Morbidity and mortality of post-tonsillectomy bleeding: Analysis of cases

Objectives: To analyse the circumstances of mortality in post-tonsillectomy bleeding cases, in order to better manage serious problems during resuscitation. Design: Reports of inquiry committees on post-tonsillectomy mortalities. Setting: State of Israel Ministry of Health committees. Participants: Senior otolaryngologists and related professionals, and the involved medical staff who participated in the inquiry committees. Main outcomes measures: Identification of actions causing undesirable effects on resuscitation outcomes. Results: In recent years, the post-tonsillectomy mortality rate in Israel has been one in 12 000. The two main causes of death have been severe haemorrhagic shock and airway obstruction. Conclusions: Active bleeding should be treated, rather than waiting for spontaneous resolution. An efficient airway should be established early during resuscitation, either by intubation (within two minutes) or by cricothyroidotomy. The two main factors endangering the patient's life during resuscitation are severe blood loss, interfering with effective cardiac output, and airway obstruction. Blood loss should be quickly substituted.