Can a surgical tecnique be a risk for post-tonsillectomy hemorrage? Our point of view

Objectives: Some controversies have recently arisen regarding the frequency of post-operative haemorrhagic complications in relation to the surgical procedures adopted for tonsillectomy. The authors set out to verify the relationship between different surgical techniques and post-operative haemorrhage based on the analysis of data derived from multi-centric studies appeared during the last fifteen years. Materials and Methods: Multi-centric English and Italian studies pertaining to the frequency of post-tonsillectomy haemorrhage secondary to different surgical techniques published between 2000 and 2015 were selected. The data relevant to post-surgical haemorrhagic complications were elaborated by ANOVA test. Results: Eight multi-centric studies were analysed. The mean frequency of post-tonsillectomy haemorrhage was: 1.13% for primary haemorrhage, 5.37% for secondary haemorrhage, and 6.5% as overall for cold dissection with cold haemostasis; 0.99% for primary haemorrhage, 2.91% for secondary haemorrhage, and 3.9% as overall for cold dissection with hot haemostasis; 1.31% for primary haemorrhage, 7.38% for secondary haemorrhage, and 8.69% as overall for hot dissection with hot haemostasis. The statistical comparison did not show significant differences between the frequencies of post-tonsillectomy primary, secondary, and total haemorrhage in relation to the surgical techniques employed. Conclusion: A great variability in the frequency of haemorrhagic complications reported in the selected articles was found, regardless of the surgical technique employed. These findings, together with the lack of a statistically significant difference in post-tonsillectomy haemorrhage between the techniques employed, must be carefully considered by professionals involved in health organizations in clinical wards and the relative problems linked to medical liability.