Objective: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy á chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy á chaud and tonsillectomy á froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsil.
Material and methods: All patients had been operated on at the Department of Otorhinolaryngology, St. Marina University Hospital, "Prof. P. Stoyanov"- Varna University of Medicine 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years).
Results: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative hemorrhages which required treatment under general anesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of ‘selected` elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of hemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative hemorrhages.
Conclusion: There is no increased risk of postoperative hemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies.
Scripta Scientifica Medica 2008; 40(2): 149-152
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