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International Journal of Cardiology Feb 2024Bleeding complications are one of the most serious postoperative complications after cardiac surgery and are associated with high mortality, especially in patients with...
OBJECTIVES
Bleeding complications are one of the most serious postoperative complications after cardiac surgery and are associated with high mortality, especially in patients with infective endocarditis (IE). Our objectives were to identify the risk factors and develop a prediction model for postoperative bleeding complications in IE patients.
METHODS
The clinical data of IE patients treated from October 2013 to January 2022 were reviewed. Multivariate logistic regression analysis was used to evaluate independent risk factors for postoperative bleeding complications and develop a prediction model accordingly. The prediction model was verified in a temporal validation cohort. The performance of the model was evaluated in terms of its discrimination power, calibration, precision, and clinical utility.
RESULTS
A total of 423 consecutive patients with IE who underwent surgery were included in the final analysis, including 315 and 108 patients in the training cohort and validation cohort, respectively. Four variables were selected for developing a prediction model, including platelet counts, systolic blood pressure, heart failure and vegetations on the mitral and aortic valves. In the training cohort, the model exhibited excellent discrimination power (AUC = 0.883), calibration (Hosmer-Lemeshow test, P = 0.803), and precision (Brier score = 0.037). In addition, the model also demonstrated good discrimination power (AUC = 0.805), calibration (Hosmer-Lemeshow test, P = 0.413), and precision (Brier score = 0.067) in the validation cohort.
CONCLUSIONS
We developed and validated a promising risk model with good discrimination power, calibration, and precision for predicting postoperative bleeding complications in IE patients.
Topics: Humans; Risk Assessment; Endocarditis; Endocarditis, Bacterial; Risk Factors; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies
PubMed: 37827281
DOI: 10.1016/j.ijcard.2023.131432 -
European Archives of... Dec 2022The influence of tonsil anatomical differences on post-tonsillectomy hemorrhage and pain has not been studied yet. This study aimed to establish a classification and...
PURPOSE
The influence of tonsil anatomical differences on post-tonsillectomy hemorrhage and pain has not been studied yet. This study aimed to establish a classification and grading scale of palatine tonsil anatomy, not size, for personalized post-tonsillectomy care.
METHODS
Between August 2020 and August 2021, 337 children who underwent extracapsular tonsillectomy were recruited. The images of tonsil anatomy during the surgery were recorded and then classified and graded. Postoperative hemorrhage was recorded, and the degree of pain was measured using a visual analog scale (VAS). The primary outcomes were the associations between postoperative hemorrhage, pain, and the classification and grade of tonsil anatomy, analyzed by univariable and multivariable analyses.
RESULTS
186 of the 337 patients (55.2%) were male and 151 (44.8%) were female; the mean age was 5.59 years. The overall postoperative hemorrhage rate was 4.1%. The mean postoperative VAS score was 4.96. By univariable analysis with logistic regression model, significant associations were found between postoperative hemorrhage and the grade 2 and grade 3 tonsillar lower pole, and grade 3 tonsillar bed. Multivariable analysis with binary logistic regression model also revealed significant associations between postoperative hemorrhage and the grade 2 and grade 3 lower pole (OR: 8.23, 95% CI 1.01-67.37, P = 0.049; OR: 23.86, 95% CI 2.22-56.47, P = 0.009, respectively) and grade 3 tonsillar bed (OR: 14.25, 95% CI 1.46-18.75, P = 0.022). Linear regression analysis showed the associations between postoperative pain and grade 2 and grade 3 lower pole (β: 0.88, 95% CI 0.31-1.32, P = 0.002; β: 1.56, 95% CI 1.29-3.29, P = 0.001, respectively) and grade 3 anterior surface (β: 0.85, 95% CI 0.30-3.07, P = 0.004). Age and upper pole were not associated with the postoperative hemorrhage and pain neither.
CONCLUSION
In the present study, we established a novel classification and 3-grade scale of palatine tonsil anatomy, based on upper pole, anterior surface, lower pole, and tonsillar bed. Furthermore, we revealed for the first time that some anatomical characteristics of tonsils were associated with post-tonsillectomy complications.
Topics: Child; Humans; Male; Female; Child, Preschool; Palatine Tonsil; Tonsillectomy; Postoperative Hemorrhage; Pain, Postoperative
PubMed: 35852650
DOI: 10.1007/s00405-022-07515-3 -
Clinical & Experimental Ophthalmology Apr 2014The rate of postoperative haemorrhage has been reported inconsistently in retrospective studies of endoscopic dacryocystorhinostomy but has not been evaluated... (Observational Study)
Observational Study
BACKGROUND
The rate of postoperative haemorrhage has been reported inconsistently in retrospective studies of endoscopic dacryocystorhinostomy but has not been evaluated prospectively with the powered endoscopic technique. The purpose of this study was to assess the rate of postoperative haemorrhage in patients undergoing powered endoscopic dacryocystorhinostomy.
DESIGN
A prospective, single-surgeon, observational case series.
PARTICIPANTS
Cases 18 years old or more were included if they presented with radiologically confirmed primary acquired nasolacrimal duct obstruction. Exclusion criteria included evidence of canalicular disease, ectropion or facial palsy, and previous surgery on the lacrimal drainage system. One hundred seventy-four cases fulfilled the criteria for inclusion. The mean age of patients was 62.9 years, 65% were female.
METHODS
Powered endoscopic dacryocystorhinostomy.
MAIN OUTCOME MEASURE
Postoperative haemorrhage. Significant haemorrhage was defined as that which necessitated packing, cautery, surgical intervention, a blood transfusion or delayed discharge.
RESULTS
The rates of total and significant postoperative haemorrhage were 1.7% and 0.6%, respectively. Antithrombotic agents were ceased on a case-by-case basis according to physician recommendation. Aspirin was stopped in 4 of 16 patients taking this agent preoperatively, and warfarin was stopped in one of three patients.
CONCLUSION
Significant postoperative haemorrhage following endoscopic dacryocystorhinostomy is rare. Further studies are required to assess whether antithrombotic agents significantly increase the risk of bleeding. The decision to cease agents should be made on a case-by-case basis in consultation with a physician.
Topics: Adult; Aged; Aged, 80 and over; Dacryocystorhinostomy; Endoscopy; Female; Fibrinolytic Agents; Humans; Incidence; Lacrimal Apparatus Diseases; Male; Middle Aged; Nasolacrimal Duct; Postoperative Hemorrhage; Prospective Studies; Withholding Treatment; Young Adult
PubMed: 23845103
DOI: 10.1111/ceo.12162 -
American Journal of Otolaryngology 2022To investigate the clinical characteristics and treatment methods associated with delayed epistaxis following endoscopic sinus surgery.
OBJECTIVE
To investigate the clinical characteristics and treatment methods associated with delayed epistaxis following endoscopic sinus surgery.
METHODS
The clinical data of 46 patients with delayed epistaxis following endoscopic sinus surgery were retrospectively analyzed. To explore the clinical features, pathogenesis, and treatment plan for delayed epistaxis, the postoperative bleeding time, bleeding inducements, systemic complications, surgical approach, the hemorrhage locations and responsible vessels, and treatment methods were analyzed.
RESULTS
The average bleeding time was 16.34 ± 9.05 days after the operation, and 76.6% of the cases occurred 6-20 days after the operation. Sphenopalatal artery hemorrhage accounted for 69.6% (32/46), the most common of which was a posterior nasal septal artery hemorrhage (17/32). A total of 45 patients received endoscopic low-temperature plasma hemostasis following ineffective nasal packing, and no rebleeding in the ipsilateral nasal cavity was observed during the postoperative follow-up for 3 to 6 months.
CONCLUSIONS
The peak of hemorrhaging in delayed epistaxis following endoscopic sinus surgery occurred at 6-20 days post-operatively. Bleeding of the posterior nasal septal artery from the sphenopalatine artery was the most common. Surgical methods were closely related to delayed postoperative hemorrhage. Treatment with low temperature plasma hemostasis under nasal endoscope was found to be effective.
Topics: Endoscopy; Epistaxis; Humans; Nasal Cavity; Nose; Postoperative Hemorrhage; Retrospective Studies
PubMed: 35378344
DOI: 10.1016/j.amjoto.2022.103406 -
Therapeutische Umschau. Revue... 2017
Review
Topics: Blood Loss, Surgical; Drug Administration Schedule; Evidence-Based Medicine; Fibrinolytic Agents; Humans; Monitoring, Intraoperative; Postoperative Complications; Postoperative Hemorrhage; Treatment Outcome
PubMed: 29268649
DOI: 10.1024/0040-5930/a000927 -
International Journal of Surgery... 2013Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are...
BACKGROUND
Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery.
METHODS
During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage (n = 7) or hemorrhage due to non-coagulopathic causes (n = 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes.
RESULTS
There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 ± 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 ± 29.31 min; P = 0.027).
CONCLUSION
Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.
Topics: Abdomen; Adult; Aged; Cold Ischemia; Cross-Sectional Studies; Female; Humans; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Hemorrhage; Radiography; Retrospective Studies; Risk Factors; Ultrasonography
PubMed: 24161418
DOI: 10.1016/j.ijsu.2013.10.004 -
British Journal of Hospital Medicine... Oct 2017Coagulation testing has long been part of the routine assessment of the preoperative patient, with the aim of identifying those with a bleeding disorder who might suffer... (Review)
Review
Coagulation testing has long been part of the routine assessment of the preoperative patient, with the aim of identifying those with a bleeding disorder who might suffer significant perioperative bleeding. Some of the issues surrounding this involve the low prevalence of bleeding disorders in the general population, and the implications of further testing for both the patient and the health-care system. Studies suggest that this practice is not evidence based and is considered to be outdated. Most guidelines now advise against routine coagulation screens before surgery, and instead recommend taking a thorough personal and family history of bleeding in order to determine the need for further investigations. This review analyses current evidence on this topic and provides a comprehensive view of the relevance of preoperative coagulation testing.
Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Loss, Surgical; Global Health; Humans; Incidence; Postoperative Hemorrhage; Preoperative Care
PubMed: 29019732
DOI: 10.12968/hmed.2017.78.10.566 -
Anesthesiology Nov 2010Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature.... (Review)
Review
Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.
Topics: Animals; Blood Coagulation Disorders; Hemodilution; Hemorrhage; Humans; Postoperative Hemorrhage; Treatment Outcome
PubMed: 20881594
DOI: 10.1097/ALN.0b013e3181f22b5a -
The Laryngoscope Aug 2008In rare cases, the intensity of posttonsillectomy hemorrhage (PTH) may become life-threatening requiring major surgical means and intensive care. This study was...
OBJECTIVES/HYPOTHESIS
In rare cases, the intensity of posttonsillectomy hemorrhage (PTH) may become life-threatening requiring major surgical means and intensive care. This study was conducted to assess the outcome of life-threatening PTH and its clinical features in a larger patient population.
STUDY DESIGN AND METHODS
Cases occurring during the clinical career of the authors were collected and added by own expert reports to lawsuits and professional boards in cases who had undergone tonsillectomy elsewhere. PTH resulting in hemorrhagic shock requiring resuscitation, ligature of greater arteries in the neck, tracheotomy, packing of the pharynx, embolization, and/or blood transfusions were labeled as life threatening.
RESULTS
Seventy-nine patients had experienced life-threatening PTH between 1980 and 2006, comprising 36 children and 39 adults (age not stated for 4 patients). There were 42 female and 34 male patients (gender not stated for 3 patients). Only nine patients experienced primary bleeding, secondary PTH clearly prevailed (n = 70; 89.6%) in this patient population. Single episodes of life-threatening PTH were reported for 11 cases including two patients with and nine without remaining neurological sequelae. Three of the 11 patients were children (age not stated for 2 patients). Repeated episodes of life-threatening PTH occurred in 68 patients (32 children) including eight with remaining sequelae.
CONCLUSIONS
Life-threatening PTH is an apparently rare, most commonly unpredictable state of emergency requiring a clear management protocol. However, repeated episodes of bleeding classified most clinical courses and should alert the medical staff. Although the bleeding rate after tonsillectomy in children is generally acknowledged to be very low, the rate of life-threatening PTH is apparently higher than in adults. Gender seems not to be a risk factor. Secondary PTH can no longer be assessed to be less dangerous than primary PTH.
Topics: Adolescent; Adult; Age Distribution; Causality; Child; Child, Preschool; Female; Germany; Humans; Length of Stay; Male; Middle Aged; Postoperative Hemorrhage; Risk Factors; Sex Distribution; Tonsillectomy; Treatment Outcome
PubMed: 18496156
DOI: 10.1097/MLG.0b013e3181734f7e -
Scandinavian Journal of Surgery : SJS :... Mar 2017Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of... (Observational Study)
Observational Study
BACKGROUND AND AIMS
Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center.
MATERIALS AND METHODS
A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.
RESULTS
A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy.
CONCLUSION
Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.
Topics: Aged; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Incidence; Logistic Models; Male; Middle Aged; Pancreatectomy; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 26929287
DOI: 10.1177/1457496916631854