Effectiveness of bismuth subgallate for preventing bleeding following adenotonsillectomy: A multicentre study.

Background: Tonsillectomy and adenotonsillectomy are surgical procedures routinely performed worldwide, with various complications, including postoperative bleeding (PTH). Among haemostatic agents, bismuth subgallate (BS) has been employed in the past decades, but its use is controversial in children.
Objective: This retrospective, multicentre study aims to evaluate the effectiveness and safety of BS in preventing PTH following tonsillectomy and adenotonsillectomy.
Materials and Methods: Two cohorts of children between 0 and 18 years of age were compared in two different hospitals. The first (active) group of patients included children who underwent tonsillectomy/adenotonsillectomy performed using BS added to gauze swabs, whereas this agent was not administered to the second (control) group. The following variables were analysed: age, gender, degree of tonsillar hyperplasia, length of hospital stay, acute complications (including bleeding and infection), further admissions to the Paediatric Emergency Department (PED), and further hospital admissions in the 30 days postoperatively.
Results: Four-thousand- seven hundred forty-four children were included in the study, 2598 in the active group and 2146 in the control group. The cases included in the active treatment group displayed a significantly reduced PTH prevalence, 1.4 versus 2.6 % (p < 0.05). No cases of neurological complications or aspiration pneumonia were detected.
Conclusions: This study supports BS as a safe and reliable option for preventing severe PTH following tonsillectomy/adenotonsillectomy.
Competing Interests: Declaration of competing interest We declare that there are no prior publications or submission with any overlapping information, including studies and patients. We declare that the manuscript has not been and will not be submitted to any other journal while under consideration by American Journal of Otolaryngology--Head and Neck Medicine and Surgery. We declare that there is no competing interest in the submission we have made. We declare that none of the authors received any honorarium, grant, or other form of payment for this study. We declare that each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.
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