Bleeding complications after tonsil surgery in nationwide German health insurance data

Aim Bleeding complications following tonsillectomy (TE), adenotonsillectomy (ATE), tonsillotomy (TT) and adenotonsillotomy (ATT) are a principal reason for in-house tonsil surgery. This nationwide German study aimed to evaluate postoperative bleeding and its risk factors after in-house TE, TT, ATE and ATT.

Material and methods 50,139 cases with in-house tonsil surgery were identified in claims and core data of the German local health care funds (AOK). 26,688 cases (53.2%) had chronic tonsillitis (CT; 61.9% female) and 23,451 (46.8%) had tonsillar hypertrophy (TH; 43.7% female) as their principal diagnosis. The effect of type of surgery on the 30-day risk of reintervention for bleeding was estimated using logistic regression with risk adjustment for age, sex and comorbidity.

Results The median age was 21 years (inter-quartile range 14-29) in the CT subgroup and 4 years (3-6) in the TH subgroup. The proportions of type of surgery differed by principal diagnosis (CT vs. TH): 73.2% vs. 3.0% (TE), 19.3% vs. 26.2% (ATE), 3.3% vs. 15.2% (TT) and 4.3% vs. 55.6% (ATT; p<0.001). The reintervention rate was 7.7% in chronic tonsillitis compared to 1.8% in tonsillar hypertrophy (p<0.001). In chronic tonsillitis, ATE (odds ratio 0.77; 95% confidence interval 0.63-0.94) and TT (OR 0.63; 95% CI 0.44-0.89) were associated with a lower risk of reintervention compared to TE. In tonsillar hypertrophy, TT (OR 0.32; 95% CI 0.20-0.50) und ATT (OR 0.38; 95% CI 0.25-0.57) had a lower risk.

Conclusion Both principal diagnosis and type of surgery have significant effects on the risk of postoperative bleeding.

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

Publication History

Article published online:
12 May 2023