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Khirurgiia 2021Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic...
Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.
Topics: Humans; Incidence; Pancreatectomy; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Hemorrhage
PubMed: 33395516
DOI: 10.17116/hirurgia202101177 -
Journal of Cardiac Surgery Nov 2019
Topics: Aged; Anemia; Blood Loss, Surgical; Cardiac Surgical Procedures; Erythrocyte Transfusion; Female; Humans; Male; Postoperative Hemorrhage
PubMed: 31441554
DOI: 10.1111/jocs.14221 -
European Archives of... Mar 2022Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the...
PURPOSE
Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff.
METHODS
This retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences.
RESULTS
A total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1-19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm-6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol.
CONCLUSION
The discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.
Topics: Adult; Child; Humans; Postoperative Hemorrhage; Postoperative Period; Retrospective Studies; Tonsillectomy
PubMed: 34557959
DOI: 10.1007/s00405-021-07080-1 -
Journal of Perioperative Practice 2023Oxford guidelines were developed after critically reviewing the existing literature and aim to assist anaesthetists, surgeons and allied healthcare staff in providing... (Review)
Review
Oxford guidelines were developed after critically reviewing the existing literature and aim to assist anaesthetists, surgeons and allied healthcare staff in providing optimal care for patients undergoing tonsillectomy as a day-case procedure. Appropriate patient selection, provision of robust analgesia, antiemesis, perioperative warming and hydration are key factors to ensure patient comfort and allow same-day discharge. Patients can be discharged home after a minimum observation of 6h as this is the period with the greatest risk of primary haemorrhage. All patients must have a clear and safe understanding of which complications may occur and know how to seek help. A team effort and close collaboration between the anaesthetic, surgical, theatre and ward teams are essential to achieve optimum outcomes and reduce the rate of failed discharges.
Topics: Humans; Adult; Tonsillectomy; Pain Management; Postoperative Hemorrhage; Ambulatory Surgical Procedures; Analgesia
PubMed: 34396825
DOI: 10.1177/17504589211031067 -
Journal of Hepato-biliary-pancreatic... May 2023Postoperative hemorrhage (POH) is a severe adverse event following pancreatic injury. The present study aimed to investigate the risk factors and outcomes of POH after... (Clinical Trial)
Clinical Trial
BACKGROUND
Postoperative hemorrhage (POH) is a severe adverse event following pancreatic injury. The present study aimed to investigate the risk factors and outcomes of POH after pancreatic injury.
METHODS
All patients with a confirmed diagnosis of pancreatic injury who underwent surgical intervention between January 2010 and December 2018 were identified and extracted from the trauma database. Logistic regression was performed to identify the risk factors for POH and specific outcomes.
RESULTS
A total of 88 cases that underwent surgical intervention were analyzed, and POH occurred in 31 (35.23%) patients. After multivariable analysis, independent predictors of POH were intra-abdominal abscess (IAA) (p = .002), intestinal fistula (p = .008), shock on admission (p = .003), absence of abdominal suction drainage (p = .005), and higher body mass index (BMI) (p = .005). In addition, patients with POH after pancreatic injury also showed more complications, prolonged hospital and ICU durations, and a significantly higher mortality rate (p = .004).
CONCLUSIONS
Patients with IAA, intestinal fistula, shock on admission, absence of abdominal suction drainage, and higher BMI score were associated with POH after pancreatic injury. Moreover, POH was associated with a poor prognosis.
CLINICAL TRIAL REGISTER
The study was registered on ClinicalTrials.gov (Unique identifier: NCT03681041).
Topics: Humans; Intestinal Fistula; Pancreatic Diseases; Pancreatic Fistula; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Risk Factors
PubMed: 36270802
DOI: 10.1002/jhbp.1251 -
Transfusion Oct 2020Bleeding complications are common in cardiac surgery and lead to an increase in morbidity and mortality. This is multifactorial in aetiology including the effects of... (Review)
Review
Bleeding complications are common in cardiac surgery and lead to an increase in morbidity and mortality. This is multifactorial in aetiology including the effects of cardiopulmonary bypass, the drugs given to manipulate the coagulation system and the vascular nature of the surgery itself. Viscoelastic tests provide a point of care, rapid assessment of coagulation which offer the advantage of faster turnaround times and a nuanced view of the elements of the coagulation system allowing targeted therapy to be delivered quickly. Both thomboelastography (TEG)and thromboelastometry (ROTEM) have been recommended for use in cardiac surgery, both have shown a reduction in transfusion and bleeding when used as part of a testing algorithm. They are particularly useful in assessing residual heparinisation and fibrinogen levels. Additionally, TEG allows the evaluation of the effects of anti-platelet agents on platelet function. This review discusses the mechanisms by which bleeding occurs in cardiac surgery and explores three uses of viscoelastic testing in cardiac surgery: to predict bleeding, to assess platelet function and peri-operative testing to reduce transfusion.
Topics: Anticoagulants; Antifibrinolytic Agents; Blood Coagulation Disorders; Blood Loss, Surgical; Blood Transfusion; Cardiac Surgical Procedures; Coronary Artery Bypass; Extracorporeal Circulation; Fibrinogen; Fibrinolysis; Heparin; Humans; Hypothermia, Induced; Platelet Function Tests; Point-of-Care Systems; Postoperative Hemorrhage; Preoperative Care; Procedures and Techniques Utilization; Protamines; Randomized Controlled Trials as Topic; Thrombelastography
PubMed: 32955756
DOI: 10.1111/trf.16075 -
World Journal of Surgery Aug 2021The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The...
BACKGROUND
The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.
METHODS
Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (n = 26), liver transplantation (n = 24) and other (n = 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.
RESULTS
Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p = 0.14). Recurrence was similar after stenting and embolization (n = 4/18, 22% vs n = 8/26, 31%, p = 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n = 2/10, 20% vs. n = 11/16, 69%, p = 0.042).
CONCLUSION
IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.
Topics: Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Middle Aged; Pancreatectomy; Postoperative Hemorrhage; Radiography, Interventional; Retrospective Studies; Treatment Outcome
PubMed: 33866425
DOI: 10.1007/s00268-021-06116-1 -
Georgian Medical News Apr 2021Objective - to study the character of possible postoperative complications and to define the reason and frequency of postoperative hemorrhage as a complication of...
Objective - to study the character of possible postoperative complications and to define the reason and frequency of postoperative hemorrhage as a complication of partial nephrectomy. From January 2008 to December 2019 were performed 175 partial nephrectomy (PN) by a single surgeon in a high volume center. 41 operations were laparoscopic partial nephrectomy (LPN), 134 - open partial nephrectomy (OPN). In 152 cases kidney cancer was detected. Physical status, tumor volume, R.E.N.A.L. score, operative access, warm ischemia time (WIT), postoperative bleeding and its severity and treatment options were assessed in both groups of patients. Based on our study, R.E.N.A.L score may be a good tool in prognosis of a delay postoperative bleeding after nephron sparing surgery and this is statistically significant. On the other hand, single R.E.N.A.L score characteristics can't be reliable predictors of a delay bleeding. It is possible that a lack of cases with a significant postoperative bleeding in current study (6 of 175 cases) have some statistical restrictions. From our point of view, for better prognosis of delay bleeding, aside from hephrometric system it is important to take into account a proximity of a segmental arteries to a resection border, presens of any type of a coagulopathy and a preoperative antithrombotic therapy, obesity. High R.E.N.A.L score index is connected with a risk of significant postoperative bleeding, but this type of bleeding is rare after any nephron sparing surgery. Postoperative selective angioembolization is a method of choice and, in most cases, effective to stop kidney bleeding and nephron preservation.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Treatment Outcome
PubMed: 34103423
DOI: No ID Found -
Expert Review of Gastroenterology &... Oct 2022Current guidelines recommend aspirin maintenance for high-risk endoscopic procedures. Some Asian physicians noticed increasing postoperative bleeding in patients taking... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
Current guidelines recommend aspirin maintenance for high-risk endoscopic procedures. Some Asian physicians noticed increasing postoperative bleeding in patients taking aspirin. We aimed to explore whether risk of postoperative hemorrhage due to aspirin differs in the East and the West.
METHODS
PubMed, EMBASE and Cochrane library database were systematically reviewed. We only included trials that met our criteria.
RESULTS
There is significant association between aspirin and postoperative bleeding (P < 0.001), especially in Eastern population (data from Japan, Korea, Turkey and China, P < 0.001). Result from the West (data from America, Canada and Australia) had no statistical significance (P = 0.07). For Easterners, aspirin increased bleeding risk after endoscopic submucosal dissection (ESD) and endoscopic sphincterotomy (EST). For Westerners, aspirin increased bleeding risk post endoscopic mucosal resection (EMR). For patients undergoing ESD, those who continued to receive aspirin had higher bleeding risk than patients who interrupted it for more than 7 days (P = 0.005).
CONCLUSION
Aspirin increases risk of postoperative hemorrhage. Easterners are more likely to suffer from bleeding after aspirin administration than Westerners. Stopping aspirin for more than 7 days may be advisable to control bleeding post ESD for patients with low risk of thrombosis.
Topics: Humans; Aspirin; Platelet Aggregation Inhibitors; Gastrointestinal Hemorrhage; Retrospective Studies; Postoperative Hemorrhage; Endoscopic Mucosal Resection; Stomach Neoplasms; Gastric Mucosa
PubMed: 36245097
DOI: 10.1080/17474124.2022.2137489 -
Scientific Reports Jul 2021To develop a predictive model and a nomogram for predicting postoperative hemorrhage in preoperative patients undergoing laparoscopic pancreaticoduodenectomy (LPD). A...
To develop a predictive model and a nomogram for predicting postoperative hemorrhage in preoperative patients undergoing laparoscopic pancreaticoduodenectomy (LPD). A total of 409 LPD patients that underwent LPD by the same surgical team between January 2014 and December 2020 were included as the training cohort. The preoperative data of patients were statistically compared and analyzed for exploring factors correlated with postoperative hemorrhage. The predictive model was developed by multivariate logistic regression and stepwise (stepAIC) selection. A nomogram based on the predictive model was developed. The discriminatory ability of the predictive model was validated using the receiver operating characteristic (ROC) curve and leave-one-out method. The statistical analysis was performed using R 3.5.1 ( www.r-project.org ). The predictive model including the risk-associated factors of postoperative hemorrhage was as follows: 2.695843 - 0.63056 × (Jaundice = 1) - 1.08368 × (DM = 1) - 2.10445 × (Hepatitis = 1) + 1.152354 × (Pancreatic tumor = 1) + 1.071354 × (Bile duct tumor = 1) - 0.01185 × CA125 - 0.04929 × TT - 0.08826 × APTT + 26.03383 × INR - 1.9442 × PT + 1.979563 × WBC - 2.26868 × NEU - 2.0789 × LYM - 0.02038 × CREA + 0.00459 × AST. A practical nomogram based on the model was obtained. The internal validation of ROC curve was statistically significant (AUC = 0.7758). The validation by leave-one-out method showed that the accuracy of the model and the F measure was 0.887 and 0.939, respectively. The predictive model and nomogram based on the preoperative data of patients undergoing LPD can be useful for predicting the risk degree of postoperative hemorrhage.
Topics: Aged; Female; Humans; Logistic Models; Male; Middle Aged; Models, Theoretical; Nomograms; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Hemorrhage; ROC Curve; Risk Factors
PubMed: 34285333
DOI: 10.1038/s41598-021-94387-y