International Practice Variation in Post‐Tonsillectomy Hemorrhage: A Survey Study of Pediatric Otolaryngologists

ABSTRACT Background A significant complication of pediatric tonsillectomy is post‐tonsillectomy bleeding (PTB). Management within and outside of the operating room (OR) is not standardized. We consolidated international similarities and differences in PTB management. Methods This cross‐sectional survey study was conducted from April 4 to May 16, 2024. It involved a 55‐item questionnaire distributed online to a sample of pediatric otolaryngologists from 22 countries, and is a part of larger study on tonsillectomy. The study achieved a 38.2% response rate (112 of 293). Eligibility included proficiency in English and currently practicing pediatric otolaryngology. Results A tonsil bleed was defined by 49.2% as any bleeding presenting to the hospital. In all, 58.3% signified taking patients for operative management in the presence of active bleeding. Operative criteria included persistent bleeding on presentation, repeated bleeding while admitted, severity, signs/symptoms of anemia or hemodynamic instability, or age less than 3 and non‐cooperative. When treating PTB within the OR, bipolar cautery is used by 60.6%. In all, 57.3% admit all patients experiencing a PTB for 23‐h observation versus 21.2% who admit a subset of patients for 23‐h observation. In all, 47.7% indicated that they have a formal monitoring program for bleeding rates in their institution/practice. Readmission rates are monitored by 60.7% of respondents. Conclusion There are no standardized best practices for PTB. Our study confirmed moderate numbers of formal monitoring programs, and varying clinical decision rules when defining a tonsil bleed, readmitting a PTB, and management within or outside of the OR. Understanding global variation may facilitate development of future clinical practice guidelines.