Epidemiology of late postoperative bleeding in OSA-related
tonsil surgery: a multicentric retrospective study

J 2025

Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study

VODICKA, Jan; Martin CHOVANEC; Milan URÍK; Břetislav GÁL; Rami KATRA et. al.

Basic information

Original name

Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study

Authors

Edition

Journal of applied biomedicine, České Budějovice, Faculty of Health and Social Care, University of South Bohemia, 2025, 1214-021X

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30206 Otorhinolaryngology

Country of publisher

Czech Republic

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 2.000 in 2024

Organization unit

Faculty of Medicine

DOI

https://doi.org/10.32725/jab.2025.016

UT WoS

001586816800004

EID Scopus

2-s2.0-105017772934

Keywords in English

Obstructive sleep apnea; Postoperative haemorrhage; Tonsillectomy; Tonsillotomy; Uvulopalatopharyngoplasty

Abstract

In the original language

Introduction: Tonsil-related procedures are considered fundamental and effective in the surgical treatment of obstructive sleep apnea (OSA). The range of techniques includes intratonsillar approaches, such as tonsillotomy (TT), as well as extracapsular procedures, such as tonsillectomy (TE) and uvulopalatopharyngoplasty (UPPP). Patients undergoing these procedures span all age groups, from children to seniors. Methods: This multicentric retrospective study, conducted between 2014 and 2018, analysed data from 3,498 patients who underwent bilateral TT, TE, or UPPP for OSA or ronchopathy. The cohort included 2,221 men (63.49%) and 1,277 women (36.51%). Of these, 2,808 patients (80.27%) underwent TT, 226 (6.46%) underwent TE, and 464 (13.26%) underwent UPPP. Results: Late postoperative haemorrhage (LPOH) occurrence was significantly associated with the type of surgery (p < 0.0001) and the hospital where the procedure was performed (p < 0.0001). The incidence of LPOH in the TT group ranged from 0% to 5.88% across hospitals (p = 0.0068); whereas in the TE and UPPP groups, rates ranged from 0% to 33.33% (p = 0.0413 and p = 0.0409, respectively). The occurrence of repetitive bleeding was not influenced by treatment choice (readmission vs. outpatient care, observation vs. surgical revision, general vs. local anaesthesia). The severity of bleeding in all three groups was not affected by age and gender. The use of anticoagulants negatively impacted LPOH severity (p = 0.0166) in the UPPP group. No deaths occurred in our sample; however, three cases of severe postoperative bleeding (grade "D") were observed. Conclusion: Late postoperative haemorrhage remains a serious complication of tonsil-related surgery with the potential for life-threatening outcomes. The marked variability in bleeding incidence between surgical techniques and departments highlights the need for standardised perioperative protocols. Although no fatalities occurred, the occurrence of severe cases underlines the importance of vigilant postoperative monitoring. In our OSA cohort, tonsillotomy showed favourable safety, and recent evidence suggests it may represent a valuable alternative also in recurrent tonsillitis, warranting further research.

Cite

VODICKA, Jan; Martin CHOVANEC; Milan URÍK; Břetislav GÁL; Rami KATRA; Petr SKOPEK; Veronika GLUMBIKOVA; Anna SVEJDOVA; Zdenek KNIZEK; Jan KOLIN; Hana DOLEZALOVA; Libor SYCHRA; Patrik BURSA; Lenka JETMAROVA; Silvia BERKOVA; Pavel STREJCEK; Josef HAJEK; Tomas KOSTLIVY and David SLOUKA. Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study. Journal of applied biomedicine. České Budějovice: Faculty of Health and Social Care, University of South Bohemia, 2025, vol. 23, No 3, p. 126-137. ISSN 1214-021X. Available from: https://doi.org/10.32725/jab.2025.016.

@article{2527460,
   author = {Vodicka, Jan and Chovanec, Martin and Urík, Milan and Gál, Břetislav and Katra, Rami and Skopek, Petr and Glumbikova, Veronika and Svejdova, Anna and Knizek, Zdenek and Kolin, Jan and Dolezalova, Hana and Sychra, Libor and Bursa, Patrik and Jetmarova, Lenka and Berkova, Silvia and Strejcek, Pavel and Hajek, Josef and Kostlivy, Tomas and Slouka, David},
   article_location = {České Budějovice},
   article_number = {3},
   doi = {https://doi.org/10.32725/jab.2025.016},
   keywords = {Obstructive sleep apnea; Postoperative haemorrhage; Tonsillectomy; Tonsillotomy; Uvulopalatopharyngoplasty},
   language = {eng},
   issn = {1214-021X},
   journal = {Journal of applied biomedicine},
   title = {Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study},
   url = {https://jab.zsf.jcu.cz/artkey/jab-202503-0004_epidemiology-of-late-postoperative-bleeding-in-osa-related-tonsil-surgery-a-multicentric-retrospective-study.php},
   volume = {23},
   year = {2025}
}

TY  - JOUR
ID  - 2527460
AU  - Vodicka, Jan - Chovanec, Martin - Urík, Milan - Gál, Břetislav - Katra, Rami - Skopek, Petr - Glumbikova, Veronika - Svejdova, Anna - Knizek, Zdenek - Kolin, Jan - Dolezalova, Hana - Sychra, Libor - Bursa, Patrik - Jetmarova, Lenka - Berkova, Silvia - Strejcek, Pavel - Hajek, Josef - Kostlivy, Tomas - Slouka, David
PY  - 2025
TI  - Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study
JF  - Journal of applied biomedicine
VL  - 23
IS  - 3
SP  - 126-137
EP  - 126-137
PB  - Faculty of Health and Social Care, University of South Bohemia
SN  - 1214021X
KW  - Obstructive sleep apnea
KW  - Postoperative haemorrhage
KW  - Tonsillectomy
KW  - Tonsillotomy
KW  - Uvulopalatopharyngoplasty
UR  - https://jab.zsf.jcu.cz/artkey/jab-202503-0004_epidemiology-of-late-postoperative-bleeding-in-osa-related-tonsil-surgery-a-multicentric-retrospective-study.php
N2  - Introduction: Tonsil-related procedures are considered fundamental and effective in the surgical treatment of obstructive sleep apnea (OSA). The range of techniques includes intratonsillar approaches, such as tonsillotomy (TT), as well as extracapsular procedures, such as tonsillectomy (TE) and uvulopalatopharyngoplasty (UPPP). Patients undergoing these procedures span all age groups, from children to seniors. Methods: This multicentric retrospective study, conducted between 2014 and 2018, analysed data from 3,498 patients who underwent bilateral TT, TE, or UPPP for OSA or ronchopathy. The cohort included 2,221 men (63.49%) and 1,277 women (36.51%). Of these, 2,808 patients (80.27%) underwent TT, 226 (6.46%) underwent TE, and 464 (13.26%) underwent UPPP. Results: Late postoperative haemorrhage (LPOH) occurrence was significantly associated with the type of surgery (p < 0.0001) and the hospital where the procedure was performed (p < 0.0001). The incidence of LPOH in the TT group ranged from 0% to 5.88% across hospitals (p = 0.0068); whereas in the TE and UPPP groups, rates ranged from 0% to 33.33% (p = 0.0413 and p = 0.0409, respectively). The occurrence of repetitive bleeding was not influenced by treatment choice (readmission vs. outpatient care, observation vs. surgical revision, general vs. local anaesthesia). The severity of bleeding in all three groups was not affected by age and gender. The use of anticoagulants negatively impacted LPOH severity (p = 0.0166) in the UPPP group. No deaths occurred in our sample; however, three cases of severe postoperative bleeding (grade "D") were observed. Conclusion: Late postoperative haemorrhage remains a serious complication of tonsil-related surgery with the potential for life-threatening outcomes. The marked variability in bleeding incidence between surgical techniques and departments highlights the need for standardised perioperative protocols. Although no fatalities occurred, the occurrence of severe cases underlines the importance of vigilant postoperative monitoring. In our OSA cohort, tonsillotomy showed favourable safety, and recent evidence suggests it may represent a valuable alternative also in recurrent tonsillitis, warranting further research.
ER  -

VODICKA, Jan; Martin CHOVANEC; Milan URÍK; Břetislav GÁL; Rami KATRA; Petr SKOPEK; Veronika GLUMBIKOVA; Anna SVEJDOVA; Zdenek KNIZEK; Jan KOLIN; Hana DOLEZALOVA; Libor SYCHRA; Patrik BURSA; Lenka JETMAROVA; Silvia BERKOVA; Pavel STREJCEK; Josef HAJEK; Tomas KOSTLIVY and David SLOUKA. Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study. \textit{Journal of applied biomedicine}. České Budějovice: Faculty of Health and Social Care, University of South Bohemia, 2025, vol.~23, No~3, p.~126-137. ISSN~1214-021X. Available from: https://doi.org/10.32725/jab.2025.016.

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