Are More Adults Bleeding After Tonsillectomy Than in the Past?

Abstract

Objective: Post-tonsillectomy hemorrhage (PTH) rates have increased in children over the last decade. This study aimed to determine whether PTH incidence in adults had also increased over the last 15 years.

Study design: Retrospective study.

Setting: TriNetX database.

Methods: A search was conducted using TriNetX for patients 18 years and older within the US Collaborative Network who had undergone tonsillectomy (CPT codes 42821 or 42826) and yielded 72,232 subjects. PTH diagnoses were identified using ICD-10 codes J95.830 or K91.840, and those who returned to the operating room (RTOR) to control PTH were identified using CPT 42962. PTH events that occurred and analgesics given following 14 days of tonsillectomy were tabulated annually from 2008 to 2022. Mann-Kendall test for monotonic trend examined significant trends in PTH and analgesic use.

Results: Mean age at tonsillectomy was 32.8 years (SD = 13.8). 4.1% were diagnosed with PTH in 2008, compared with 6.2% by 2022 (p = 0.0030). In 2008, 0.7% required RTOR to control PTH, compared with 2.4% in 2022 (p < 0.0001). Use of codeine decreased from 6.9% in 2008 to 2.5% in 2022 (p = 0.0022). Use of ibuprofen, acetaminophen, ketorolac, and oxycodone increased from 1.6% to 23.4% (p = 0.0005), 36.1% to 78.6% (p < 0.0001), 1.5% to 11.9% (p < 0.0001), and 20.6% to 63.6% (p < 0.0001), respectively. No change was detected in use of hydrocodone.

Conclusion: Post-tonsillectomy analgesia in adults has changed significantly over the last 15 years. Our study highlights a concurrent increase in PTH which bears more investigation.

Level of evidence: 3 Laryngoscope, 2025.