Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort

Objectives: Traditionally secondary post-tonsillectomy haemorrhage has been thought to be due to postoperative infection and as such is treated with broad-spectrum antibiotics. The aim of this study was to identify clinical evidence of infection in patients with secondary post-tonsillectomy haemorrhage that might justify the use of antibiotics in these patients.

Design: Prospective data collection.

Setting: Tertiary University Teaching Hospital.

Participants: Adult patients admitted with post-tonsillectomy haemorrhage over a 2-year period.

Main Outcome Measures: Temperature, white cell count, Neutrophil count and C-reactive protein.

Results: 47 patients were admitted with secondary post-tonsillectomy haemorrhage. Fifteen out of 47 patients (32%) had an elevated white cell count but in them the other indicators of temperature and C-reactive protein were extremely variable: none of these 15 patients was pyrexial (> 37.6 C). An elevated C-reactive protein was found in 55% of patients but none had an elevated white cell count. The elevated C-reactive protein may have been influenced by the recent surgery rather than infection. Overall there was no clear interrelation between the indicators of infection in the patients and none had the three main indicators of infection (pyrexia, increased white cell count and elevated C-reactive protein).

Conclusions: Our results suggest that clinical signs of infection are lacking in patients with secondary tonsillectomy bleeding. Correspondingly the routine use of antibiotics should be questioned for secondary tonsillectomy haemorrhage.