Frequency and Associated Factors of Post-Operative Bleeding Following Tonsillectomy in Children at Mardan Medical Complex: A Cross-Sectional Study

Abstract

Background: Tonsillectomy is among the most frequently performed pediatric surgical procedures worldwide. Although it is generally safe, postoperative hemorrhage remains one of the most serious and potentially life-threatening complications. Understanding its frequency and associated factors is crucial for improving patient outcomes and surgical safety in regional healthcare contexts. Objective: To determine the frequency and associated risk factors for postoperative bleeding following tonsillectomy among children at Mardan Medical Complex, Mardan, Pakistan. Methods: A descriptive cross-sectional study was conducted involving 151 children under 18 years of age who underwent elective tonsillectomy. Demographic data, clinical diagnoses, surgical techniques, and surgeon experience were recorded. Postoperative bleeding was classified into four grades of severity. Statistical analyses were performed using SPSS version 26, with chi-square tests and 95% confidence intervals to evaluate associations between variables, considering p < 0.05 as significant. Results: Postoperative bleeding occurred in 29 patients (19.2%). Male gender (p = 0.002; OR = 4.65, 95% CI: 1.65–13.08), adolescent age 11–15 years (p = 0.003), and cold dissection technique (p < 0.001; OR = 4.66, 95% CI: 2.02–10.73) were significantly associated with higher bleeding risk. No significant association was found with diagnosis or surgeon experience. Electrocautery showed superior hemostatic control compared to cold dissection. Conclusion: Post-tonsillectomy hemorrhage remains a notable complication in pediatric surgery. Male gender, adolescent age, and cold dissection technique were significant predictors of postoperative bleeding. Electrocautery is recommended as a safer surgical approach, particularly in high-risk subgroups such as adolescent males.