• Tonsillectomy;
  • tonsillotomy;
  • postoperative hemorrhage;
  • ambulatory surgery;
  • outcome assessment (healthcare);
  • quality assurance (healthcare);
  • Level of Evidence: 2b.



To analyze the incidence of primary bleeding following tonsil surgery and to evaluate risk factors.

Study Design:

Register study of the results from the National Tonsil Surgery Register in Sweden covering the period 1997 to 2008 and 54,696 operations.


Data were collected by means of three questionnaires, two filled in by professionals and one 6 months postoperatively by the patient/parent.


A total of 719 patients experienced primary postoperative bleeding during the hospital stay (1.3%). A number of independent factors were correlated with decreased risk of post-tonsillectomy hemorrhage: younger age (P < .0001), female sex (P < .0001), type of surgery (tonsillotomy) (P = .0006), and surgery performed on a day-surgery basis (P < .0001). Indication for surgery and number of operations performed at the department did not correlate with postoperative bleeding risk. A significant decrease in primary postoperative hemorrhage rate from 2% to 0.96% was found during the study period.


Primary hemorrhage following tonsil surgery is rare. During the study period, a significant decrease in primary bleeding rates occurred. The changes in practice with an increasing proportion of day-surgery cases and tonsillotomy have contributed to the reduced risk, but cannot completely explain the reduction.