Safety of Cold Dissection Tonsillectomy for Chronic Tonsillitis in Adults: A Retrospective Analysis of Postoperative Hemorrhage Rates

Background Postoperative hemorrhage is one of the main complications of tonsillectomy. Analysis of outcomes following cold dissection in adults allows assessment of complication rates in a specific clinical setting. Aim To assess the rates of primary and secondary postoperative hemorrhage following bilateral extracapsular cold dissection tonsillectomy in adults with chronic tonsillitis and descriptively compare the results with published data. Materials and Methods Medical records of 68 patients aged ≥18 years who underwent surgery in 2024 and 2025 at Dr. Paramonov’s Clinic in Saratov were retrospectively analyzed. The primary endpoint was the overall rate of recorded postoperative hemorrhage. Primary hemorrhage was defined as bleeding occurring within the first 24 hours after surgery, inclusive; secondary hemorrhage was defined as bleeding occurring more than 24 hours after surgery. Operative duration and postoperative peritonsillar abscesses were also recorded. Descriptive statistics and an exact binomial 95% confidence interval were used. Postoperative pain and long-term quality of life were not assessed. Results Postoperative hemorrhage was recorded in 2 of 68 patients (2.94%; exact 95% confidence interval, 0.36% to 10.22%). Primary hemorrhage occurred in one patient and secondary hemorrhage in another (1.47% each). No postoperative peritonsillar abscesses were recorded. Conclusions In this series, bilateral extracapsular cold dissection tonsillectomy was associated with a recorded postoperative hemorrhage rate of 2.94%, with no recorded peritonsillar abscesses. The retrospective design and small sample size limit the precision of the estimate. Prospective comparative studies assessing pain, recovery time, and quality of life will provide a more comprehensive characterization of the safety and tolerability of this method.