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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 -
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 -
Wiener Medizinische Wochenschrift (1946) Oct 2022Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively,...
BACKGROUND
Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively, is one of the most serious complications.
OBJECTIVE
To determine the frequency of hemorrhage in children after adenotonsillectomy and to compare postoperative hemorrhage with regard to age and sex.
METHODS
A cross-sectional longitudinal study was conducted at the Ear, Nose, and Throat Clinic, University Clinical Center Tuzla, and included all children of both sexes, aged 3 to 15 years, who underwent adenotonsillectomy during a 1.5-year period.
RESULTS
A total of 201 children aged 3-15 years underwent adenotonsillectomy, 113 males and 88 females, which corresponds to a ratio of 1.28: 1. Adenotonsillectomy was performed in 147 (73.1%) patients and adenoidectomy in 54 (27%). In the overall sample, there were 19 (9.5%) subjects with postoperative hemorrhage. Primary hemorrhage occurred in 9 subjects (47%) and secondary hemorrhage in 10 subjects (53%). Significantly more female subjects had postoperative hemorrhage. In the group of subjects with hemorrhage, the mean age (standard deviation) was 8.45 (3.3) years. Tonsillar lodges are common sites of hemorrhage.
CONCLUSION
The frequency and causes of hemorrhage after adenotonsillectomy in our study are partially comparable to the world data.
Topics: Adenoidectomy; Child; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Postoperative Hemorrhage; Tonsillectomy
PubMed: 35759051
DOI: 10.1007/s10354-022-00945-y -
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 -
International Journal of Pediatric... Aug 2023To evaluate the association of treatment with nebulized tranexamic acid (TXA) with rates of operative intervention in post-tonsillectomy hemorrhage (PTH).
OBJECTIVE
To evaluate the association of treatment with nebulized tranexamic acid (TXA) with rates of operative intervention in post-tonsillectomy hemorrhage (PTH).
METHODS
Single tertiary-referral center and satellite hospitals, retrospective cohort of adult and pediatric patients who were diagnosed with PTH in 2015-2022 and treated with nebulized TXA and standard care, compared with an age- and gender-matched control cohort treated with standard care. Patients were typically treated in the emergency department with a single dose of 500mg/5 mL TXA delivered via nebulizer.
RESULTS
1110 total cases of PTH were observed, and 83 were treated with nebulized TXA. Compared to 249 age- and gender-matched PTH controls, TXA-treated patients had a rate of operating room (OR) intervention of 36.1% versus 60.2% (p < 0.0001) and a rate of repeat bleeding of 4.9% versus 14.2% (p < 0.02). The odds ratio for OR intervention with TXA treatment was 0.37 (95% CI 0.22, 0.63). There were no adverse effects identified with an average follow-up time of 586 days.
CONCLUSION
Treatment of PTH with nebulized TXA is associated with lower rates of operative intervention and lower rates of repeat bleeding events. Prospective studies are needed to further characterize efficacy and optimal treatment protocols.
Topics: Adult; Humans; Child; Tranexamic Acid; Retrospective Studies; Tonsillectomy; Antifibrinolytic Agents; Hemorrhage; Postoperative Hemorrhage
PubMed: 37423163
DOI: 10.1016/j.ijporl.2023.111644 -
Paediatric Anaesthesia Jun 2023Circumcision is a common surgical procedure performed in pediatric male patients. Ketorolac is an effective adjunct in multimodal regimens for postoperative pain...
BACKGROUND
Circumcision is a common surgical procedure performed in pediatric male patients. Ketorolac is an effective adjunct in multimodal regimens for postoperative pain control. However, many urologists and anesthesiologists refrain from administering ketorolac due to concern for postoperative bleeding.
AIMS
Compare the risk of clinically significant bleeding after circumcision with and without intraoperative ketorolac administration.
METHODS
A single-center, retrospective cohort study was conducted of pediatric patients 1-18 years of age who underwent isolated circumcision by one urologist from 2016 to 2020. Clinically significant bleeding was defined as bleeding requiring intervention within the first 24 h of circumcision. Interventions included use of absorbable hemostats, placement of sutures, or return to the operating room.
RESULTS
Of 743 patients, 314 (42.3%) did not receive ketorolac and 429 (57.7%) received intraoperative ketorolac 0.5 mg/kg. Postoperative bleeding requiring intervention occurred in one patient (0.32%) in the non-ketorolac group versus four patients (0.93%) in the ketorolac group (difference 0.6%, 95% CI [-0.8%, 2.0%], p = 0.403).
CONCLUSIONS
There was no statistically significant difference in postoperative bleeding requiring intervention between the non-ketorolac and ketorolac groups. Future studies regarding the association between ketorolac and postoperative bleeding are needed.
Topics: Child; Humans; Male; Ketorolac; Anti-Inflammatory Agents, Non-Steroidal; Retrospective Studies; Pain, Postoperative; Postoperative Hemorrhage
PubMed: 36892424
DOI: 10.1111/pan.14661 -
European Archives of... May 2022Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy.
METHODS
The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively.
RESULTS
Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively).
CONCLUSIONS
This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.
Topics: Blood Loss, Surgical; Humans; Operative Time; Peritonsillar Abscess; Postoperative Hemorrhage; Tonsillectomy
PubMed: 35169892
DOI: 10.1007/s00405-022-07294-x -
Tidsskrift For Den Norske Laegeforening... Mar 2021Tonsillectomy and tonsillotomy are common surgical procedures, especially among children and adolescents. Post-operative bleeding is a potentially alarming and dangerous...
BACKGROUND
Tonsillectomy and tonsillotomy are common surgical procedures, especially among children and adolescents. Post-operative bleeding is a potentially alarming and dangerous complication. We wished to identify the prevalence of postoperative bleeding and associated risk factors in Ålesund hospital.
MATERIAL AND METHOD
The study is based on a retrospective review of the records of all patients who underwent tonsil surgery at Ålesund hospital in the five-year period from 2015-2019.
RESULTS
Of 1394 patients who underwent tonsil surgery, tonsillectomy was performed in 1285 patients and tonsillotomy in 109 patients. Thirty patients (2.2 %) had primary haemorrhage (< 24 hours). Twenty patients (1.4 %) were hospitalised due to secondary haemorrhage (> 24 hours), after an average of 5.4 days. Five patients (0.4 %) were reoperated due to postoperative bleeding. No postoperative bleeding was recorded after tonsillotomy. Increased risk of late postoperative bleeding was found for patients aged 16 years and over, and patients with primary haemorrhage.
INTERPRETATION
The proportion of cases of postoperative bleeding was low compared to international studies. Our figures are likely representative for other otorhinolaryngology departments in Norway, and may provide useful information to clinicians and patients prior to tonsil surgery.
Topics: Adolescent; Child; Humans; Norway; Palatine Tonsil; Postoperative Hemorrhage; Retrospective Studies; Tonsillectomy
PubMed: 33754678
DOI: 10.4045/tidsskr.20.0813 -
Head & Neck Jan 2021Transcervical arterial ligation has been studied as a useful procedure to prevent bleeding events after transoral robotic surgery (TORS). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transcervical arterial ligation has been studied as a useful procedure to prevent bleeding events after transoral robotic surgery (TORS).
METHODS
A systematic review of English-language literature on arterial ligation in TORS from 2005 to 2019 was conducted using Cochrane, PubMed, Web of Science (WoS), and ScienceDirect databases. Studies evaluating ligation and rates of postoperative hemorrhage were included. Meta-analysis of included studies was performed to assess impact of ligation on postoperative hemorrhage.
RESULTS
Five studies with 2008 patients were included. History of radiation (odds ratio [OR] = 2.26, P = .02) and advanced tumor stage (OR = 1.93, P = .02) were found to predispose patients to postoperative hemorrhage. Arterial ligation was protective against severe hemorrhage in the mixed primary surgical modality cohort (OR = 0.33, P = .03) and in the TORS-only subgroup (OR = 0.21, P = .02), but did not significantly impact overall odds of postoperative hemorrhage.
CONCLUSION
Transcervical arterial ligation offers protection against major/severe postoperative hemorrhage in patients undergoing TORS.
LEVEL OF EVIDENCE
II.
Topics: Humans; Ligation; Oropharyngeal Neoplasms; Postoperative Hemorrhage; Robotic Surgical Procedures
PubMed: 32974970
DOI: 10.1002/hed.26480 -
Medicine Jul 2023To evaluate the efficacy and safety of perioperative cryotherapy combined with intra-articular injection of tranexamic acid (TXA) in total knee arthroplasty (TKA) and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the efficacy and safety of perioperative cryotherapy combined with intra-articular injection of tranexamic acid (TXA) in total knee arthroplasty (TKA) and explore a new strategy of enhanced recovery after TKA.
METHODS
We randomly divided 200 patients into 4 groups: normal saline (10 mL) by drainage (Group A, placebo); intra-articular injection of TXA (1 g, 10 mL, Group B); normal saline (10 mL) and continuous cryotherapy postoperatively (Group C) and intra-articular injection of TXA (1 g, 10 mL) and continuous cryotherapy postoperatively (Group D). Primary outcomes were blood loss volume, postoperative pain and circumference variation. We also recorded consumption of analgesics, postoperative length of stay (p-LOS), range of motion (ROM), function score (Hospital for Special Surgery) and severe complications.
RESULTS
There were statistically significant differences in postoperative drainage volume, total blood loss, hidden blood loss, and visual analogue scale at rest and walking on postoperative day 1 (POD1), POD2, POD3, ROM (POD3, 7, discharge, postoperative month), circumference variation (POD3, 7), p-LOS, Hospital for Special Surgery score (discharge) and drop of hemoglobin on POD3 (P < .05) among 4 groups, but there were no significant differences in intraoperative blood loss, postoperative prothrombin, activated partial thromboplastin time, overall number of patients or total consumption of oxycodone and perioperative complications (e.g., incidence of surgical site infection, deep venous thrombosis, and cold injury) among them (P > .05).
CONCLUSION
Continuous cryotherapy combined with intra-articular injection of TXA provides short-term advantages in reducing blood loss, pain, postoperative swelling, p-LOS and increasing ROM and joint function in the early postoperative period after TKA without increasing any severe complications.
Topics: Humans; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Injections, Intra-Articular; Postoperative Hemorrhage; Saline Solution; Tranexamic Acid
PubMed: 37478271
DOI: 10.1097/MD.0000000000034381