The Implications of “Controlled” Studies of Tonsillectomy and Adenoidectomy

Evaluation of Post-tonsillectomy Bleeding in the Adult Population

A retrospective review of a consecutive series of 685 adult patients undergoing tonsillectomy was conducted. Determinations were made of the post-tonsillectomy bleeding rate, the need for intervention to control bleeding, and the blood transfusion rate. Statistical analysis was used to determine whether bleeding rates differed according to three criteria: gender, indication for tonsillectomy, and age. Post-tonsillectomy bleeding occurred in 35 patients (5.1%); five of these patients experienced bleeding during the first 24 hours postoperatively, and the remaining 30 experienced delayed bleeding. When it occurred, the mean time lapse between tonsillectomy and bleeding was 6.9 days (±4.1). Twenty of the 35 patients (57.1%) required a procedure to control their bleeding, but no patient required a transfusion. There was no statistically significant difference in bleeding rates based on gender, the indication for surgery (chronic tonsillitis, obstructive sleep apnea syndrome, or to rule out neoplasia), and age. These results indicate that (1) post-tonsillectomy bleeding occurs in approximately 1 of 20 adults independent of individual patient characteristics, (2) more than half of patients who bleed are likely to require a procedure to control their hemorrhage, and (3) the need for transfusion is distinctly unlikely.

Efficacy of tonsillectomy for recurrent throat infection in adults

OBJECTIVE/HYPOTHESIS

Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for tonsillectomy. We sought to determine whether tonsillectomy would benefit this group.

STUDY DESIGN

Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993.

METHODS

Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2-year periods before and after tonsillectomy were tabulated. Statistical comparisons were made using the Student's t test. Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy.

RESULTS

Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci. When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure.

CONCLUSIONS

Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources.