The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta-Analysis

ObjectiveTo investigate the impact of the surgical indication on posttonsillectomy bleed rates. Data SourcesPubMed, Scopus, CINAHL. Review MethodsA systematic review was performed searching for articles published from the date of inception to July 6, 2022. English language articles describing posttonsillectomy hemorrhage rates in pediatric patients (age <= 18) stratified by indication were selected for inclusion. A meta-analysis of proportions with comparison (Delta) of weighted proportions was conducted. All studies were assessed for risk of bias. ResultsA total of 72 articles with 173,970 patients were selected for inclusion. The most common indications were chronic/recurrent tonsillitis (CT/RT), obstructive sleep apnea/sleep-disordered breathing (OSA/SDB), and adenotonsillar hypertrophy (ATH). Posttonsillectomy hemorrhage rates for CT/RT, OSA/SDB, and ATH were 3.57%, 3.69%, and 2.72%, respectively. Patients operated on for a combination of CT/RT and OSA/SDB had a bleed rate of 5.99% which was significantly higher than those operated on for CT/RT alone (Delta 2.42%, p = .0006), OSA/SDB alone (Delta 2.30%, p = .0016), and ATH alone (Delta 3.27%, p < .0001). Additionally, those operated on for a combination of ATH and CT/RT had a hemorrhage rate of 6.93%, significantly higher than those operated on for CT/RT alone (Delta 3.36%, p = .0003), OSA/SDB alone (Delta 3.01%, p = .0014), and ATH alone (Delta 3.98%, p < .0001). ConclusionPatients operated on for multiple indications had significantly higher rates of posttonsillectomy hemorrhage than those operated on for a single surgical indication. Better documentation of patients with multiple indications would help further characterize the magnitude of the compounding effect described here.