High Bleeding Rates After Tonsil Surgery in Denmark and Opportunities for Quality Improvement

ABSTRACT Objectives To examine postoperative bleeding rates and associated patient and surgical factors after tonsil surgery in Denmark and identify targets for quality improvement. Design Multicentre cohort study using prospectively collected registry data. Setting Five Danish ENT departments contributing to the Danish Tonsil Database, 2018–2024. Participants Children, adolescents and adults undergoing tonsillectomy, adenotonsillectomy, tonsillotomy, adenotonsillotomy or acute tonsillectomy for benign indications. Main Outcome Measures Clinically confirmed postoperative bleeding within 30 days. Modified Poisson regression with robust standard errors estimated adjusted relative risks (RRs). Results Among 6145 procedures, postoperative bleeding occurred after 14% of tonsillectomies, 9.9% of adenotonsillectomies, 10% of acute tonsillectomies, 1.7% of tonsillotomies and 2.6% of adenotonsillotomies. Among bleeding events, 51% required general anaesthesia, 32% local anaesthesia and 17% resolved spontaneously. After tonsillectomy, male sex (adjusted RR 1.69, 95% CI 1.44–2.00) and resident surgery (adjusted RR 1.25, 95% CI 1.04–1.51) were associated with higher risk, while patients aged < 12 years (adjusted RR 0.53, 95% CI 0.37–0.74) and 12–17 years (adjusted RR 0.57, 95% CI 0.43–0.76) had lower risk than adults. Cold dissection with cold haemostasis tonsillectomy had the lowest crude bleeding rate (9.8%), but operative technique was not independently associated with bleeding after adjustment. No deaths occurred. Conclusions Bleeding rates after tonsillectomy were higher than those reported in several international cohorts, while rates after tonsillotomy were low. Cold dissection with cold haemostasis tonsillectomy had the lowest observed rate, although adjusted analyses were not statistically significant. These findings support structured quality‐improvement work and continued monitoring.