1. Introduction
Tonsillectomy is one of the most common surgical procedures worldwide. According to the most recent National Health Statistics Report, published in 2017, over 390,000 tonsillectomies were performed in United States, 102,000 of them were in ages 15-44 years old [1]. The most common indications for tonsillectomy in adults are recurrent throat infections (with or without suppurative complications such as peritonsillar abscess), sleep-disordered breathing and obstructive sleep apnea (OSA) [2].
Tonsillectomy can be performed through several techniques; Cold dissection techniques uses sharp dissector with a tonsil knife, scalpel and scissors, while hot dissection make use of cautery. Hot techniques may be associated with increased postoperative pain and longer healing times [3-4]. Radiofrequency ablation (i.e, coblation) is a technique which uses lower temperatures giving rise to less thermal injury and potentially less postoperative pain. A Cochrane review of 9 trials that compared coblation with other techniques found no significant differences in pain and speed of recovery between the different techniques [5].
The most common post-tonsillectomy complications are nausea and vomiting, dehydration, pain and bleeding. Post-tonsillectomy bleeding (PTB), the most significant complication, usually occurs in 0.28% to 20% of cases [6] and may rarely lead to suffocation, airway obstruction, hemorrhagic shock and death [7]. Primary PTB occurs within the first 24 hours and is usually related to surgical technique, while delayed bleeding occurs later, usually within the first 10 days—most commonly on the sixth or seventh day and is attributed to the slough of eschar [8].
Studies suggested that risk factors for PTB are indication for surgery, obesity, surgical technique and smoking status, amongst others [9-18]. However, only a few of these studies were conducted in the adult population.
Post-operative pain was shown in the pediatric population to be associated with increased PTB risk [20-24]. There have been no studies examining this correlation in the adult population. The aim of our study was to delineate the risk factors for PTB in the adult population, with special emphasis on post-operative pain scores.