-
Acta Radiologica (Stockholm, Sweden :... Dec 2020Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization.
BACKGROUND
Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization.
PURPOSE
To assess the safety and efficacy of embolotherapy for hemorrhagic complications of partial nephrectomy and to analyze the potential correlation between multiple bleeding sites on angiography and surgical complexity.
MATERIAL AND METHODS
A cohort of 25 patients presenting with severe, postoperative bleeding after partial nephrectomy and treated with catheter-directed superselective embolization was included. Patients' demographics, radiological investigations before the embolization, and clinical outcome after embolization were analyzed. Mann-Whitney U test was used to analyze the potential difference in the RENAL score between patients with one or more bleeding sites in the resection area.
RESULTS
Selective renal angiography revealed multiple bleeding sites at the resection bed in 8 (32%) patients with amorphous contrast extravasation in 10 (40%) patients. Embolization with use of a microcatheter and microcoils was effective to stop the bleeding in all but one patient, the latter requiring a second embolization two days later. Transient decrease in renal function was noted in 3/25 (12%) patients with full recovery in two of the three. Patients with multiple bleeding sites did not show significantly different RENAL scores compared to patients with a single bleeding site ( = 0.148).
CONCLUSION
Embolotherapy for postoperative partial nephrectomy-related bleeding is safe and effective with a low rate of recurrent bleeding. The number of bleeding sites at the resection area did not correlate to the RENAL score.
Topics: Adult; Aged; Angiography; Embolization, Therapeutic; Female; Humans; Laparoscopy; Male; Middle Aged; Nephrectomy; Postoperative Hemorrhage
PubMed: 32102548
DOI: 10.1177/0284185120907253 -
European Archives of... Jun 2023To analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared...
PURPOSE
To analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared to bipolar diathermy was of particular interest.
METHODS
The data from tonsil surgery patients were retrospectively collected between 2012 and 2018 in the Hospital District of Southwest Finland. The surgical method, instruments, indication, sex and age and their association with a postoperative hemorrhage were analyzed.
RESULTS
A total of 4434 patients were included. The postoperative hemorrhage rate for tonsillectomy was 6.3% and for tonsillotomy 2.2%. The most frequently used surgical instruments were monopolar diathermy (58.4%) cold steel with hot hemostasis (25.1%) and bipolar diathermy (6.4%) with the overall postoperative hemorrhage rates 6.1%, 5.9% and 8.1%, respectively. In tonsillectomy patients, the risk for a secondary hemorrhage was higher with bipolar diathermy compared to both monopolar diathermy (p = 0.039) and the cold steel with hot hemostasis technique (p = 0.029). However, between the monopolar and the cold steel with hot hemostasis groups, the difference was statistically non-significant (p = 0.646). Patients aged > 15 years had 2.6 times higher risk for postoperative hemorrhage. The risk of a secondary hemorrhage increased with tonsillitis as the indication, primary hemorrhage, tonsillectomy or tonsillotomy without adenoidectomy, and male sex in patients aged ≤ 15 years.
CONCLUSION
Bipolar diathermy increased the risk for secondary bleedings compared to both monopolar diathermy and the cold steel with hot hemostasis technique in tonsillectomy patients. Monopolar diathermy did not significantly differ from the cold steel with hot hemostasis group regarding the bleeding rates.
Topics: Humans; Male; Palatine Tonsil; Retrospective Studies; Postoperative Hemorrhage; Tonsillectomy; Diathermy; Hemostasis
PubMed: 36813861
DOI: 10.1007/s00405-023-07892-3 -
Clinics in Liver Disease Feb 2009Coagulopathy is an essential component of the acute liver failure (ALF) syndrome and reflects the central role of liver function in hemostasis. ALF is a syndrome... (Review)
Review
Coagulopathy is an essential component of the acute liver failure (ALF) syndrome and reflects the central role of liver function in hemostasis. ALF is a syndrome characterized by the development of hepatic encephalopathy and coagulopathy within 24 weeks of the onset of acute liver disease. Coagulopathy in this setting is a useful prognostic tool in ALF and a dynamic indicator of the hepatic function. If severe, it can be associated with bleeding and is commonly a major obstacle to the performance of invasive procedures in patients with ALF. This review focuses on the epidemiology, pathophysiology, presentation, evaluation, and management of coagulopathy in ALF.
Topics: Blood Coagulation Disorders; Disease Progression; Hemorrhage; Humans; International Normalized Ratio; Liver Failure, Acute; Liver Transplantation; Postoperative Hemorrhage
PubMed: 19150314
DOI: 10.1016/j.cld.2008.10.001 -
Seminars in Thrombosis and Hemostasis Oct 2017
Review
Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Hemostasis; Humans; Platelet Function Tests; Postoperative Hemorrhage; Predictive Value of Tests; Reproducibility of Results; Thrombelastography
PubMed: 28719915
DOI: 10.1055/s-0037-1602665 -
International Journal of Pediatric... Aug 2021Post-tonsillectomy hemorrhage (PTH) is a serious complication after a tonsillectomy. Utility of lab work at presentation for PTH was low. This study aims to determine...
INTRODUCTION
Post-tonsillectomy hemorrhage (PTH) is a serious complication after a tonsillectomy. Utility of lab work at presentation for PTH was low. This study aims to determine the frequency and type of labs drawn at emergency department (ED) presentation and assess the incidence of uncovering a previously unidentified coagulopathy.
METHODS
A retrospective chart review was performed on pediatric patients who were seen in the ED after tonsillectomy at a tertiary care children's hospital from 2017 to 2019. Exclusion criteria were the following: no tonsillar bleed, history of known coagulopathy, treated by outside provider, ≥18 years old. Lab work included complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), and von Willebrand factor (VWF).
RESULTS
364/723 (50.3%) patients met inclusion criteria. 179/364 (49.2%) patients were male and 309/364 (84.9%) patients were Caucasian. Average age at surgery was 8.12 years (SD = 4.0) and average post-operative day at presentation was 6 days (SD = 2.1). Operative control of bleed was performed in 68/364 (18.7%) patients. 334/364 (91.8%) patients had labs drawn in the ED. 64/334 (19.1%) patients were anemic (hemoglobin (Hgb) < 11), 46/334 (13.8%) patients had thrombocytosis (platelets>450,000), 10/334 (3.0%) had elevated PTT and 8/334 (2.4%) had elevated PT. Hematology was consulted in 14/364 (3.8%) patients of whom 6/14 were diagnosed with von Willebrand disease and 1/14 with factor VII deficiency. Aminocaproic acid was used in 8/364 (2.2%) patients due to elevated PTT in 3/8 and multiple episodes of bleeding in 5/8.3/364 (0.8%) patients needed a blood transfusion. No difference was found in incidence of abnormal lab work in patients who did and did not need operative control of bleed (p = .125). Of the 334 patients who had ED labs drawn, 7 (2.1%) had an uncovered coagulopathy.
CONCLUSION
Uncovering incidental coagulopathies is rare in patients who present with PTH. Though anemia was the most common abnormality noted, only a small percentage required transfusion, with all having abnormal vital signs. Thrombocytosis was the next common abnormality, and this can be seen in an inflammatory state. Developing algorithms is necessary to better guide appropriate lab work in patients who present with PTH and to provide optimal value of care to patients.
Topics: Adolescent; Blood Coagulation Disorders; Child; Hemorrhage; Humans; Male; Partial Thromboplastin Time; Postoperative Hemorrhage; Retrospective Studies; Tonsillectomy
PubMed: 34192615
DOI: 10.1016/j.ijporl.2021.110807 -
Otolaryngology--head and Neck Surgery :... Jun 2011To use meta-analytic techniques to examine the effect of dexamethasone on the risk of postoperative bleeding following tonsillectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To use meta-analytic techniques to examine the effect of dexamethasone on the risk of postoperative bleeding following tonsillectomy.
DATA SOURCES
PubMed and Embase databases accessed on April 23, 2009, and April 28, 2009.
REVIEW METHODS
Using principles of meta-analysis, inclusion and exclusion criteria were developed to identify all randomized controlled trials of patients undergoing tonsillectomy in which perioperative intravenous dexamethasone was administered in at least 1 treatment arm and bleeding complications were reported. Electronic databases were searched to identify candidate articles. Two authors independently abstracted data from each article. Discrepancies were resolved by consensus. A fixed-effects model was used to pool relative risks among studies using the Mantel-Haenszel method. Studies were assessed for publication bias using a funnel plot of studies' effect size vs standard error of the effect size as well as Begg test and Egger test. A P value <.05 was considered significant.
RESULTS
The primary search identified 85 potential studies. Fourteen met inclusion criteria and were selected for meta-analysis. No significant heterogeneity was found among studies (I(2)< 0.1%; 95% confidence interval [CI], 0%-55%; P = .68). The pooled relative risk (RR) of postoperative bleeding did not differ significantly between patients receiving dexamethasone and controls (RR, 1.02; 95% CI, 0.65-1.61; P = .92). When studies were stratified by age, primary vs secondary hemorrhage, and follow-up duration, no further significant differences in bleeding rate were identified. No evidence of publication bias was found using Begg (P = .70) or Egger (P = .73) tests.
CONCLUSION
The results of this meta-analysis indicate that perioperative dexamethasone does not confer an increased risk of postoperative bleeding in patients undergoing tonsillectomy.
Topics: Dexamethasone; Humans; Infusions, Intravenous; Postoperative Hemorrhage; Preoperative Care; Prognosis; Risk Factors; Tonsillectomy; United States
PubMed: 21493330
DOI: 10.1177/0194599811399538 -
Scandinavian Journal of Urology Feb 2014The aim of this study was to assess the prevalence, potential risk factors and management of delayed post-percutaneous nephrolithotomy (PCNL) bleeding.
OBJECTIVE
The aim of this study was to assess the prevalence, potential risk factors and management of delayed post-percutaneous nephrolithotomy (PCNL) bleeding.
MATERIAL AND METHODS
Records of 2512 patients who had undergone PCNL from April 2008 to April 2011 were reviewed retrospectively. The prevalence of delayed post-PCNL hemorrhage and correlation of different variables such as age, body mass index, stone location and burden, surgical approach, type and number of access ports, type of drainage, comorbidities and previous history of stone surgery with postoperative bleeding were assessed. The efficacy of conservative management and need for angioembolization were analyzed.
RESULTS
In total, 2304 patients [1562 men (67.8%) and 742 women (32.2%)], with a mean age of 46.4 ± 13.6 years (range 17-86 years), were enrolled in the study. The prevalence of delayed hemorrhage was 2.6% (61 patients) and the mean time to the onset of hemorrhage after PCNL was 5.8 days (range 3-11 days). Of 61 patients presenting with delayed hemorrhage, only 16 patients received a blood transfusion. Eight patients underwent angiography because of uncontrolled bleeding and only three underwent embolization. No significant association was found between other variables and post-PCNL hemorrhage, except for type of drainage, in that tubeless surgery increased the rate of postoperative bleeding.
CONCLUSION
Delayed hemorrhage is an uncommon complication following PCNL that can be successfully managed with conservative management; only a few patients will require angiography and then embolization. Tubeless PCNL significantly predicted the occurrence of severe postoperative bleeding.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nephrostomy, Percutaneous; Postoperative Hemorrhage; Prevalence; Retrospective Studies; Risk Factors; Time Factors; Young Adult
PubMed: 24256570
DOI: 10.3109/21681805.2013.806586 -
Anesthesiology Apr 2015
Review
Topics: Animals; Blood Coagulation; Blood Coagulation Factors; Humans; Postoperative Hemorrhage; Wounds and Injuries
PubMed: 25654437
DOI: 10.1097/ALN.0000000000000608 -
The American Surgeon Jun 2023
Topics: Female; Humans; Uterine Artery; Hysterectomy; Postoperative Hemorrhage; Pelvis
PubMed: 34841911
DOI: 10.1177/00031348211054069 -
Gastrointestinal Endoscopy Clinics of... Jan 2007Over the last 20 years, endoscopic hemostasis has become the primary method of controlling acute, overt upper gastrointestinal hemorrhage (UGIH) and prevent rebleeding.... (Review)
Review
Over the last 20 years, endoscopic hemostasis has become the primary method of controlling acute, overt upper gastrointestinal hemorrhage (UGIH) and prevent rebleeding. Although uncommon, procedure-related complications may occur. This article reviews the risks attributable to endoscopic hemostasis in acute UGIH and how to help prevent these complications.
Topics: Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Postoperative Hemorrhage; Treatment Outcome
PubMed: 17397782
DOI: 10.1016/j.giec.2006.10.005