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BMJ Open Jan 2023Post-tonsillectomy haemorrhage (PTH) is the most common and significant life-threatening complication following tonsillectomy, especially in children. Coblation...
INTRODUCTION
Post-tonsillectomy haemorrhage (PTH) is the most common and significant life-threatening complication following tonsillectomy, especially in children. Coblation tonsillectomy (CTE) at low temperature is extensively used in China and has gradually replaced conventional tonsil dissection. However, risk of late PTH has been shown to increase with the use of hot instruments. The aim of this study is to detect post-CTE haemorrhage (PCTH) rates and analyse risk factors of PCTH in China, through a nationwide multicentre prospective study.
METHODS AND ANALYSIS
This investigator-initiated, prospective, multicentre clinical trial will involve children with tonsil disease who will undergo CTE from 22 research centres in different cities in China. All operations will be performed using the same technique of extracapsular tonsillectomy. Data will be collected for all patients enrolled in this study through a preoperative visit, intraoperative data and a postoperative visit. The measurement data conforming to a normal distribution will be expressed by means±SDs, and a Student's t-test will be used for comparison. The comparison among groups of counting data will be expressed by percentage or rate, and a χ test will be used for comparison. Non-conditional logistic regression analysis will be used to analyse the preoperative, intraoperative and postoperative risk factors for haemorrhage rate after CTE. P<0.05 will be considered statistically significant.
ETHICS AND DISSEMINATION
This study protocol was approved by the Ethics Committee of Shanghai Children's Hospital/Shanghai Jiao Tong University (reference number 2021R096-E01). All patients will provide written informed consent. Results of this study are to be published in respected, peer-reviewed journals and findings presented at scientific conferences in the field of paediatric otorhinolaryngology.
TRIAL REGISTRATION NUMBER
NCT05206799.
Topics: Humans; Child; Tonsillectomy; Prospective Studies; Postoperative Hemorrhage; China; Palatine Tonsil; Multicenter Studies as Topic
PubMed: 36627154
DOI: 10.1136/bmjopen-2022-063401 -
Deutsches Arzteblatt International Aug 2013
Topics: Anticoagulants; Humans; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Premedication
PubMed: 24069072
DOI: 10.3238/arztebl.2013.0523 -
The Annals of Thoracic Surgery Aug 2005
Topics: Cardiac Surgical Procedures; Cardiopulmonary Bypass; Heart Defects, Congenital; Humans; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Sternum; Thoracotomy; Time Factors
PubMed: 16039228
DOI: 10.1016/j.athoracsur.2005.06.033 -
Interactive Cardiovascular and Thoracic... Jun 2012At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an...
At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We performed a case-note review on propensity-matched patients to assess the outcome of reoperation for bleeding regarding morbidity and mortality. In total, 101 patients (7.0%) underwent surgical re-exploration due to excessive postoperative bleeding. Significant risk factors for reoperation for bleeding after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher mortality. Surviving reoperated patients significantly had a lower EuroSCORE and a shorter time on ECC compared with non-survivors. The average time to re-exploration was 155 min longer for non-survivors when compared with survivors.
Topics: Aged; Cardiac Surgical Procedures; Case-Control Studies; Chi-Square Distribution; Denmark; Female; Hospitals, University; Humans; Male; Middle Aged; Postoperative Hemorrhage; Propensity Score; Registries; Reoperation; Risk Assessment; Risk Factors; Survival Analysis; Time Factors; Treatment Outcome
PubMed: 22368106
DOI: 10.1093/icvts/ivs050 -
Ear, Nose, & Throat Journal Jul 2017Despite the sheer number of pediatric tonsillectomies performed in the United States annually, there is no clear consensus as to which surgical technique is superior.... (Comparative Study)
Comparative Study
Despite the sheer number of pediatric tonsillectomies performed in the United States annually, there is no clear consensus as to which surgical technique is superior. One way to compare surgical techniques is to study the morbidity associated with each. We report postoperative hemorrhage rates, one of the frequently encountered major adverse events, as part of a retrospective chart review across four different surgical techniques. These surgeries involved either (1) Coblation, (2) Co-blation with partial suture closure of the tonsillar fossa, (3) diathermy, or (4) partial intracapsular tonsillectomy (PIT). Of the 7,024 children we evaluated, 99 (1.4%) experienced a postoperative hemorrhage that required a second surgery; hemorrhage occurred after 33 of the 3,177 Coblation-alone procedures (1.04%), 28 of the 1,633 Coblation with partial suture closure procedures (1.71%), 29 of the 1,850 diathermies (1.57%), and 9 of the 364 PIT procedures (2.47%). Statistical analysis of hemorrhage rates with each surgical technique yielded p values >0.05 in each case (Coblation alone and Coblation with partial suture closure: p = 0.29; diathermy: p = 0.47; PIT, p = 0.20). Based on these data, we conclude that none of these techniques is significantly superior in terms of decreasing the risk of post-tonsillectomy hemorrhage in children. Therefore, surgeons should continue to use the surgical procedure they are most familiar with to optimize recovery in the postoperative period.
Topics: Adolescent; Child; Female; Humans; Male; Postoperative Hemorrhage; Retrospective Studies; Suture Techniques; Tonsillectomy
PubMed: 28719712
DOI: 10.1177/014556131709600702 -
The Journal of Thoracic and... Sep 2009Excessive postoperative hemorrhage in cardiac surgery is a serious clinical complication placing substantial demands on hospital resources. This study quantifies the...
BACKGROUND
Excessive postoperative hemorrhage in cardiac surgery is a serious clinical complication placing substantial demands on hospital resources. This study quantifies the exact impact of postoperative hemorrhage on hospital costs in Germany.
METHODS
We retrospectively analyzed data collected prospectively in the Quality Assurance Database at the Heart Center of the Klinikum Augsburg, Germany. All relevant perioperative data for resources consumption were analyzed and compared in patients with and without excessive postoperative hemorrhage in cardiac surgery. Multivariate regression analysis identified the incremental costs of postoperative hemorrhage while adjusting for potential confounding.
RESULTS
A total of 1118 patients had cardiac surgery between January and December 2006. Six percent were identified with excessive postoperative hemorrhage. The risk of experiencing a postoperative complication (including death) (P < .0001), returning to operating room for reexploration (P < .0001), staying in intensive care unit for longer than 72 hours (P < .0001), receiving ventilation for longer than 24 hours (P < .0001), and receiving any kind of postoperative blood transfusion (P < .0001) was significantly higher in patients with excessive postoperative hemorrhage. Twenty-two percent of patients with excessive postoperative hemorrhage died compared with 6% of the patients without excessive postoperative hemorrhage (P < .0001). When adjusting for potential confounding factors, the incremental costs of excessive postoperative hemorrhage was euro6251 (95% confidence interval, 4594-7909).
CONCLUSIONS
The average hospital costs related to excessive postoperative hemorrhage in cardiac surgery in Germany are substantial and associated with a significant risk of postoperative complications and death. Clinical interventions that can effectively prevent or address excessive postoperative hemorrhage in cardiac surgery are likely to have substantial cost-effectiveness potential.
Topics: Aged; Cardiac Surgical Procedures; Costs and Cost Analysis; Female; Germany; Hospital Costs; Humans; Intensive Care Units; Length of Stay; Male; Multivariate Analysis; Postoperative Hemorrhage; Quality Assurance, Health Care; Retrospective Studies
PubMed: 19698857
DOI: 10.1016/j.jtcvs.2009.02.021 -
The Journal of Thoracic and... Nov 2019We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding. (Clinical Trial)
Clinical Trial
OBJECTIVE
We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding.
METHODS
In a preplanned secondary analysis of prospectively collected data from the Limiting IV Chloride to Reduce AKI trial (NCT02020538), univariate and multivariable regression analyses explored the association between peak systolic blood pressure, peak mean arterial pressure, and peak central venous pressure recorded postoperatively on the day of surgery and multiple metrics of bleeding. Patients at increased bleeding risk due to specific criteria were excluded from analysis. The primary outcome was chest tube drainage (milliliters per hour) on the day of surgery. Secondary outcomes included red blood cell transfusion, surgical re-exploration for bleeding, and hospital mortality.
RESULTS
The study cohort comprised 793 patients. Mean ± standard deviation peak systolic blood pressure, mean arterial pressure, and central venous pressure were 125 ± 15 mm Hg, 83 ± 9 mm Hg, and 12 ± 4 mm Hg, respectively. Median (interquartile range) chest tube drainage on the day of surgery was 33 mL/hour (interquartile range, 23 mL/hour-51 mL/hour). Adjusted for prespecified variables, there was no positive association between peak systolic blood pressure and bleeding outcomes, including chest tube drainage (-2.2 mL/10 mm Hg; 95% confidence interval, -3.9 to -0.5 mL/h/10 mm Hg; P = .01) or volume of transfusion (-15 mL/10 mm Hg; 95% confidence interval, -29 to -1 mL/h/10 mm Hg; P = .04). Results remained broadly consistent across multiple secondary outcomes and regardless of whether systolic blood pressure or mean arterial pressure was the explanatory variable.
CONCLUSIONS
The lack of positive association between peak systolic blood pressure or peak mean arterial pressure with metrics of bleeding after cardiac surgery promotes equipoise for testing the influence of higher blood pressure targets during the early postoperative period.
Topics: Arterial Pressure; Australia; Blood Pressure Determination; Cardiac Surgical Procedures; Central Venous Pressure; Chest Tubes; Drainage; Erythrocyte Transfusion; Female; Hospital Mortality; Humans; Male; Middle Aged; Mortality; Outcome and Process Assessment, Health Care; Postoperative Hemorrhage
PubMed: 30853233
DOI: 10.1016/j.jtcvs.2019.01.063 -
Indian Heart Journal 2016Magnesium level alteration may cause coagulation abnormality resulting in bleeding complication after off-pump coronary artery bypass grafting. In this study, we... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Magnesium level alteration may cause coagulation abnormality resulting in bleeding complication after off-pump coronary artery bypass grafting. In this study, we investigated the effect of magnesium on the postoperative coagulation profile and bleeding in OPCAB patients.
METHODS
In a double blind clinical trial, six hundred patients were randomly allocated to two groups: group A (n=150) and group B (n=450). Group A received 50mg/kg of magnesium sulfate (MS) in 100ml 0.9% NaCl solution over 20min before the anesthesia induction. Group B or control group received only 100ml 0.9% NaCl solution at the same time points. OPCAB was performed with standard technique and device. Blood samples were collected 30min before and 6h after the surgery to analyze hemoglobin and blood coagulation tests. Postoperative exploration for bleeding, blood transfusion, and volume of transfusion was recorded. The two groups compared with t-test and χ(2) tests and p-valve <0.05 were considered as significant.
RESULTS
However, postoperative hemoglobin was statistically lower in group A compared with group B, but platelet, PT, and aPTT tests were not statistically different between two groups. The serum MS level, exploration for bleeding, volume of packed cell transfusion, and volume of postoperative bleeding were statistically different between group A vs group B.
CONCLUSION
Preoperative MS use may be associated with the postoperative platelet dysfunction and increased tendency to bleeding. This is an important risk factor for postoperative bleeding in the OPCAB in absence of CPB use.
Topics: Aged; Blood Transfusion; Calcium Channel Blockers; Coronary Artery Bypass, Off-Pump; Coronary Artery Disease; Double-Blind Method; Female; Follow-Up Studies; Humans; Magnesium Sulfate; Male; Platelet Aggregation; Postoperative Hemorrhage; Prospective Studies
PubMed: 27316489
DOI: 10.1016/j.ihj.2015.08.023 -
American Heart Journal Mar 2013Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the...
BACKGROUND
Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the literature, we sought to investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in patients undergoing orthopedic surgery.
METHODS AND RESULTS
We performed a retrospective cohort analysis of 3,082 consecutive subjects ≥21 years of age undergoing hip, knee, or spine surgery between November 1, 2008, and December 31, 2009. Patient characteristics were ascertained using International Classification of Diseases, Ninth Revision, diagnosis coding and retrospective review of medical records, and laboratory/blood bank databases. In-hospital outcomes included myocardial necrosis (elevated troponin), major bleeding, coded myocardial infarction, and coded hemorrhage as defined by International Classification of Diseases, Ninth Revision, coding. Of the 3,082 subjects, mean age was 60.8 ± 13.3 years, and 59% were female. Myocardial necrosis, coded myocardial infarction, major bleeding, and coded hemorrhage occurred in 179 (5.8%), 20 (0.7%), 165 (5.4%), and 26 (0.8%) subjects, respectively. Increasing age (P < .001), coronary artery disease (P < .001), cancer (P = .004), and chronic kidney disease (P = .01) were independent predictors of myocardial necrosis, whereas procedure type (P < .001), cancer (P < .001), female sex (P < .001), coronary artery disease (P < .001), and chronic obstructive pulmonary disease (P = .01) were independent predictors of major bleeding.
CONCLUSION
There is a delicate balance between thrombotic and bleeding events in the perioperative period after orthopedic surgery. Perioperative risk of both thrombosis and bleeding deserves careful attention in preoperative evaluation, and future prospective studies aimed at attenuating this risk are warranted.
Topics: Aged; Cohort Studies; Female; Humans; Incidence; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Thrombosis
PubMed: 23453114
DOI: 10.1016/j.ahj.2012.11.005 -
Clinical Otolaryngology : Official... Apr 2018To report our experience of postoperative haemorrhage in patients following transoral robotic surgery (TORS).
BACKGROUND
To report our experience of postoperative haemorrhage in patients following transoral robotic surgery (TORS).
METHODS
Data were collected on patients having TORS. Postoperative haemorrhage within 30 days was graded using the Mayo Clinic grading system.
RESULTS
Transoral robotic surgery operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Haemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent haemorrhage were 5.19 times greater in patients who had a staged neck dissection after TORS (P = .05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection (P = .107). There were no haemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery.
CONCLUSIONS
Surgical intervention for TORS haemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery.
Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Mouth Neoplasms; Neck Dissection; Neoplasm Staging; Otorhinolaryngologic Neoplasms; Postoperative Hemorrhage; Retrospective Studies; Robotic Surgical Procedures
PubMed: 29194991
DOI: 10.1111/coa.13041