3. Results
Between 2015-2022 a total of 305 adult patients met the inclusion
criteria.
We included patients who underwent tonsillectomy (232 patients),
tonsillotomy (intracapsular tonsillectomy) (31 patients) and
tonsillectomy with UPPP (42 patients), as described on Table 1.
Age distribution and indication
for surgery are depicted on Figures 1 and 2, respectively. Male to
female ratio was 1:1 with a mean age of 30.5 years old (18-82, ± 12) and
mean BMI of 26.6 kg/m2 (16-42, ± 5). Thirty-nine
patients (13%) were current smokers. Patients who underwent
tonsillectomy with UPPP were more likely to be older males who smoke,
with higher BMI scores. The indication for their surgery was exclusively
OSA. Surgical technique was cold dissection in 238 patients (79%), hot
dissection in 36 patients (12%) and coblation (radiofrequency) in 25
patients (9%). In 31 patients (10%) sutures were used: in 13 patients
the sutures were between the pillars while in 18 patients it was used
for hemostasis at the tonsillar bed. Post-operative pain scores on the
visual analogue scale (VAS) and rates of PTB were similar between
tonsillectomy with and without UPPP, but both were lower in the
tonsillotomy group.
In our cohort, 49 patients (16%) had PTB, as described in Table 2. 6
patients (12%) had Primary PTB (within 24 hours of surgery) while the
rest, 43 patients (88%), had secondary PTB (later than 24 hours
post-operatively). Conservative treatment was sufficient in 30 patients
(62%) and 19 patients (38%) needed control of hemorrhage in the
operating rooms. Eight patients (16%) had multiple hemorrhages and 4 of
them required multiple interventions to control the bleeding.
A multi-variable logistic regression was used to test correlation
between the independent variables and PTB in order to find factors that
are associated with bleeding, as depicted on Figure 3.
At the younger age group (18-30 years old) 15.5% of patients developed
PTB, compared to 3.9% in older patients (+ 30 years old) (adjusted odds
ratio [OR] 3.9, 95% confidence interval [CI] 2.1-6.7). Fourteen
percent of males developed PTB compared to 8.2% in females, with the OR
for a male to develop PTB being 1.71 (95% CI 1.01-2.92). Smoking was
associated with higher rates of PTB, with 19.2% of smokers developed
PTB compared to 10.5% in non-smokers (OR 1.8, 95% CI 1.36-3.42). When
comparing the indication for surgery, it was found that patients with
recurrent throat infections as indication for surgery developed PTB in
23.3% of cases compared to 10% in patients with OSA (OR 2.32, 95% CI
1.83-4.2). Surgical technique also had effect on bleeding risk – 19%
of patients who underwent surgery using hot dissection technique
developed PTB, compared to 11% in cold and coblation groups together
(OR 1.7, 95% CI 1.1-2.5).
Mean VAS scores of all patients on POD-0, POD-1 and POD-2 were 2.4, 4.6,
3.2, respectively. Post-operative VAS on day 1 and 2 were higher in
patients with PTB, as depicted on Figure 4 (OR 2.18, 95% CI 1.73-2.44).
Every increase of 1 unit in VAS score, increases the risk of PTB in 6%
(p < 0.05).
Most patients (94%) were discharged by POD-3 and majority (72%) on
POD-2. 95% of the patients arrived for their scheduled outpatient
clinic follow-up. Only 5% were lost to follow-up. All were questioned
whether they had any type of PTB. Of them, 250 (86%) felt better and 40
(14%) were still having some pain