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Journal of Vascular and Interventional... Nov 2023
Topics: Humans; Free Tissue Flaps; Postoperative Hemorrhage; Embolization, Therapeutic; Vascular Surgical Procedures; Arteries
PubMed: 37527769
DOI: 10.1016/j.jvir.2023.07.026 -
Journal of Gastroenterology and... Dec 2020Postoperative hemorrhage is a rare but potentially lethal complication of hepatobiliary and pancreatic surgeries. This study aimed to retrospectively evaluate the...
BACKGROUND AND AIM
Postoperative hemorrhage is a rare but potentially lethal complication of hepatobiliary and pancreatic surgeries. This study aimed to retrospectively evaluate the clinical outcome of patients with delayed postoperative hemorrhage and compare the results according to the surgical procedure.
METHODS
Overall, 4220 patients underwent surgery for hepatobiliary and pancreatic diseases. Delayed postoperative hemorrhage (observed more than 24 h postoperatively) occurred in 62 patients. Of these, 61 underwent interventional radiology to achieve hemostasis. Patients' clinical data were analyzed retrospectively. The chi-squared or Fisher's exact test was used in data analysis.
RESULTS
A total of 62 patients (1.5%) developed delayed postoperative hemorrhage; 61 (1.4%) of them underwent interventional radiology to achieve hemostasis. Median duration from surgery to interventional radiology was 19 days (range: 5-252 days). Sentinel bleeding was detected in 31 patients; Clinical success was achieved in 54 patients (88.5%) by interventional radiology. Overall mortality rate was 26.2%. Causes of 16 in-hospital deaths were uncontrollable hemorrhage (n = 4) and worsening of general condition after hemostasis (n = 12). Mortality rates were 50.0% (11/22) and 12.8% (5/39) after hepatobiliary surgery and pancreatic resection, respectively. Mortality rate was significantly higher after hepatobiliary surgery than after pancreatic surgery (P = 0.002).
CONCLUSIONS
Interventional radiology can be successfully performed to achieve hemostasis for delayed hemorrhage after hepatobiliary and pancreatic surgeries. Because successful interventional radiology does not necessarily lead to survival, particularly after hepatobiliary surgery, meticulous attention to prevent surgical complications and intensive treatments before and after interventional radiology are required to improve outcomes.
Topics: Adult; Aged; Aged, 80 and over; Biliary Tract Surgical Procedures; Delayed Diagnosis; Digestive System Diseases; Female; Hemostasis, Surgical; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Diseases; Postoperative Hemorrhage; Radiography, Interventional; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 32525234
DOI: 10.1111/jgh.15140 -
Journal of the American College of... Aug 2004Postoperative hemorrhage, particularly delayed hemorrhage after pancreaticoduodenectomy, is a serious complication and one of the most common causes of mortality after...
BACKGROUND
Postoperative hemorrhage, particularly delayed hemorrhage after pancreaticoduodenectomy, is a serious complication and one of the most common causes of mortality after pancreaticoduodenectomy.
STUDY DESIGN
The medical records of 500 patients who underwent pancreaticoduodenectomy between October 1994 and December 2002 were analyzed with regard to postoperative hemorrhagic complications. Delayed hemorrhage was defined as bleeding at the operation site after 5 or more postoperative days.
RESULTS
Delayed hemorrhage occurred in 22 patients (4.4%), with a median time of 13 days (range 7 to 32 days) after pancreaticoduodenectomy, and developed more frequently (9/77 versus 13/423, p = 0.003) in patients with preceding intraabdominal complications such as pancreatic fistula, bile fistula, and intraabdominal abscess. In 17 of these 22 patients, angiography and laparotomy revealed bleeding foci at 14 arterial and 3 anastomotic sites. In nine patients, hemorrhage developed from pseudoaneurysms of the major arteries around the pancreaticojejunostomy. Hemostatis was attempted by transcatheter arterial embolization in 14 patients and with laparotomy in 4 patients. Four of 14 patients who received transcatheter arterial embolization eventually required laparotomy. Overall, 4 of the 22 delayed hemorrhage patients died (18.2%) of complications related to massive bleeding or transcatheter arterial embolization.
CONCLUSIONS
Delayed hemorrhage after pancreaticoduodenectomy is associated with a high mortality. Intraabdominal complications after pancreaticoduodenectomy should be evaluated properly and guidelines for the diagnosis and treatment of delayed hemorrhage should be established in advance. Clinicians must be alert to the possibility of pseudoaneurysm hemorrhage.
Topics: Abdominal Abscess; Adult; Aged; Aged, 80 and over; Biliary Fistula; Embolization, Therapeutic; Female; Hemostasis, Surgical; Humans; Male; Middle Aged; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Postoperative Hemorrhage; Time Factors
PubMed: 15275871
DOI: 10.1016/j.jamcollsurg.2004.04.005 -
Orbit (Amsterdam, Netherlands) Apr 2021Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital...
Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital surgery has not been investigated. We describe four cases of severe delayed postoperative hemorrhage associated with NOACs, in addition to three cases in patients on traditional antithrombotic agents. Time of delayed hemorrhage ranged from postoperative day 2 to 6. Six patients required surgical intervention to achieve control of bleeding, and two patients required transfusion of blood products. Risk factors and management of this rare complication are discussed.
Topics: Administration, Oral; Anticoagulants; Humans; Postoperative Hemorrhage; Risk Factors
PubMed: 32295502
DOI: 10.1080/01676830.2020.1752744 -
Medicine Jan 2021Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but...
Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but potentially life-threatening complication reported after PN. Thus, this study evaluated the imaging and surgical factors associated with postoperative hemorrhage after PN and the clinical results of trans-arterial embolization. A retrospective review of the institutional PN database was performed from May 2012 to January 2019, revealing that we performed 810 PN procedures at our institution. In total, 12 patients were referred to the interventional radiology department for vascular complications after the procedure. Patients with and without transarterial embolization (TAE) were age- and sex-matched with 56 patients. Preoperative imaging characteristics and operative details were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of hemorrhage. Furthermore, renal functions at diagnosis, after operation or embolization for TAE cases, and at the last follow-up were recorded. A diagnosis of hemorrhage was made at a median of 4 (range, 0-25) days after surgery. The majority of patients (50%) presented with gross hematuria. T test revealed higher renal tumor-parenchyma contact area (TPA) (P = .0407), Length-A (P = .0136), Length-P (P = .0267), operation time (P = .0214) and estimated blood loss (P = .0043) in patients with hemorrhage than in controls. Binary logistic regression analysis identified TPA (P = .048) and estimated blood loss (P = .042) as independent predictors for postoperative hemorrhage with an area under the ROC curve of 0.705 (64% sensitivity and 79% specificity). In conclusion, the occurrence of hemorrhage after PN was associated with a larger TPA and more estimated blood loss during the procedure. In patients who underwent selective TAE, renal function remained comparable with that of controls.
Topics: Computed Tomography Angiography; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Nephrectomy; Postoperative Hemorrhage; Predictive Value of Tests; Vascular Surgical Procedures
PubMed: 33545932
DOI: 10.1097/MD.0000000000023581 -
Otolaryngology--head and Neck Surgery :... Mar 2017Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and... (Meta-Analysis)
Meta-Analysis Review
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
Topics: Child; Humans; Patient Readmission; Postoperative Hemorrhage; Reoperation; Tonsillectomy
PubMed: 28094660
DOI: 10.1177/0194599816683915 -
Journal of the American Academy of... Aug 2020
Topics: Curettage; Hematoma; Humans; Mohs Surgery; Postoperative Hemorrhage; Treatment Outcome
PubMed: 31009672
DOI: 10.1016/j.jaad.2019.04.031 -
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 -
International Surgery 2013Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective...
Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal complications after splenectomy with a focus on early diagnosis and management of hemorrhage after splenectomy. The medical files of patients who underwent splenectomy between January 1990 and March 2011 were reviewed retrospectively. The cause, characteristics, management, and outcome in patients with post-splenectomy hemorrhage were analyzed. Fourteen of 604 patients (1.19%) undergoing splenectomy had intraperitoneal hemorrhage: reoperation was performed in 13 patients, and 3 patients died after reoperation, giving the hospital a mortality rate of 21.43%; whereas, 590 of 604 patients (98%) had no hemorrhage following splenectomy, and the mortality rate (0.34%) in this group was significantly lower (P < 0.001). The complications following splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P < 0.001). According to the reasons for splenectomy, 14 patients with post-splenectomy hemorrhage were grouped into two groups: splenic trauma (n = 9, group I) and portal hypertension (n = 5, group II). The median interval between splenectomy and diagnosis of hemorrhage was 15.5 hours (range, 7.25-19.5 hours). No differences were found between groups I and II in terms of incidence of postoperative hemorrhage, time of hemorrhage after splenectomy, volume of hemorrhage, and mortality of hemorrhage, except transfusion. Intra-abdominal hemorrhage after splenectomy is associated with higher hospital mortality rate and complications. Early massive intraperitoneal hemorrhage is often preceded by earlier sentinel bleeding; careful clinical inquiry and ultrasonography are the mainstays of early diagnosis.
Topics: Adolescent; Adult; Aged; Female; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Splenectomy; Treatment Outcome; Young Adult
PubMed: 23438277
DOI: 10.9738/CC63.1 -
Gan To Kagaku Ryoho. Cancer &... Nov 2012Postoperative anastomotic hemorrhage is a relatively rare complication. However, when it does occur, immediate treatment is needed.
BACKGROUND
Postoperative anastomotic hemorrhage is a relatively rare complication. However, when it does occur, immediate treatment is needed.
METHODS
In all, 1,700 patients underwent curative gastrectomy between 2000 and 2010. Anastomotic hemorrhage was observed in 9 patients after surgery. The clinical course of these 9 patients was analyzed.
RESULTS
The median age of the patients was 62 years, and all patients were men. Two patients underwent distal gastrectomy, 1 underwent laparoscopic distal gastrectomy, and 6 underwent total gastrectomy. Bleeding occurred as follows: 5 were at gastro- or esophagojejunostomic site, 2 were at gastroduodenostomic site, and 2 were at jejunojejunostomic site. Five patients received conservative treatment and 2 underwent re-operation. Two additional patients achieved complete hemostasis with endoscopic treatment. The patients who received endoscopic treatment were discharged earlier than those who received other treatments.
CONCLUSIONS
Endoscopic intervention was useful for the diagnosis and treatment of postoperative anastomotic hemorrhage.
Topics: Aged; Anastomosis, Surgical; Gastrectomy; Humans; Male; Middle Aged; Postoperative Hemorrhage; Stomach Neoplasms
PubMed: 23268056
DOI: No ID Found