The post-operative tonsillectomy (POPT) study: A multi-centre prospective paediatric cohort study

Objectives: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary.Design: Prospective observational cohort study.Setting: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed.Participants: Children (>= 4 years, <= 16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology.Main Outcome Measures1. Frequency and severity of post-operative bleeding.2. Intensity and pattern of post-operative pain.Results: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008).Conclusion: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.

Automated summary

This study investigated post-operative bleeding and pain following paediatric tonsillectomy. The results showed that 44% of children experienced post-operative bleeding, with blood in the saliva being the most common. Increasing age significantly increased the odds of bleeding. Higher surgeon grade and using intracapsular coblation tonsillectomy reduced the frequency of bleeding compared to other techniques. Lower age and intracapsular coblation tonsillectomy significantly reduced rates of post-operative pain compared to other techniques.