Current practices in the management of post-operative epistaxis: a survey of Australian and New Zealand otolaryngologists

Background: Post-operative epistaxis has a reported incidence rate between 1.4% and 7.5%. Unlike spontaneous epistaxis, the cause is secondary to mucosal trauma or vessel exposure, yet there are no consensus guidelines on how to treat epistaxis in the post-operative setting. This study aims to investigate and describe current management practices for post-operative epistaxis among Australian and New Zealand otolaryngologists to ascertain the status quo and where further research is required. Methods: An anonymised electronic survey was sent to members of the Australian Society of Otolaryngology, Head and Neck Surgery (ASOHNS) and the New Zealand Society of Otolaryngology, Head and Neck Surgery (NZSOHNS), remaining open for one month in each country, over July to August, and September to October 2024, respectively. Questions on their current management of post-operative epistaxis, and demographic data on the work environment and experience of the responder were collected. Results: A total of 146 responses were received (response rate of 21.2%). The majority (86%, 125/146) of responders routinely give systemic tranexamic acid. Only a third (34%, 50/146) routinely give prophylactic antibiotics. Topical therapy was the most common first-line treatment chosen (82%, 119/146), with co-phenylcaine being the most frequently used agent (92.5%, 135/146). Sphenopalatine artery ligation and angioembolisation were avoided if possible. Forty-two-point-five percent (62/146) of respondents reported variation in their management of paediatric patients, with a decreased use of nasal packing and electing for earlier operative management. Conclusions: There is wide variability in the management of post-operative epistaxis and the literature is limited. Further research is required to compare different treatment modalities in this subgroup of patients who present with epistaxis.