Analysis of an Observational Versus Surgical Approach for Pediatric Post-Tonsillectomy Hemorrhage.

Objectives: Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients, yet management strategies vary due to limited outcome data. Historically, all patients at our institution with postoperative bleeding or visible clot were taken to the OR. In 2018, a new protocol was introduced in which patients with a visible clot but no active bleeding were managed conservatively. This study evaluates the efficacy and revisit outcomes of this observational approach versus immediate surgical intervention.

Methods: A retrospective cohort study was conducted at a tertiary center over two 3-year periods. Pediatric patients (< 18 years) presenting to the ED (emergency department) with PTH were categorized into pre-protocol (n = 86, surgical) and post-protocol (n = 134, observational) cohorts. Outcomes included revisit rates, surgical intervention rates, and hospital length of stay. Statistical analysis was performed using two-sample t tests and Fisher's exact tests.

Results: The post-protocol cohort had a higher proportion of patients presenting with PTH (3.86% vs. 5.88%, p = 0.0018), but fewer underwent surgery (54.65% vs. 26.87%, p < 0.0001). No significant differences were found in repeat visits leading to surgery or multiple surgical interventions. More patients with a visible clot avoided surgery post-protocol (3.49% vs. 29.85%, p < 0.0001). However, the average hospital stay was longer (9.25 vs. 13.13 h, p = 0.0774).

Conclusion: An observational approach for pediatric PTH patients with clot-only presentation significantly reduced the need for surgical intervention. This strategy may minimize unnecessary procedures and improve care quality.

Level of evidence: 3: