-
European Archives of... Mar 2022Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the...
PURPOSE
Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff.
METHODS
This retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences.
RESULTS
A total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1-19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm-6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol.
CONCLUSION
The discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.
Topics: Adult; Child; Humans; Postoperative Hemorrhage; Postoperative Period; Retrospective Studies; Tonsillectomy
PubMed: 34557959
DOI: 10.1007/s00405-021-07080-1 -
West African Journal of Medicine Sep 2022Post-tonsillectomy hemorrhage (PTH) is one of the more life-threatening /lethal complications and the leading malpractice claims/convictions in Oto-laryngological...
BACKGROUND
Post-tonsillectomy hemorrhage (PTH) is one of the more life-threatening /lethal complications and the leading malpractice claims/convictions in Oto-laryngological practice.
OBJECTIVE
A Study on PTH reduction strategy in Jos, North Central Nigeria.
STUDY DESIGN
Prospective Cohort Study.
METHODS
Participants who met the criteria under GA had dissection Tonsillectomy ± Adenoidectomy between August 1, 2017-July 31, 2019 at the Jos University Teaching Hospital, Nigeria, were enrolled. Data analysis was by SPSS version 21.0 Chicago, IL, USA.
RESULTS
We studied 96 participants with a M:F = 1.7:1. Age range was 9months-51years with a Median = 3.0years. Snoring-83(86.5%), Nasal obstruction - 71(74.0%), Mouth breathing -18(18.8), OSA(S) - 17(17.7%) were main features. Seventy-Eight (81.2%) were Grade III & IV and 71(75.0%) had Adenoid Nasopharyngeal Ratio >0.5. Mean INR was 1.22 ± 0.24 where 28(29.2%) were abnormal. Post-operative blood loss was 10ml - 250ml with Median = 35ml. There was a correlations between the Brodsky's grading with Tonsil volume and between Tonsil grade with volume of blood loss. An estimated 76.0% had the surgery within 60mins. We practice 'awake' extubation. Incidence of Primary PTH of 3.1% with no secondary PTH or mortality.
CONCLUSION
We established that blood loss was directly proportional to the tonsil size which brings new insights in PTH prevention. Our use of specific agents for GA, technique/ expertise, pillar infiltration with Lignocaine, 'awake extubation, liberal post-operative analgesia with systemic antibiotics may be responsible for the low incidence of PTH in this series.
Topics: Child; Humans; Lidocaine; Nigeria; Postoperative Hemorrhage; Prospective Studies; Tonsillectomy
PubMed: 36128799
DOI: No ID Found -
The Journal of Heart and Lung... Nov 2017Bleeding events remain a significant and frequent complication of continuous-flow left ventricular assist devices (VADs). von Willebrand factor (VWF) is critical to... (Review)
Review
Bleeding events remain a significant and frequent complication of continuous-flow left ventricular assist devices (VADs). von Willebrand factor (VWF) is critical to hemostasis by acting as a bridging molecule at sites of vascular injury for normal platelet adhesion as well as promoting platelet aggregation under conditions of high shear. Clinical and experimental data support a role for acquired von Willebrand disease in VAD bleeding episodes caused by shear-induced qualitative defects in VWF. Pathologic shear induces VWF unfolding and proteolysis of large multimers into smaller less hemostatic multimers via ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). This review outlines the pathobiology of VWF disruption in the context of VADs as well as current diagnostic and management strategies of the associated acquired von Willebrand disease.
Topics: Heart Failure; Heart-Assist Devices; Hemostasis; Humans; Postoperative Hemorrhage; Risk Factors; von Willebrand Factor
PubMed: 28756118
DOI: 10.1016/j.healun.2017.06.004 -
European Archives of... Nov 2021LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding...
PURPOSE
LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding postoperative complications and among relevant patients subgroups. In a large cohort of patients including relevant patient subgroups, we evaluated intra- and postoperative complications using LSJ.
METHODS
Single-centre register-based study evaluating 3346 patients undergoing hemi- or total thyroidectomy. We compared differences in intra- and postoperative complications using LSJ compared to conventional technique. Multivariate analyses were conducted to adjust for potential confounders.
RESULTS
Compared to the conventional technique, LSJ was associated with less postoperative drainage (OR 0.4, p = 0.02) and postoperative haemorrhage (OR 0.3, p = 0.02) among patients undergoing hemi- and total thyroidectomy with benign histology, respectively, but with increased risk of postoperative infection [3 (6.4%) vs. 0 (0.0%) patients, p = 0.04] among patients undergoing total thyroidectomy with malignant histology. LSJ was associated with reduced operation duration (- 12.2 min, p < 0.001, - 7.9 min, p < 0.001 and - 13.2 min, p = 0.002) and intraoperative blood loss (- 52.1 ml, p < 0.001, - 13.6 ml, p < 0.001 and - 12.9 ml, p = 0.02) compared to conventional technique among patients undergoing total and hemithyroidectomy with benign histology and hemithyroidectomy with malignant histology, respectively.
CONCLUSION
LSJ was associated with a reduced risk of postoperative haemorrhage and less postoperative drainage but increased risk of postoperative infection depending on the type of thyroidectomy and histology of the thyroid gland. LSJ was associated with only a small reduction in operation duration and intraoperative blood loss.
TRIAL REGISTRATION
The study was based on data prospectively registered in the Danish national database THYKIR.
Topics: Blood Loss, Surgical; Humans; Postoperative Complications; Postoperative Hemorrhage; Thyroid Gland; Thyroidectomy
PubMed: 33689021
DOI: 10.1007/s00405-021-06685-w -
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 -
Vestnik Otorinolaringologii 2013The objective of the present study was to analyse the modern literature concerning the prevalence of hemorrhage following tonsillectomy (TE) and the factors responsible... (Review)
Review
The objective of the present study was to analyse the modern literature concerning the prevalence of hemorrhage following tonsillectomy (TE) and the factors responsible for its development. Chronic tonsillitis affects from 4% to 15% of the general population and accounts for 23.7% of all pharyngeal disorders. Despite the significant decrease in the frequency of TE during the last years, it remains a most popular surgical procedure in otorhinolaryngological clinics all over the world. Hemorrhage is the most frequent complication of TE registered in 2.5% to 9.2% of the patients on the average, with early (primary) hemorrhages occurring more frequently than late ones as shown in the majority of the studies. The possible risk factors of postoperative hemorrhage are described. The significance of some of these factors (male sex, age, surgeon's experience, surgical technique,techniques of intraoperative hemostasis, elevated arterial pressure) is estimated based on the analysis of results of many relevant studies; their influence on the frequency of hemorrhage following tonsillectomy is fairly well confirmed. The effects of other factors, such as the season, whether conditions at the time of TE, duration of surgery, smoking, etc. are hypothetical.
Topics: Humans; Postoperative Complications; Postoperative Hemorrhage; Prevalence; Tonsillectomy
PubMed: 23991457
DOI: No ID Found -
Dansk Medicinhistorisk Arbog 2005Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each...
Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each year. The indications for surgery and the surgical principles have largely remained the same for a century, but different techniques have been employed. As in all surgical procedures, there are complications to tonsillectomy, first and foremost postoperative bleeding which occurs in 4-8% of all operated patients. In the last 100 years many studies have been undertaken to shed light on the frequency of postoperative bleeding following tonsillectomy. It is noteworthy that the studies have been carried out at times where there was a certain interest in the subject whereas in other periods of time, the subject has been of little interest to researchers. The definition of postoperative hemorrhage is not unambiguous. Despite the fact that various surgical techniques have been applied, no significant change in the incidence of postoperative hemorrhage after tonsillectomy has been shown over the past 100 years. The study calls for caution when evaluating new surgical techniques since the incidences of postoperative hemorrhage have been shown to change between high and low percentages through the entire 100 year period.
Topics: Denmark; History, 19th Century; History, 20th Century; Humans; Postoperative Hemorrhage; Tonsillectomy
PubMed: 17152759
DOI: No ID Found -
Journal of Bronchology & Interventional... Jul 2017
Topics: Aged; Bronchial Arteries; Bronchoscopy; Cellulose, Oxidized; Diagnosis, Differential; Embolization, Therapeutic; Female; Hemoptysis; Humans; Lung Neoplasms; Postoperative Hemorrhage
PubMed: 28696975
DOI: 10.1097/LBR.0000000000000390 -
Current Opinion in Urology Mar 2014Postpercutaneous nephrolithotomy (PCNL) bleeding is the most dreaded complication following PCNL. In this article, we refer to risk factors contributing to post-PCNL... (Review)
Review
PURPOSE OF REVIEW
Postpercutaneous nephrolithotomy (PCNL) bleeding is the most dreaded complication following PCNL. In this article, we refer to risk factors contributing to post-PCNL bleeding and the criteria to decide the line of management in such cases. We further discuss the treatment algorithm for the management of the complication.
RECENT FINDINGS
A perfect puncture is a 'key' to avoid post-PNL bleeding. Superselective angioembolization (SAE) is an efficacious and well tolerated method of controlling post-PCNL bleeding, and the success rate of SAE is found to be greater than 80%. Pseudoaneurysm is the commonest finding of SAE, which is responsible for post-PCNL bleeding. A recent study suggested that multiple percutaneous accesses, more than two bleeding sites identified during renal angiography, and the use of gelatine sponge alone as the embolic material were high-risk factors for the failure of SAE. A significant number of patients experience postinfarction syndrome in varying degree of severity after SAE.
SUMMARY
Post-PCNL bleeding is a life-threatening complication. Most of the post-PCNL bleeds subside with conservative management, and SAE is an effective means of controlling post-PCNL bleeding. A skilled interventionist can achieve successful control of bleeding with a variety of agents available. Multiple punctures and evidence of more than two lesions predict high risk of failure of SAE.
Topics: Algorithms; Critical Pathways; Hemostatic Techniques; Humans; Nephrostomy, Percutaneous; Postoperative Hemorrhage; Risk Factors; Treatment Outcome
PubMed: 24445556
DOI: 10.1097/MOU.0000000000000025 -
Obesity Surgery Jul 2023Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been... (Meta-Analysis)
Meta-Analysis Review
Seamguard Buttressing of the Staple Line During Laparoscopic Sleeve Gastrectomy Appears to Decrease the Incidence of Postoperative Bleeding, Leaks, and Reoperations. A Systematic Review and Meta-Analysis of Non-Randomized Comparative Studies.
Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as oversewing/suturing (OS/S), omentopexy/gastropexy (OP/GP), gluing, and buttressing. However, many surgeons do not use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other or even supports the use of reinforcement over no-reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG.
Topics: Humans; Surgical Stapling; Laparoscopy; Reoperation; Incidence; Obesity, Morbid; Gastrectomy; Postoperative Hemorrhage
PubMed: 37204531
DOI: 10.1007/s11695-023-06649-5