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The Journal of Laryngology and Otology Aug 2022Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule...
OBJECTIVE
Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited.
METHOD
This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular ( 379) and intracapsular tonsillectomy ( 351) across all ages and indications using Coblation technology.
RESULTS
A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 0.3 per cent; 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage ( 0.01).
CONCLUSION
Coblation intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.
Topics: Adolescent; Adult; Child; Humans; Pain, Postoperative; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Sleep Apnea Syndromes; Tonsillectomy
PubMed: 34583787
DOI: 10.1017/S0022215121002565 -
Pancreatology : Official Journal of the... Apr 2023This study aimed to assess the outcomes and characteristics of post-pancreatectomy hemorrhage (PPH) in over 1000 patients who underwent pancreatoduodenectomy (PD) at a...
BACKGROUND/OBJECTIVES
This study aimed to assess the outcomes and characteristics of post-pancreatectomy hemorrhage (PPH) in over 1000 patients who underwent pancreatoduodenectomy (PD) at a high-volume hepatopancreaticobiliary center.
METHODS
This retrospective study analyzed consecutive patients who underwent PD from 2010 through 2021. PPH was diagnosed and managed using our algorithm based on timing of onset and location of hemorrhage.
RESULTS
Of 1096 patients who underwent PD, 33 patients (3.0%) had PPH; incidence of in-hospital and 90-day mortality relevant to PPH were one patient (3.0%) and zero patients, respectively. Early (≤24 h after surgery) and late (>24 h) PPH affected 9 patients and 24 patients, respectively; 16 patients experienced late-extraluminal PPH. The incidence of postoperative pancreatic fistula (p < 0.001), abdominal infection (p < 0.001), highest values of drain fluid amylase (DFA) within 3 days, and highest value of C-reactive protein (CRP) within 3 days after surgery (DFA: p < 0.001) (CRP: p = 0.010) were significantly higher in the late-extraluminal-PPH group. The highest values of DFA≥10000U/l (p = 0.022), CRP≥15 mg/dl (p < 0.001), and incidence of abdominal infection (p = 0.004) were identified as independent risk factors for PPH in the multivariate analysis. Although the hospital stay was significantly longer in the late-extraluminal-PPH group (p < 0.001), discharge to patient's home (p = 0.751) and readmission rate within 30-day (p = 0.765) and 90-day (p = 0.062) did not differ between groups.
CONCLUSIONS
Standardized management of PPH according to the onset and source of hemorrhage minimizes the incidence of serious deterioration and mortality. High-risk patients with PPH can be predicted based on the DFA values, CRP levels, and incidence of abdominal infections.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Postoperative Hemorrhage; Pancreatectomy; Postoperative Complications; Pancreatic Fistula; Risk Factors
PubMed: 36764874
DOI: 10.1016/j.pan.2023.01.004 -
European Archives of... Apr 2024Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers...
PURPOSE
Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers and patients. We investigated the epidemiology of postoperative bleeding during endoscopic nasal and sinus surgery and explored possible bleeding triggers.
METHODS
We evaluated the patients who underwent endoscopic nasal and sinus surgery. Data regarding the age, sex, presence of hypertension, and abnormal coagulability, including oral anticoagulants, diagnoses, operative procedures, intraoperative use of drills and blood loss, and postoperative antimicrobial administration of eligible patients, were extracted from medical records and retrospectively reviewed.
RESULTS
One hundred and eighty-six patients underwent endoscopic nasal or sinus surgery during the study period, and postoperative bleeding occurred in 9 patients (4.8%). Posterior nasal neurotomy (PNN) was the procedure most likely to cause postoperative bleeding (4 surgeries, 13.3%). Postoperative antimicrobial administration significantly reduced the incidence of postoperative bleeding (p = 0.04).
CONCLUSIONS
Postoperative bleeding requiring intervention occurs in 4.8% of cases, and PNN is associated with a high risk of postoperative bleeding. Wound infection is a potential cause of postoperative bleeding, and antimicrobial administration should be considered in addition to local treatment.
Topics: Humans; Retrospective Studies; Endoscopy; Postoperative Hemorrhage; Nose; Anti-Infective Agents
PubMed: 38085306
DOI: 10.1007/s00405-023-08377-z -
International Journal of Clinical... Nov 2022The aim of this prospective study was to investigate the effect of a high dose of ulinastatin on platelets and coagulation in patients undergoing mitral valve and/or...
BACKGROUND
The aim of this prospective study was to investigate the effect of a high dose of ulinastatin on platelets and coagulation in patients undergoing mitral valve and/or aortic valve replacement with cardiopulmonary bypass (CPB).
MATERIALS AND METHODS
273 patients were enrolled in this open-label study. According to patients' willingness, 243 patients were assigned to the ulinastatin group and 30 to the control group. In the ulinastatin group, ulinastatin (300,000 U) was given after the induction of anesthesia, ulinastatin (400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000 U) was administered after weaning from CPB. Complete blood count and coagulation function test were conducted 1 day before surgery and on the first postoperative day. Bleeding and other safety events were recorded during hospitalization.
RESULTS
Less postoperative major bleeding occurred in the ulinastatin group (0.4 vs. 6.7%, p = 0.03). Moreover, 1 day after CPB, platelet count in the ulinastatin group increased significantly compared to that in the control group (157.7 ± 71.0 vs. 132.1 ± 59.6, p = 0.03). Interestingly and contrary to what was expected, activated partial thromboplastin time (APTT) and prothrombin time (PT) did not differ significantly between the two groups. Ulinastatin application did not cause significant increase in total costs (p = 0.89).
CONCLUSION
In heart valve replacement surgery with CPB, high-dose ulinastatin could reduce postoperative bleeding and promote platelet recovery with no significant additional medical cost.
Topics: Humans; Prospective Studies; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Postoperative Hemorrhage; Aortic Valve
PubMed: 35979898
DOI: 10.5414/CP204219 -
Asian Journal of Surgery May 2022
Topics: Hemorrhage; Humans; Pancreatectomy; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Postoperative Hemorrhage; Risk Factors
PubMed: 35246345
DOI: 10.1016/j.asjsur.2022.02.045 -
The Laryngoscope Jun 2021The primary objective of this investigation was to determine rates of abnormal coagulation panels and diagnoses of coagulopathies in children with post-tonsillectomy...
OBJECTIVES/HYPOTHESIS
The primary objective of this investigation was to determine rates of abnormal coagulation panels and diagnoses of coagulopathies in children with post-tonsillectomy hemorrhage (PTH). Secondary objectives identified patient demographics and hemorrhage event characteristics that correlated with a coagulopathy diagnosis.
STUDY DESIGN
Case series with chart review.
METHODS
Patients requiring operative control of PTH at a tertiary children's hospital between 2015 and 2019 were included. Details of tonsillectomy procedures and hemorrhage events were reviewed along with screening labs for coagulopathy, referrals to hematology and bleeding disorder diagnoses.
RESULTS
There were 250 children included. Mean age was 8.8 years (95% CI: 8.2-9.4) and 53.6% were males. PTH events occurred at a median of postoperative day six (mean: 5.9, 95% CI: 5.4-6.3), and 14.8% occurred within 24 hours of surgery. In this series, 23 patients (9.2%) had a second PTH, and three (1.2%) had a third PTH. Single and multiple PTH patients were similar with respect to age, gender, postoperative day, and technique (P > .05). Screening coagulation panels were obtained on presentation in 67.8% of children with one PTH and abnormally elevated in 38.3%. All children with multiple PTHs had labs drawn with 34.8% having elevated levels. No child with a single PTH was diagnosed with a bleeding disorder. Conversely, 87.0% of children with multiple PTHs saw hematology and three (13.0%) were diagnosed with a bleeding disorder (P < .001).
CONCLUSIONS
Obtaining coagulation panels in pediatric patients presenting with PTH is rarely useful and diagnosing a coagulopathy is uncommon. However, among children with a second PTH, referral to hematology is reasonable as this group has a significantly higher, albeit small, incidence of undiagnosed bleeding disorders.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:E2069-E2073, 2021.
Topics: Blood Coagulation Disorders; Child; Female; Humans; Male; Postoperative Hemorrhage; Tonsillectomy
PubMed: 33146421
DOI: 10.1002/lary.29244 -
World Neurosurgery Dec 2020To determine preoperative factors contributing to postoperative hemorrhage after stereotactic brain biopsy (STB), clinical implications of postoperative hemorrhage, and...
OBJECTIVE
To determine preoperative factors contributing to postoperative hemorrhage after stereotactic brain biopsy (STB), clinical implications of postoperative hemorrhage, and the role of postoperative imaging in clinical management.
METHODS
Retrospective review of STB (2005-2018) across 2 institutions including patients aged >18 years undergoing first STB. Patients with prior craniotomy, open biopsy, or prior STB were excluded. Preoperative variables included age, sex, neurosurgeon seniority, STB method. Postoperative variables included pathology, postoperative hemorrhage on computed tomography, immediate and 30-day postoperative seizure, infection, postoperative hospital stay duration, and 30-day return to operating room (OR). Analysis used the Fisher exact tests for categorical variables.
RESULTS
Overall, 410 patients were included. Average age was 56.5 (±16.5) years; 60% (n = 248) were men. The majority of biopsies were performed by senior neurosurgeons (66%, n = 270); frontal lobe (42%, n = 182) and glioblastoma (45%, n = 186) were the most common location and pathology. Postoperative hemorrhage occurred in 28% (114) of patients with 20% <0.05 cm and 8% >0.05 cm. Postoperative hemorrhage of any size was associated with increased rate of postoperative deficit within both 24 hours and 30 days, postoperative seizure, and length of hospital stay when controlling for pathology. Hemorrhages >0.05 cm had a 16% higher rate of return to the OR for evacuation, due to clinical deterioration as opposed to radiographic progression.
CONCLUSIONS
Postbiopsy hemorrhage was associated with higher risk of immediate and delayed postoperative deficit and seizure. Postoperative computed tomography should be used to determine whether STB patients can be discharged same day or admitted for observation; clinical evaluation should determine return to OR for evacuation.
Topics: Biopsy; Brain Neoplasms; Cerebral Hemorrhage; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Stereotaxic Techniques
PubMed: 32956884
DOI: 10.1016/j.wneu.2020.09.084 -
Journal of Shoulder and Elbow Surgery May 2020Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding and the need for transfusion. The purpose of the study was to assess... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding and the need for transfusion. The purpose of the study was to assess whether TXA could reduce the incidence of postoperative swelling and hematoma formation and pain and opioid use in the early postoperative period following the Latarjet procedure.
METHODS
A randomized controlled trial was conducted in 100 patients undergoing open Latarjet surgery for anterior shoulder instability by a single surgeon. Patients were randomized to receive either 1 g TXA or a placebo intravenously preoperatively. Outcomes measured during the perioperative period were (1) intraoperative blood loss, (2) postoperative blood loss (via drain output), (3) postoperative swelling/hematoma formation, (4) visual analog scale (VAS) score, and (5) postoperative opioid use (in morphine milligram equivalents).
RESULTS
There was no significant difference in intraoperative blood loss (60.9 vs. 68.9 mL, P = .18). However, there was significantly lower postoperative blood loss with TXA (29.6 vs. 64.9 mL, P < .01). There was a significantly lower rate of painful postoperative swelling (4% vs. 32%, P < .01). Additionally, we found a significantly lower VAS score for pain (1.7 vs. 3.0, P < .01) and significantly less postoperative opioid use (9.4 vs. 22 mg, P < .01) in the TXA group. Postoperative swelling was shown to correlate with increased pain and opioid use (P < .01).
CONCLUSION
Our study found that TXA significantly reduced postoperative blood loss, painful postoperative swelling, and hematoma formation and subsequently reduced postoperative pain and opioid use following the Latarjet procedure.
Topics: Administration, Intravenous; Adult; Analgesics, Opioid; Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Joint Instability; Male; Pain, Postoperative; Postoperative Hemorrhage; Shoulder Joint; Tranexamic Acid; Young Adult
PubMed: 32305106
DOI: 10.1016/j.jse.2020.01.066 -
Surgical Laparoscopy, Endoscopy &... Dec 2023One anastomosis gastric bypass (OAGB) has gained popularity among bariatric surgeons due to the shorter operative time, fewer sites for anastomotic leaks and internal...
INTRODUCTION
One anastomosis gastric bypass (OAGB) has gained popularity among bariatric surgeons due to the shorter operative time, fewer sites for anastomotic leaks and internal herniation, shorter learning curve, ease of reversibility and revision with equivalent results to Roux en Y gastric bypass in terms of weight loss and co-morbidity resolution. We present our experience in managing early postoperative bleeding after OAGB.
PATIENTS AND METHODS
Patients who underwent OAGB in Bariatric Surgery Unit, Ain Shams University Hospitals between January 2016 and January 2023 were followed up for 30 days for early postoperative complications. Patients were 210 females (70%) and 90 males, with a mean age of 41.3±7.1 years, and mean preoperative body mass index of 45.2±6.1 kg/m². The incidence of early postoperative bleeding, the sites of the bleeding and management strategy were reported.
RESULTS
Fourteen of 300 patients (4.67%) developed early postoperative bleeding after OAGB. Intraluminal bleeding occurred in 4 patients, 3 of which were controlled by endoscopy and one by laparoscopic suturing. Intra-abdominal bleeding occurred in 10 patients, 7 of which were successfully managed conservatively, and 3 required laparoscopic management. Two cases had both intra-abdominal bleeding and intraluminal bleeding in the distal stomach, confirmed by intraoperative endoscopy, and controlled by laparoscopic suturing.
CONCLUSION
Early postoperative bleeding after OAGB is a rare complication (4.67%). Conservative treatment is more successful in controlling intra-abdominal bleeding. In case of failed conservative treatment, laparoscopy is the method of choice. Most cases of intra-luminal bleeding need early endoscopic intervention.
Topics: Male; Female; Humans; Adult; Middle Aged; Gastric Bypass; Obesity, Morbid; Bariatric Surgery; Anastomotic Leak; Postoperative Complications; Postoperative Hemorrhage; Laparoscopy; Retrospective Studies
PubMed: 37852220
DOI: 10.1097/SLE.0000000000001232 -
Journal of Cardiothoracic and Vascular... Apr 2021Although most physicians are comfortable managing the limited anticoagulant effect of aspirin, the recent administration of potent P2Y receptor inhibitors in patients... (Meta-Analysis)
Meta-Analysis Review
Although most physicians are comfortable managing the limited anticoagulant effect of aspirin, the recent administration of potent P2Y receptor inhibitors in patients undergoing cardiac surgery remains a dilemma. Guidelines recommend discontinuation of potent P2Y inhibitors 5- to- 7 days before surgery to reduce the risk of postoperative hemorrhage. Such a strategy might not be feasible before urgent surgery, due to ongoing myocardial ischemia or in patients at high risk for thromboembolic events. Recently, different point-of-care devices to assess functional platelet quality have become available for clinical use. The aim of this narrative review was to evaluate the implications and potential benefits of platelet function monitoring in guiding perioperative management and therapeutic options in patients treated with antiplatelets, including aspirin or P2Y receptor inhibitors, undergoing cardiac surgery. No objective superiority of one point-of-care device over another was found in a large meta-analysis. Their accuracy and reliability are generally limited in the perioperative period. In particular, preoperative platelet function testing has been used to assess platelet contribution to bleeding after cardiac surgery. However, predictive values for postoperative hemorrhage and transfusion requirements are low, and there is a significant variability between and within these tests. Further, platelet function monitoring has been used to optimize the preoperative waiting period after cessation of dual antiplatelet therapy before urgent cardiac surgery. Furthermore, studies assessing their value in therapeutic decisions in bleeding patients after cardiac surgery are scarce. A general and liberal use of perioperative platelet function testing is not yet recommended.
Topics: Cardiac Surgical Procedures; Humans; Platelet Aggregation Inhibitors; Platelet Function Tests; Point-of-Care Systems; Postoperative Hemorrhage; Reproducibility of Results
PubMed: 32807601
DOI: 10.1053/j.jvca.2020.07.050