteristics of the pre and post-protocol groups showed no statistical significance Patients with the conservative protocol stayed an average of 4.2 hours longer, though this did not reach statistical significance (pre: 7.38h, post: 11.58h, p = 0.0812).

Conclusions: This conservative management algorithm for children with PTH dramatically reduces the need for OR utilization, without a statistical change in readmission rates or length of stay.