Post-tonsillectomy Bleeding in Pediatric Hemophilia Patients

Introduction: Post-tonsillectomy hemorrhage is the most concerning complication after pediatric tonsillectomy/adenotonsillectomy (TA). The risk of post-tonsillectomy bleeding in children with hemophilia is not well described. We compared the incidence of post-tonsillectomy bleeding in children with hereditary hemophilia versus matched controls.

Methods: We conducted a retrospective cohort study from 2015-2024 using the TriNetX U.S. Collaborative Network to identify pediatric patients (≤18 years) who underwent TA. Patients with hemophilia were identified using ICD-10-CM codes D66 and D67 and compared to patients without hemophilia. Propensity score matching was performed 1:1 based on age, sex, race, and ethnicity. The primary outcome was postoperative bleeding identified using ICD10 codes.

Results: Pre-match, 258 hemophilia and 342,303 control patients underwent TA. Hemophilia patients more often received hemostatic agents (aminocaproic acid 32.4%, N=81 vs 0.18%, N=588; factor VIII 17.6%, N=44 vs 0.04, N=140; tranexamic acid 10.4%, N=26 vs 0.23%, N=744; desmopressin 4.8%, N=12 vs 0.13%, N=436) and received less NSAID prescriptions (12.4%, N=31 vs 56.5%, N=186,947) (all p<.0001). After matching (N=245/group; mean age 9.21±5.31 vs 9.00±4.84 years), bleeding occurred in 4.9% (N=12) in both groups (RR 1.00, 95% CI 0.46-2.18). Events requiring operative control of hemorrhage were below the database's threshold for detection following matching.

Conclusions: These findings suggest that current perioperative management of children with hemophilia undergoing TA can result in postoperative bleeding outcomes comparable to unaffected peers. Further work incorporating medication dose/timing may refine best practices for this high-risk population.