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European Archives of... Nov 2020Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a...
PURPOSE
Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a potentially fatal complication. We aim to assess the incidence of hemorrhage after tonsillectomy in our institution, and to evaluate and identify the possible associated risk factors.
METHODS
This retrospective study included 897 patients who underwent tonsillectomy between January 2015 and December 2018, 50.7% women and 49.3% men, aged between 2 and 83 years. No coagulopathies were identified. Comparison of age, gender, surgical indication, coagulation profile, concomitant adenoidectomy, surgical technique, surgeon's experience and hemostasis method between groups with and without post-operative bleeding was made.
RESULTS
Our incidence of post-tonsillectomy hemorrhage was 6%. Most patients (83.3%) had secondary bleeding (> 24 h after surgery). In 22.2% of the bleeding cases, it was necessary to revise the hemostasis in the operating room. Adulthood (age ≥ 18 years) (p < 0.001), INR values ≥ 1.2 (p = 0.014), aPTT values ≥ 35 s (p = 0.001), as well as concomitant adenoidectomy (p < 0.001) were the predictors of post-tonsillectomy bleeding.
CONCLUSION
Recognition of adult age, INR ≥ 1.2, aPTT ≥ 35 s and concomitant adenoidectomy as risk factors can be useful in identifying the patients at higher risk for bleeding complications.
Topics: Adenoidectomy; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Postoperative Hemorrhage; Retrospective Studies; Risk Assessment; Risk Factors; Tonsillectomy; Young Adult
PubMed: 32451667
DOI: 10.1007/s00405-020-06060-1 -
International Journal of Surgery... Mar 2015A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate efficacy for the reduction of postoperative blood loss and transfusion... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate efficacy for the reduction of postoperative blood loss and transfusion requirements of topical use of tranexamic acid in patients undergoing primary total hip arthroplasty.
METHOD
Potential articles were identified from Medline (1966 - September 2014), Embase (1980 - September 2014), Pubmed (1980 - September 2014) and The Cochrane Central Register of Controlled Trials. Other internet databases are also searched to find trials according to the Cochrane Collaboration guidelines. Moreover, gray literatures are also selected from the reference list of the included studies. High quality randomized controlled trials (RCTs) and non-RCTs were selected. The software RevMan 5.1 was used for the mate-analysis.
RESULTS
Four RCTs and four non-RCT meet the inclusion criteria. There were significant differences in hemoglobin, total blood loss, transfusion requirements and postoperative drainage volume between TXA groups and control groups. There were no significant differences in length of stay, incidence of wound infection, deep vein thrombosis (DVT) and pulmonary embolism (PE) between treatment and control groups.
CONCLUSIONS
Present meta-analysis indicates that the antifibrinolytic agent, also known as tranexamic acid, could reduce hemoglobin decline, volume of drainage, total blood loss and transfusion requirements after THA, and is not related to adverse reactions or complications such as wound infection, DVT and PE.
Topics: Administration, Topical; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Transfusion; Humans; Postoperative Hemorrhage; Pulmonary Embolism; Surgical Wound Infection; Tranexamic Acid; Venous Thrombosis
PubMed: 25576011
DOI: 10.1016/j.ijsu.2014.12.023 -
Blood Coagulation & Fibrinolysis : An... Oct 2022Individuals with chronic liver disease (CLD) have an increased risk of bleeding from thrombocytopenia and changes in hemostasis. The aim of this study was to evaluate...
Individuals with chronic liver disease (CLD) have an increased risk of bleeding from thrombocytopenia and changes in hemostasis. The aim of this study was to evaluate the frequency of and the factors associated with the occurrence of bleeding in CLD patients who underwent dental surgical procedures. This was a retrospective study whose data were collected in a hospital dentistry service between 2010 and 2016. The patients were referred from the gastroenterology and liver transplantation services of a university hospital for dental treatment. The study followed the STROBE guidelines. Among the 71 surgical procedures performed, there were 17 (24%) perioperative and postoperative bleeding episodes, 14 of which were in pretransplant patients and 11 received blood transfusion before dental surgery. Individuals with a previous history of bleeding (PR = 2.67, CI = 1.07-6.67, P = 0.035) and those with a platelet count before surgery 50 × 10 9 /l or less (PR = 7.48, CI = 1.70-32.86, P = 0.008) had a higher prevalence of perioperative and postoperative bleeding episodes than their peers without a previous history of bleeding, and those with platelet count greater than 50 × 10 9 /l. The approach to individuals with CLD is complex and represents a challenge to the clinician. A careful anamnesis combined with laboratory screening of coagulation disorders appears to be useful to identify individuals at a major risk of bleeding. Studies identifying the predisposing factors of bleeding in CLD patients support well tolerated protocols for oral surgery in this group.
Topics: Humans; Liver Diseases; Oral Surgical Procedures; Postoperative Hemorrhage; Retrospective Studies; Thrombocytopenia
PubMed: 35867941
DOI: 10.1097/MBC.0000000000001157 -
Transplant International : Official... May 2017Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney...
Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical-site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24-hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical-site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical-site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.
Topics: Adult; Case-Control Studies; Female; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Ontario; Postoperative Hemorrhage; Risk Factors
PubMed: 28120465
DOI: 10.1111/tri.12926 -
Journal of Clinical Neuroscience :... Feb 2015Impaired haemostasis represents a major risk factor for bleeding complications in neurosurgical patients. Coagulopathy commonly occurs after (brain) trauma and major... (Review)
Review
Impaired haemostasis represents a major risk factor for bleeding complications in neurosurgical patients. Coagulopathy commonly occurs after (brain) trauma and major haemorrhage or originates from antithrombotic medication. Point of care (POC) devices for bedside assessment of haemostatic parameters are increasingly used in various medical specialties. Results can be instantly implemented into treatment modalities as results are delivered within a very short period. POC coagulation testing has also shown beneficial effects in the treatment of neurosurgical patients. Identification of hyperfibrinolysis is achieved through viscoelastic testing of haemostasis and bedside coagulometry hastens the management of anticoagulated patients in need of urgent neurosurgical procedures. Results of POC testing of platelet function have been correlated with patient outcomes after traumatic brain injury and furthermore, quantification of antiplatelet medication effects on platelet activity is made possible through the use of these devices. Further studies are needed to characterise the potential of POC testing of platelet function. Antiplatelet medication plays an important role in regard to haemorrhagic and thromboembolic risks. Therefore, POC testing of platelet activity may improve treatment modalities in patients undergoing neurosurgical procedures as well as neurointerventional procedures (such as intracranial stent placement). In this article we summarise the available data of POC testing in neurosurgical patients and discuss the potential of these devices in this field. POC technologies have improved patient care in various medical fields and in our view it is likely that this will also apply to the field of neurosurgery.
Topics: Blood Coagulation Tests; Female; Humans; Neurosurgical Procedures; Platelet Aggregation Inhibitors; Point-of-Care Testing; Postoperative Hemorrhage
PubMed: 25439750
DOI: 10.1016/j.jocn.2014.07.029 -
The Journal of Craniofacial Surgery May 2017The aim of this study was to analyze the location and cause of postoperative bleeding after posterior pharyngeal flap pharyngoplasty and to investigate the surgical...
The aim of this study was to analyze the location and cause of postoperative bleeding after posterior pharyngeal flap pharyngoplasty and to investigate the surgical techniques with the goal of treating the bleeding. The patients received posterior pharyngeal flap pharyngoplasty in the Cleft Lip and Palate Treatment and Research Center of Shanghai Jiaotong University School of Medicine from January 2003 to December 2014, and postoperative bleeding in the surgical area was retrospectively analyzed. According to the record of the exploration of hemostasis, the locations and causes of the bleeding were summarized. In the 12-year study, a total of 1037 patients received posterior pharyngeal flap pharyngoplasty, including 621 males and 416 females with ages ranging from 4 to 40 years and a mean age of 13.7 years. Among these patients, 7 individuals (0.68%) experienced significant postoperative bleeding with the exploration of hemostasis. All patients were male, aged 5 to 26 years with a mean age of 15.7 years, and all were sent back to the operating room for exploration of hemostasis under general anesthesia. The sites of bleeding included 2 patients (28.6%) of the soft palate, 2 patients (28.6%) of the pharyngeal flap pedicle, and 3 patients (42.8%) of the nasopharynx. In posterior pharyngeal flap pharyngoplasty, particular attention should be paid to the protection of the blood vessels in the soft palate and the treatment of the vascular pedicle. Postoperative bleeding is very dangerous and generally requires immediate exploration in the operating room under general anesthesia.
Topics: Adolescent; Adult; Child, Preschool; China; Cleft Lip; Cleft Palate; Female; Hemostasis, Surgical; Humans; Male; Otorhinolaryngologic Surgical Procedures; Outcome and Process Assessment, Health Care; Palate, Soft; Pharynx; Postoperative Hemorrhage; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Surgical Flaps
PubMed: 28060087
DOI: 10.1097/SCS.0000000000003358 -
Der Chirurg; Zeitschrift Fur Alle... Jun 2015Liver resection has developed into the current standard procedure due to modern resection techniques, profound knowledge of the liver anatomy and optimized surgical and... (Review)
Review
Liver resection has developed into the current standard procedure due to modern resection techniques, profound knowledge of the liver anatomy and optimized surgical and anesthesiological strategies to allow extended resections with both low morbidity and mortality. Initially major blood loss was the biggest concern with liver resection and a Pringle's manoeuvre was necessary. Nowadays, biliary leakage is the major problem after liver surgery. Besides the classical conventional clamp crushing technique for parenchymal transection, various devices including ultrasound, microwaves and staplers have been introduced. Minimally invasive techniques have become increasingly important for liver resection but are still applied in selected patients only. The selection of the resection technique and device mainly depends on the extent of the resection and also on the liver parenchyma, the liver disease, costs, personal experiences and preferences. This article presents a selection of techniques used in modern parenchymal transection during liver resection with special focus on transection time, blood loss, bile leakage and costs.
Topics: Biliary Fistula; Combined Modality Therapy; Hepatectomy; Humans; Liver Diseases; Minimally Invasive Surgical Procedures; Postoperative Complications; Postoperative Hemorrhage; Reoperation
PubMed: 25298187
DOI: 10.1007/s00104-014-2892-x -
The Journal of Surgical Research Aug 2023Postoperative bleeding is a common complication in congenital heart surgery. We aimed to evaluate effects of topical and intravenous tranexamic acid (TXA) administration... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Postoperative bleeding is a common complication in congenital heart surgery. We aimed to evaluate effects of topical and intravenous tranexamic acid (TXA) administration on postoperative hemoglobin and bleeding in children with acyanotic congenital heart disease (CHD).
METHODS
In this randomized clinical trial, 50 acyanotic CHD children were allocated into two groups of topical (n = 25) and infusion (n = 25). Children in the infusion group were given intravenous TXA 50 mg/kg after sternotomy. Children in topical group were given 50 mg/kg TXA added to 20 mL of saline intrapericardially before sternal closure. Primary endpoint of study was comparison of postoperative hemoglobin and bleeding between topical and infusion groups. A linear mixed model (LMM) was used to estimate longitudinal changes in postoperative endpoints.
RESULTS
We did not observe significant differences in children's characteristics between two groups. Also, intraoperative and postoperative outcomes did not differ between two groups but children with intravenous TXA experienced significantly longer intubation time than topical children (P = 0.047). LMM analysis revealed that postoperative bleeding in topical group was lower compared to infusion group (P = 0.036). Also, age of children had a significant effect on mean changes of hemoglobin during postoperative care (β = -0.27, P = 0.030). No children died and none had serious postoperative complications such as seizures and reoperation.
CONCLUSIONS
We found that topical TXA is not superior to intravenous administration in management of blood loss. Also, no additional effect was found about topical TXA in further reducing transfusion rates and postoperative complications in acyanotic CHD children undergoing cardiac surgery.
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Blood Loss, Surgical; Administration, Intravenous; Postoperative Hemorrhage; Postoperative Complications; Heart Defects, Congenital; Hemoglobins; Administration, Topical
PubMed: 36948034
DOI: 10.1016/j.jss.2023.02.029 -
The Thoracic and Cardiovascular Surgeon Jun 2022Intraoperative and postoperative bleeding associated with allogeneic blood transfusion and reoperation is still a common and feared complication in patients undergoing...
BACKGROUND
Intraoperative and postoperative bleeding associated with allogeneic blood transfusion and reoperation is still a common and feared complication in patients undergoing surgery due to acute Type A Aortic Dissection (aTAAD). The aim of our study was to identify risk factors for higher transfusion rates.
METHODS
In this retrospective single center study we evaluated pre -, intra-, and postoperative data of 121 patients with aTAAD. Depending on the median of received packed red blood cells (PRBCs), patients were divided into Group A (<8 PRBC, = 53) and Group B (≥8 PRBC = 68). Statistical analyses (descriptive statistics, univariable and multivariable logistic regression) were performed using SPSS software 25.0. Statistical significance was assumed at -value <0.05.
RESULTS
A total of 120 patients received a blood product during their perioperative course. Among others we identified age, hemorrhagic pericardial effusion, and dual antiplatelet therapy as preoperative risk factors, low rectal temperature as intraoperative risk factor and low body temperature, positive fluid balance, high lactate level and beginning development of acute renal failure as postoperative risk factors.
CONCLUSION
Our study identifies several factors which predict a higher likelihood of bleeding and consecutive blood transfusion. Knowledge of these factors could influence the therapy to reduce transfusion requirements and lead to a targeted and more efficient use of coagulation products.
Topics: Blood Transfusion; Humans; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35042245
DOI: 10.1055/s-0041-1741004 -
American Journal of Otolaryngology 2020Although tonsillectomies carry a low-risk for adverse events, postoperative hemorrhage has been reported as the most common complication. (Comparative Study)
Comparative Study
BACKGROUND
Although tonsillectomies carry a low-risk for adverse events, postoperative hemorrhage has been reported as the most common complication.
AIM
To compare the rates of postoperative secondary hemorrhage for tonsillectomy with or without double-layer suture.
MATERIAL AND METHODS
This is a retrospective study of 5087 patients who underwent coblation tonsillectomy with or without suture from 2006 to 2016. All cases had been followed up 3 weeks and severe secondary hemorrhage cases requiring operation were analyzed.
RESULTS
The severe secondary hemorrhage rate was statistically higher in group without suture (1.96%) as compared with the group with suture (1.08%). The surgery time (36.55 ± 7.45) was longer in patients with suture as compared to patients without suture (31.50 ± 6.23). In the age between 18 and 49 years group, the higher secondary hemorrhage rate (2.44%) was found in patients without suture. The rate of postoperative hemorrhage (0.96%) was significantly higher in patients without suture as compared with patients with suture (0.36%) on postoperative 5th day.
CONCLUSIONS
The risk of severe secondary hemorrhage is reduced in coblation tonsillectomy with suture. The rate of secondary hemorrhage is lower in patients with suture in 18 to 49 years old group and on the 5th day after surgery.
Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Operative Time; Postoperative Hemorrhage; Retrospective Studies; Suture Techniques; Tonsillectomy; Treatment Outcome; Young Adult
PubMed: 32653732
DOI: 10.1016/j.amjoto.2020.102632