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