Prevalence and Risk Factors of Post-Tonsillectomy Hemorrhage in Lebanon: A Retrospective Study.

Abstract

To determine the prevalence of post-tonsillectomy hemorrhage and identify associated risk factors in a Lebanese tertiary care center. All patients who underwent tonsillectomy between January 2015 and December 2024 were included. Data were extracted from electronic medical records. Post-tonsillectomy hemorrhage was defined as clinically documented postoperative bleeding requiring medical evaluation and classified as primary (< 24 h) or secondary (≥ 24 h). Associations between patient- and surgery-related factors and post-tonsillectomy hemorrhage were assessed using bivariate analyses and multivariable logistic regression. A total of 945 patients were included (mean age 8.7 years; 85.7% pediatric). Post-tonsillectomy hemorrhage occurred in 25 patients, yielding an overall prevalence of 2.65% (95% CI, 1.7-3.9). Most hemorrhages were secondary (92%), typically occurring around postoperative day 7. Adults had a significantly higher bleeding rate than pediatric patients (7.4% vs. 1.9%, p = 0.001). Adult age was the only independent predictor of post-tonsillectomy hemorrhage (adjusted odds ratio 2.93, 95% CI 1.17-7.36). No independent associations were observed with sex, operative time, operating surgeon, concurrent procedures, histopathological findings, or routine preoperative laboratory values. Five patients (20%) required blood transfusion. Post-tonsillectomy hemorrhage is uncommon but clinically relevant in this Lebanese cohort, with secondary hemorrhage predominating. Adult age is the primary independent risk factor, supporting the need for enhanced counseling and postoperative surveillance in adult tonsillectomy patients.