(224) Incidence and Determinants of Post-Tonsillectomy Hemorrhage in Adults: A Meta-Analysis

Introduction: Tonsillectomy is a common otolaryngological procedure, and post-tonsillectomy hemorrhage (PTH) is one of its most serious complications. While pediatric PTH rates are well characterized and are reported to be around 1-5%, the incidence in adults remains poorly defined.

Methods: This study reports preliminary findings from a systematic review and meta-analysis. A literature search was conducted in July 2025. Adult patients undergoing tonsillectomy in hospital-based surgical settings were included. Of 84 studies eligible for data extraction, 9 studies identified as low risk of bias were included in a preliminary random-effects meta-analysis. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The primary outcome was the incidence of PTH, and secondary outcomes included bleeding severity by class (I–V).

Results: 6,251 adults were included in this study with 995 total PTH events. The pooled incidence of PTH in adults was 15.8% (95% CI: 12.58%–19.12%). The proportion of bleeding events classified as class I was 48.8% (n=476), class II was 27.9% (n=272), and class III (n=227)was 23.3%. Substantial heterogeneity was observed (Cochran’s Q = 76.48, I² = 89.54%).

Conclusions: This preliminary meta-analysis suggests that PTH incidence in adults is substantially higher than traditionally reported pediatric rates, indicating a significant postoperative risk. Over half of bleeding events were class II or III, highlighting the need for clinical intervention. Despite high heterogeneity, this study provides the first quantitative synthesis of adult PTH incidence and underscores the need for further high-quality studies to better define risk factors and guide perioperative management in adult tonsillectomy patients.