Introduction
Post-tonsillectomy haemorrhage remains the most significant complication following paediatric tonsillectomy and a leading cause of emergency re-attendance and readmission. National benchmarks report post-operative haemorrhage rates of approximately 3.5%. However, a substantial proportion of post-operative complications is also pain-related, contributing to reduced oral intake and dehydration. In addition to surgical factors, post-operative analgesia management may represent a modifiable contributor to avoidable readmissions. This study evaluated local outcomes at Blackpool Victoria Hospital and assessed whether enhanced parental analgesia education could reduce post-tonsillectomy readmissions.
Methods
A retrospective review was undertaken of all paediatric tonsillectomies performed between January 2024 and August 2025. Data were extracted from electronic patient records. Outcomes included primary and secondary haemorrhage, unplanned readmission, A&E attendance, and return to theatre within 28 days. Following cycle one analysis, a structured post-operative telephone follow-up intervention was implemented to reinforce parental adherence to the analgesia regime and discharge instructions in line with the Alder Hey guideline.
Results
Three hundred and fourteen patients were included in cycle one. The haemorrhage-related readmission rate was 8.28% (n=26). Primary haemorrhage occurred in 0.96% (n=3) and secondary haemorrhage in 7.32% (n=23). Additional causes of readmission included pain (1.91%), infection (1.59%), epistaxis (0.96%), fever (0.32%), and morphine intolerance (0.32%).
Conclusion
Haemorrhage-related readmission rates exceeded national benchmarks and were driven predominantly by secondary haemorrhage. Pain-related presentations contributed to post-operative complications, highlighting a potentially modifiable gap in discharge education and analgesia management. A telephone follow-up intervention was introduced to improve analgesia adherence, with a re-audit ongoing to assess its impact.
References
Royal College of Surgeons of England, British Association of Otorhinolaryngologists – Head and Neck Surgeons. National Prospective Tonsillectomy Audit: Final Report. London: RCS; 2005.
Getting It Right First Time (GIRFT). Ear, Nose and Throat Surgery: GIRFT Programme National Specialty Report. London: NHS England; 2019.
Alder Hey Children’s NHS Foundation Trust. Tonsillectomy / Adenotonsillectomy: Patient Information Leaflet (PIAG M29). Liverpool: Alder Hey Children’s NHS Foundation Trust; 2026. Available from: https://www.alderhey.nhs.uk/conditions/patient-information-leaflets/tonsillectomy-adenotonsillectomy-piag-m29/