Avoidance of primary post-tonsillectomy hemorrhage in a teaching program

Objective: To determine the incidence of primary posttonsillectomy hemorrha ge in a teaching institution by using a uniform technique, including a 3-mi nute relaxation of retraction before case termination and the use of bismut h subgallate. Design: Case series. Setting: Tertiary care academic pediatric center. Patients: A 7-year retrospective study was performed by using the medical r ecords of 1286 children without a bleeding abnormality who underwent tonsil lectomy (with or without adenoidectomy). A uniform technique, proposed to r educe hemorrhage, was used for 705 children and was not used for 581 childr en. Results: No episodes of primary hemorrhage (onset less than or equal to 24 hours after surgery) occurred, and the incidence of delayed hemorrhage (ons et >24 hours after surgery) was 1.1% in the study group. The primary hemorr hage rate of the study group was significantly lower (P =.007) than the rat e for the reference group (0.0% vs 1.0%), as was the total hemorrhage rate (1.1% vs 4.1%) and the delayed hemorrhage rate (1.1% vs 3.1%). Conclusion: A uniform technique including the use of bismuth subgallate and reassessment of the tonsillar fossae after a 3-minute observation period r educes the incidence of primary tonsillar hemorrhage in a teaching institut ion setting.