J Appl Biomed 23:126-137, 2025 | DOI: 10.32725/jab.2025.016

Epidemiology of late postoperative bleeding in OSA-related tonsil surgery: a multicentric retrospective study

Jan Vodička¹, Martin Chovanec², Milan Urík³, Břetislav Gál⁴, Rami Katra⁵, Petr Škopek⁶, Veronika Glumbíková⁷, Anna Švejdová⁸, Zdeněk Knížek¹, Jan Kolín⁹, Hana Doležalová¹⁰, Libor Sychra¹¹, Patrik Bursa¹², Lenka Jetmarová¹³, Silvia Berková¹⁴, Pavel Strejček¹⁵, Josef Hájek¹⁶, Tomáš Kostlivý^{6, *}, David Slouka⁶

1 University of Pardubice, Hospital Pardubice, Faculty of Health Studies, Department of Otorhinolaryngology and Head and Neck Surgery, Pardubice, Czech Republic

2 Charles University in Prague and University Hospital Královské Vinohrady, 3rd Faculty of Medicine, Department of Otorhinolaryngology, Prague, Czech Republic

3 Masaryk University, University Hospital Brno, Faculty of Medicine, Department of Paediatric Otorhinolaryngology, Brno, Czech Republic

4 Masaryk University Brno, Saint Anne's University Hospital and Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck Surgery, Brno, Czech Republic

5 Charles University and Motol University Hospital, 2nd Faculty of Medicine, Department of Ear, Nose and Throat, Prague, Czech Republic

6 Charles University, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Department of Otorhinolaryngology and Head and Neck Surgery, Pilsen, Czech Republic

7 Palacký University Olomouc, University Hospital Olomouc and Faculty of Medicine and Dentistry, Department of Otorhinolaryngology and Head and Neck Surgery, Olomouc, Czech Republic

8 Charles University, University Hospital Hradec Králové, Faculty of Medicine in Hradec Králové, Department of Otorhinolaryngology and Head and Neck Surgery, Hradec Králové, Czech Republic

9 General University Hospital, Department of Otorhinolaryngology, Prague, Czech Republic

10 České Budějovice Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, České Budějovice, Czech Republic

11 Svitavy Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Svitavy, Czech Republic

12 J. E. Purkyně University in Ústí nad Labem, Faculty of Education, Masaryk Hospital in Ústí nad Labem and Department of Education, Department of Otorhinolaryngology, Head and Neck Surgery, Ústí nad Labem, Czech Republic

13 Silesian Hospital in Opava, Department of Otorhinolaryngology, Opava, Czech Republic

14 Hospital in Kroměříž, Department of Otorhinolaryngology, Kroměříž, Czech Republic

15 Hospital in Jičín, Department of Otorhinolaryngology, Jičín, Czech Republic

16 Hospital Ústí nad Orlici, Department of Otorhinolaryngology, Ústí nad Orlicí, Czech Republic

Introduction: Tonsil-related procedures are considered fundamental and effective in the surgical treatment of obstructive sleep apnea (OSA). The range of techniques includes intratonsillar approaches, such as tonsillotomy (TT), as well as extracapsular procedures, such as tonsillectomy (TE) and uvulopalatopharyngoplasty (UPPP). Patients undergoing these procedures span all age groups, from children to seniors.

Methods: This multicentric retrospective study, conducted between 2014 and 2018, analysed data from 3,498 patients who underwent bilateral TT, TE, or UPPP for OSA or ronchopathy. The cohort included 2,221 men (63.49%) and 1,277 women (36.51%). Of these, 2,808 patients (80.27%) underwent TT, 226 (6.46%) underwent TE, and 464 (13.26%) underwent UPPP.

Results: Late postoperative haemorrhage (LPOH) occurrence was significantly associated with the type of surgery (p < 0.0001) and the hospital where the procedure was performed (p < 0.0001). The incidence of LPOH in the TT group ranged from 0% to 5.88% across hospitals (p = 0.0068); whereas in the TE and UPPP groups, rates ranged from 0% to 33.33% (p = 0.0413 and p = 0.0409, respectively). The occurrence of repetitive bleeding was not influenced by treatment choice (readmission vs. outpatient care, observation vs. surgical revision, general vs. local anaesthesia). The severity of bleeding in all three groups was not affected by age and gender. The use of anticoagulants negatively impacted LPOH severity (p = 0.0166) in the UPPP group. No deaths occurred in our sample; however, three cases of severe postoperative bleeding (grade "D") were observed.

Conclusion: Late postoperative haemorrhage remains a serious complication of tonsil-related surgery with the potential for life-threatening outcomes. The marked variability in bleeding incidence between surgical techniques and departments highlights the need for standardised perioperative protocols. Although no fatalities occurred, the occurrence of severe cases underlines the importance of vigilant postoperative monitoring. In our OSA cohort, tonsillotomy showed favourable safety, and recent evidence suggests it may represent a valuable alternative also in recurrent tonsillitis, warranting further research.

Keywords: Obstructive sleep apnea; Postoperative haemorrhage; Tonsillectomy; Tonsillotomy; Uvulopalatopharyngoplasty

Grants and funding:

This work was supported by the Cooperatio Program, research area SURG. Supported by Ministry of Health, Czech Republic - conceptual development of research organisation (Faculty Hospital in Pilsen - FNPl, 00669806).

Conflicts of interest:

The authors have no conflict of interest to declare.

Received: July 8, 2025; Revised: September 12, 2025; Accepted: September 26, 2025; Prepublished online: September 29, 2025; Published: September 30, 2025  Show citation