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Background <p>Tonsillectomy ranks among the most frequently performed surgical procedures in the pediatric population. Post-tonsillectomy hemorrhage (PTH) represents one of its most severe complications, potentially resulting in anemia, hemodynamic instability, reoperation, and even mortality. Nevertheless, the incidence of and risk factors for PTH are not well defined. Consequently, we performed a systematic review and meta-analysis to examine and identify risk factors for this postoperative complication.</p> Methods <p>An extensive literature search was executed across six electronic databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid MEDLINE) from their inception until June 1, 2025. We included observational studies (case–control, cohort, cross-sectional) that enrolled pediatric patients (aged 0–18&#xa0;years) undergoing tonsillectomy. Data analysis was performed using Stata 16.0 and Review Manager 5.4.1.</p> Results <p>A total of 18 studies, encompassing 844,123 children, were included in the analysis. The pooled incidence of PTH was 3% (95% CI 3%-4%; I<sup>2</sup> = 98.61%). The following factors were identified as significant risk factors: increasing age (OR = 1.12, 95% CI 1.10–1.13), age ≥ 9&#xa0;years (OR = 2.47, 95% CI 2.05–2.99), age ≥ 12&#xa0;years (OR = 2.40, 95% CI 1.83–3.03), male sex (OR = 1.19, 95% CI 1.08–1.31), abnormal coagulation parameters (OR = 3.14, 95% CI 1.15–8.56), a history of chronic tonsillitis (OR = 1.55, 95% CI 1.10–2.19), severe tonsillar embedment (OR = 2.74, 95% CI 1.66–4.50), surgery performed by a junior surgeon (OR = 1.74, 95% CI 1.36–2.22), use of cold steel dissection techniques (OR = 1.87, 95% CI 1.41–2.48), use of postoperative analgesics (OR = 4.82, 95% CI 1.25–18.58), and poor postoperative diet (OR = 4.60, 95% CI 2.22–9.52).</p> Conclusions <p>This meta-analysis quantified a pooled PTH incidence of 3% in the pediatric population and identified multiple perioperative factors associated with increased odds of PTH. The findings may guide the risk stratification of patients and inform tailored preventive strategies and perioperative optimization, ultimately enhancing surgical safety and improving postoperative outcomes.</p> Trial registration <p>PROSPERO CRD420251066627.</p>

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Incidence and risk factors of pediatric post-tonsillectomy hemorrhage: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Xi Zhang,
  • Qicheng Deng,
  • Ling Yang,
  • Min Yan

摘要

Background

Tonsillectomy ranks among the most frequently performed surgical procedures in the pediatric population. Post-tonsillectomy hemorrhage (PTH) represents one of its most severe complications, potentially resulting in anemia, hemodynamic instability, reoperation, and even mortality. Nevertheless, the incidence of and risk factors for PTH are not well defined. Consequently, we performed a systematic review and meta-analysis to examine and identify risk factors for this postoperative complication.

Methods

An extensive literature search was executed across six electronic databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid MEDLINE) from their inception until June 1, 2025. We included observational studies (case–control, cohort, cross-sectional) that enrolled pediatric patients (aged 0–18 years) undergoing tonsillectomy. Data analysis was performed using Stata 16.0 and Review Manager 5.4.1.

Results

A total of 18 studies, encompassing 844,123 children, were included in the analysis. The pooled incidence of PTH was 3% (95% CI 3%-4%; I2 = 98.61%). The following factors were identified as significant risk factors: increasing age (OR = 1.12, 95% CI 1.10–1.13), age ≥ 9 years (OR = 2.47, 95% CI 2.05–2.99), age ≥ 12 years (OR = 2.40, 95% CI 1.83–3.03), male sex (OR = 1.19, 95% CI 1.08–1.31), abnormal coagulation parameters (OR = 3.14, 95% CI 1.15–8.56), a history of chronic tonsillitis (OR = 1.55, 95% CI 1.10–2.19), severe tonsillar embedment (OR = 2.74, 95% CI 1.66–4.50), surgery performed by a junior surgeon (OR = 1.74, 95% CI 1.36–2.22), use of cold steel dissection techniques (OR = 1.87, 95% CI 1.41–2.48), use of postoperative analgesics (OR = 4.82, 95% CI 1.25–18.58), and poor postoperative diet (OR = 4.60, 95% CI 2.22–9.52).

Conclusions

This meta-analysis quantified a pooled PTH incidence of 3% in the pediatric population and identified multiple perioperative factors associated with increased odds of PTH. The findings may guide the risk stratification of patients and inform tailored preventive strategies and perioperative optimization, ultimately enhancing surgical safety and improving postoperative outcomes.

Trial registration

PROSPERO CRD420251066627.