1443. Perioperative Antibiotic Exposure and Postoperative Bleeding After Tonsillectomy
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
  • Bleeding Poster.pdf (251.7 kB)
  • Perioperative antibiotic exposure and postoperative bleeding after tonsillectomy

    Background: Over 500,000 tonsillectomies are performed annually in the US. The most feared complication is bleeding. A 2010 Cochrane review concluded that antibiotic administration did not prevent bleeding, and a 2011 American Academy of Otolaryngology – Head and Neck Surgery practice guideline recommended against antibiotics for pediatric tonsillectomy.  A recent single center study found a small but statistically significant increased rate of surgery for bleeding after this recommendation was adopted. We aimed to determine if antibiotic use was associated with postoperative bleeding.

    Methods: We examined perioperative antibiotic use and postoperative bleeding events in children undergoing routine tonsillectomy at 34 freestanding children's hospitals in the Pediatric Health Information System. We included patients >1 and <19 years old with tonsillectomies performed from 2009 through 2013.  We excluded children with high-risk conditions, additional surgical procedures, or admission from the emergency department. Exposure was a billing charge for antibiotics on the day of surgery, and the study outcome was a revisit for bleeding, identified by ICD-9 codes, within 30 days of surgery.  We controlled for patient demographics, comorbid conditions, indication, year, hospital, and dexamethasone use.

    Results: Of 107,707 eligible children undergoing tonsillectomy, 19,141 (18%) received perioperative antibiotics.  Overall, 3438 (3.2%) patients had a bleeding related visit within 30 days, including 1453 (1.3%) that required surgery for bleeding. After standardizing for covariates, the cumulative risk of revisit or surgery for bleeding was similar regardless of antibiotic exposure (Table 1).

    Conclusion: In this large multicenter study, perioperative antibiotics did not affect the risk of post-operative bleeding after tonsillectomy.  Approximately 90,000 patients annually remain potential targets for antimicrobial stewardship efforts.

    Table 1. Risk of Bleeding after Tonsillectomy

    Risk per 100 patients

    Bleeding event


    No Antibiotics




    3.08 (2.80-3.37)

    3.21 (3.10-3.33)

    -0.04 (-0.15-0.06)



    1.26 (1.08-1.44)

    1.31 (1.23-1.38)

    -0.04 (-0.20-0.12)


    Rachael Ross, MPH1, Edmund Milder, MD2 and Jeffrey S. Gerber, MD, PhD1, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Pediatrics, Naval Medical Center San Diego, San Diego, CA


    R. Ross, None

    E. Milder, None

    J. S. Gerber, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.