Classification of Posttonsillectomy Hemorrhage

Objective Apply a new classification of postoperative hemorrhage using a clear definition and seven grades (A1, A2, B1, B2, C, D, and E) depending on severity and based on the intensity of treatment needed. Postoperative hemorrhage was defined as every bleeding after extubation. Method Grade A: anamnestic recorded blood‐tinged sputum; A1 dry wound, no coagulum; A2 coagulum, dry wound after removal. Grade B: bleeding actively under examination; B1 noninvasive treatment; B2 treatment in local anaesthesia. Grade C: hemorrhage needing treatment in general anesthesia. Grade D: dramatic hemorrhage requiring blood transfusion. Grade E: fatal hemorrhage. Results Of the 4594 patients undergoing tonsillectomy within 9 months evaluation period, 818 bleeding episodes had been recorded (17.8%). A1 bleeding episodes were recorded for 146 patients, A2 for 274 patients, B1 for 104 patients, B2 for 65 patients, C for 221 patients, and D for 8 patients. No fatal hemorrhage occurred. Surgical treatment was necessary in 4.6% of all patients. About half of all bleeding episodes have been anamnestic recorded. For patients with multiple bleeding episodes, light bleedings (grade A1 to B2) increased the risk for severe bleedings of grade C or D ( P <. 05). Conclusion Postoperative hemorrhage is strongly related to the definition of bleeding episodes. A new classification could have been approved for the first time in a large study population.