{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T17:02:24Z","timestamp":1773939744532,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,12,8]],"date-time":"2018-12-08T00:00:00Z","timestamp":1544227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy\/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary\u2010care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds\/0.3% of all patients). Older age (\u226512 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47\u20106.68) and high body mass index for age (\u226585th percentile: adjusted OR: 2.26; 95% CI: 1.06\u20104.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiple hemorrhages after tonsillectomy\/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age &gt; 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 129:2765\u20132770, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27719","type":"journal-article","created":{"date-parts":[[2018,12,8]],"date-time":"2018-12-08T13:04:41Z","timestamp":1544274281000},"page":"2765-2770","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2569-8495","authenticated-orcid":false,"given":"Mallory","family":"McKeon","sequence":"first","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children's Hospital  Boston Massachusetts U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-9238","authenticated-orcid":false,"given":"Elliana","family":"Kirsh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children's Hospital  Boston Massachusetts U.S.A."},{"name":"Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Kawai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children's Hospital  Boston Massachusetts U.S.A."},{"name":"Department of Otology and Laryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Roberson","sequence":"additional","affiliation":[{"name":"Global Tracheostomy Collaborative  Raleigh, North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Watters","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication Enhancement Boston Children's Hospital  Boston Massachusetts U.S.A."},{"name":"Department of Otology and Laryngology Harvard Medical School  Boston Massachusetts U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,12,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000245160"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000108364"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.03.027"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-5876(97)00055-4"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000342319"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2008.03.009"},{"key":"e_1_2_6_8_1","first-page":"123","article-title":"Hemorrhage after Tonsillectomy: does the surgical technique really matter?","volume":"75","author":"Gysin C","year":"2013","journal-title":"Int J Pediatrc Otorhinolaryngol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130208100910"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2017.12.018"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21242"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22179"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otorri.2014.09.009"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000342317"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22347"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2004.07.006"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810389949"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0127"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.95"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.05.042"},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","unstructured":"SwansonRT SchubartJR CarrMM. 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