-
Ear, Nose, & Throat Journal Apr 2023To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk...
OBJECTIVE
To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14.
METHODS
A retrospective chart review was performed for all pediatric patients admitted to The Children's Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis.
RESULTS
Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage.
CONCLUSIONS
Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.
Topics: Child; Humans; Tonsillectomy; Adenoidectomy; Retrospective Studies; Postoperative Hemorrhage; Risk Factors
PubMed: 33689495
DOI: 10.1177/0145561321999594 -
The Journal of Urology Oct 2006Surgical paradigms may change in the era of laparoscopic surgery. We evaluated a conservative nonsurgical approach to postoperative hemorrhage following laparoscopic...
PURPOSE
Surgical paradigms may change in the era of laparoscopic surgery. We evaluated a conservative nonsurgical approach to postoperative hemorrhage following laparoscopic upper retroperitoneal surgery as opposed to the more traditional strategy of reexploring the surgical site.
MATERIALS AND METHODS
In 911 laparoscopic procedures performed in 8 years we retrospectively identified risk factors and characterized treatment for postoperative hemorrhage.
RESULTS
We considered postoperative hemorrhage to be present when postoperative transfusion was required that could not be accounted for by operative blood loss or another definable cause outside of the surgical field. Red blood cell transfusion was required after 53 procedures (5.8%), of which 34 (3.7%) were done for postoperative hemorrhage. Postoperative hemorrhage occurred only after nephrectomy in 3.3% of cases, after partial nephrectomy in 9.9% and after adrenalectomy in 5.4%. Multivariate analysis revealed a significant association of postoperative hemorrhage with patient age and American Society of Anesthesiologists score (preoperative factors), operative time and splenic injury (intraoperative factors), and gastrointestinal complications and prolonged hospitalization (postoperative factors). Postoperative hemorrhage increased mean hospitalization from 2.5 to 6.4 days. No significant differences in post-hospital recovery were associated with postoperative hemorrhage. Only 4 of the 34 patients (12%) required surgical management of postoperative hemorrhage. All other cases were conservatively managed. Outcome after surgical and conservative management did not differ except postoperative renal complications tended to be more common in the former cases (50% vs 7%).
CONCLUSIONS
Most patients with hemorrhage following laparoscopic upper retroperitoneal surgery can be treated with conservative nonsurgical interventions.
Topics: Adrenalectomy; Adult; Aged; Erythrocyte Transfusion; Female; Humans; Laparoscopy; Male; Middle Aged; Nephrectomy; Postoperative Hemorrhage; Reoperation; Retroperitoneal Space; Retrospective Studies; Risk Factors
PubMed: 16952660
DOI: 10.1016/j.juro.2006.06.023 -
Current Opinion in Critical Care Aug 2014Bleeding can be minimal, severe, life-threatening, or organ-threatening. Depending on the compensatory capacity of the patient, most bleeding events going beyond 20%... (Review)
Review
PURPOSE OF REVIEW
Bleeding can be minimal, severe, life-threatening, or organ-threatening. Depending on the compensatory capacity of the patient, most bleeding events going beyond 20% blood volume may represent an emergency as well as a risk factor for anemia, transfusion, coagulopathy, and tissue hypoperfusion. All these factors are independent predictors for survival in postoperative critical care and are drivers for resource use and costs.
RECENT FINDINGS
A systematic literature search behind the guidelines from the European Society of Anesthesiology on the management of severe perioperative bleeding gives an up-to-date evidence-based summary of strategies intended to correct hemostasis, control bleeding, and increase patient safety. The current review discusses information, recommendations, and suggestions in the European Society of Anesthesiology guidelines, which appear applicable to the bleeding patient after the end of surgery.
SUMMARY
Individualized coagulation management guided by viscoelastic tests and restrictive transfusion behavior are encouraged in clinical practice of critical care. Potential fields of research are multifold, for example, thromboembolic adverse effects of hemostatic interventions in the isochronic postoperative acute-phase response, transfusion restrictions by increasing postoperative tolerance to anemia and erythropoiesis, and implementation of guidelines and institutional algorithms.
Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Loss, Surgical; Blood Transfusion; Humans; Postoperative Hemorrhage; Practice Guidelines as Topic; Thrombelastography
PubMed: 24933407
DOI: 10.1097/MCC.0000000000000109 -
JAMA Otolaryngology-- Head & Neck... Jul 2022Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection.
IMPORTANCE
Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection.
OBJECTIVE
To evaluate the diagnostic accuracy of neck circumference measurement for early detection of postoperative hemorrhage after thyroidectomy.
DESIGN, SETTING, AND PARTICIPANTS
This diagnostic accuracy study at an academic teaching hospital used a prospective cohort of patients undergoing thyroid surgery from November 1, 2015, to January 31, 2018 (group 1), and a retrospective cohort of patients undergoing the same surgery from January 1, 2020, to September 30, 2021 (group 2). We performed repeated perioperative neck circumference measurements to evaluate the association of increased neck circumference with postthyroidectomy hemorrhage among patients at risk for hemorrhage.
MAIN OUTCOMES AND MEASURES
The primary end point was the diagnostic value of neck circumference measurement for detection of postthyroidectomy hemorrhage. Additionally, data on demographic information and risk factors for postthyroidectomy hemorrhage were examined. Data analyses were performed from November 1, 2021, to January 5, 2022.
RESULTS
The prospective cohort (group 1) comprised 60 patients (45 [75%] women) with a mean (SD) age of 52.2 (13.5) years; those who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 57.4 (9.0) years. The retrospective cohort (group 2) comprised 353 patients (258 [73%] women) with a mean (SD) age of 55.3 (14.1) years; patients who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 62.2 (10.0) years. In group 1, postoperative neck circumference increased by a median (range) of 5.0 (4.0 to 7.0) cm in patients with hemorrhage, and only 1.0 (-2.5 to 4.0) cm in patients with no postoperative bleeding (difference in the medians, 4.0 cm [95% CI, 3.0 to 5.5 cm]; effect size, 3.74 [95% CI, 2.6 to 4.9]). Defining a 7% or greater increase in neck circumference as the cutoff value for detecting postthyroidectomy hemorrhage showed a diagnostic sensitivity and specificity of 1.0 (95% CI, 0.48 to 1.0) and 0.86 (95% CI, 0.71 to 0.92), respectively. The retrospective validation also showed a difference in median (range) increase of postoperative neck circumference between patients with hemorrhage and those without-3.0 (0 to 6.0) cm vs 0.0 (-6.0 to 5.0) cm (difference in medians, 3.8 cm [95% CI, 3.0 to 4.9]; effect size, 1.63 [95% CI, 0.96 to 2.3]). Considering 12 false-positive and 332 correct-negative results, the diagnostic tool showed a sensitivity of 0.89 (95% CI, 0.51 to 0.99) and a specificity of 0.97 (95% CI, 0.94 to 0.98).
CONCLUSIONS AND RELEVANCE
The findings of this diagnostic accuracy study suggest that neck circumference measurement is a feasible and easy-to-use diagnostic tool for routine clinical care to detect postthyroidectomy hemorrhage. A 7% or greater increase over the postoperative baseline neck circumference seems to be a reliable threshold for detecting postthyroidectomy hemorrhage. Neck circumference measurement should be used in combination with surveillance of clinical signs and symptoms.
Topics: Female; Humans; Male; Middle Aged; Neck; Postoperative Hemorrhage; Prospective Studies; Retrospective Studies; Thyroidectomy
PubMed: 35679063
DOI: 10.1001/jamaoto.2022.1180 -
HPB : the Official Journal of the... Oct 2016Hemorrhage after pancreaticoduodenectomy is a potentially fatal complication. We retrospectively reviewed state-wide data to evaluate incidence, type of hemorrhage,...
BACKGROUND
Hemorrhage after pancreaticoduodenectomy is a potentially fatal complication. We retrospectively reviewed state-wide data to evaluate incidence, type of hemorrhage, treatment modalities, and outcomes.
METHODS
Healthcare Cost and Utilization Project's Florida State Inpatient Database was queried 2007-2011 for patients undergoing pancreaticoduodenectomy. Characteristics and outcomes were compared by χ. Multivariate logistic regression model was generated for risk of hemorrhage during index visit.
RESULTS
Of 2548 patients, 217 (8.5%) developed post-operative hemorrhage during their index visit with 139 (64.0%) requiring angiographic, endoscopic, or operative intervention. Overall mortality during index visit was 5.7% (146) - significantly higher in those patients who had post-operative hemorrhage (24.9%) vs not (4.0%) (p < 0.0001). Mortality was significantly higher when post-operative hemorrhage occurred during the second (POD 8-14) vs first (POD 0-7) week at 15/28 vs 16/74, respectively (p = 0.007). On multivariate analysis, male sex (OR 1.56, p = 0.003), vascular resection (OR 1.88, p = 0.017), very low hospital volume (≤7 PD/year; OR 1.62, p = 0.016), and post-operative intra-abdominal/wound infection (OR 2.31, p < 0.0001) were independent predictors for risk of hemorrhage during index visit.
CONCLUSIONS
Hemorrhage following pancreaticoduodenectomy remains common, resulting in significantly increased mortality. Hemorrhage during the second post-operative week carries approximately double the mortality of early bleeding, suggesting different etiologies requiring differing treatment approaches.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Databases, Factual; Female; Florida; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pancreaticoduodenectomy; Postoperative Hemorrhage; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 27524733
DOI: 10.1016/j.hpb.2016.07.001 -
Journal of Visceral Surgery Sep 2013
Topics: Blood Loss, Surgical; Humans; Laparotomy; Postoperative Hemorrhage; Tampons, Surgical
PubMed: 24012718
DOI: 10.1016/j.jviscsurg.2013.07.004 -
Head & Neck Aug 2017The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear.
BACKGROUND
The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear.
METHODS
A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC).
RESULTS
Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02).
CONCLUSION
Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1510-1515, 2017.
Topics: Arteries; Female; Humans; Ligation; Male; Middle Aged; Neck; Oropharyngeal Neoplasms; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Robotic Surgical Procedures; Severity of Illness Index
PubMed: 28570011
DOI: 10.1002/hed.24677 -
Nature Reviews. Cardiology May 2019Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are... (Review)
Review
Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are associated with substantial morbidity and mortality. Percutaneous closure using occluders specifically designed to improve closure and reduce procedural complications has now become the first-line treatment for PVL. In this Review, we first detail the frequency and clinical consequences of PVL closure. The role of cardiac imaging in the assessment and management of PVL, including echocardiographic imaging and adjunctive techniques such as CT, is then discussed, together with important considerations for the percutaneous closure of PVL, such as access site and device selection. Finally, we summarize the clinical evidence for percutaneous closure of PVL, including large national registries from Ireland, Spain and the UK, as well as head-to-head data comparing this procedure with surgical closure.
Topics: Comparative Effectiveness Research; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Postoperative Hemorrhage; Prosthesis Failure; Septal Occluder Device; Wound Closure Techniques
PubMed: 30659248
DOI: 10.1038/s41569-018-0147-0 -
American Journal of Surgery Jul 2007
Topics: Humans; Pancreaticoduodenectomy; Postoperative Hemorrhage; Reoperation; Time Factors
PubMed: 17560901
DOI: 10.1016/j.amjsurg.2006.12.034 -
World Journal of Surgery Nov 2011Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands...
BACKGROUND
Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center.
METHODS
From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed.
RESULTS
Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed.
CONCLUSIONS
Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.
Topics: Aged; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Pancreaticoduodenectomy; Postoperative Hemorrhage; Prognosis; Recurrence; Retrospective Studies; Risk Factors
PubMed: 21882027
DOI: 10.1007/s00268-011-1222-4