Abstract
BackgroundThis study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear.MethodsWe retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed.ResultsAltogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications.ConclusionsThis study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.
Highlights
Medical science and technology improvements are leading to an increase in aging people patients with more comorbidities
This study aimed to review and evaluate the surgical outcomes, intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy
Altogether, 732 patients who underwent emergency gastrointestinal surgery for critical digestive disorders were analyzed during the study period (median age: 53 years old, 400 male patients (55%), mostly postoperative diagnosis: appendicitis (60%)). 64 (8.7%) patients were under antithrombotic therapy (AT) in the present study
Summary
Medical science and technology improvements are leading to an increase in aging people patients with more comorbidities. Perioperative antithrombotic therapy (AT) may increase intraoperative blood loss and postoperative bleeding complications [3, 4]. There is accumulating evidence on emergency surgery for patients undergoing antiplatelet therapy for acute appendicitis and acute cholecystitis [16,17,18]. Peri- and postoperative outcomes in patients receiving AT remain unclear in an emergency gastrointestinal surgery. This study aimed to review and evaluate the surgical outcomes, intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. The effect of AT on intraoperative blood loss and perioperative complications remains unclear
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