Abstract
ObjectiveThe objectives of this prospective cohort study were to establish gender-related differences in blood loss and haemostatic profiles associated with bimaxillary surgery. In addition, we aimed to identify if any gender differences could be established which might help predict blood loss volume.Materials and methodsFifty-four patients (22 males; 32 females) undergoing bimaxillary surgery for skeletal dentofacial deformities were eligible for inclusion. Blood samples were taken 1 day preoperatively and 48 h postoperatively for detailed gender-specific coagulation analysis incorporating global coagulation assays (endogenous thrombin potential) and specific coagulation parameters. Blood loss was measured at two different time points: (1) the end of surgery, visible intraoperative blood loss (IOB) using ‘subtraction method’; and (2) 48 h postoperatively perioperative bleeding volume (CBL-48 h) using ‘haemoglobin-balance method’ and Nadler’s formula. Correlation and regression analyses were performed to identify relevant parameters affecting the amount of blood loss.ResultsSignificant differences in IOB and CBL-48 h were observed (p < 0.001). Men had higher IOB versus women, lacking statistical significance (p = 0.056). In contrast, men had significantly higher CLB-48 h (p = 0.019). Reduced CBL-48 h was shown to be most closely associated with the level of Antithrombin-III being decreased in females.ConclusionsMale gender is associated with higher IOB and CBL-48 compared with females. Gender does not affect IOB regarding haemostatic profile but does correlate strongly with procedure length. Conversely, CBL-48 is closely associated with gender-specific imbalances in the anticoagulant system.Clinical relevanceKnowledge of gender-related differences will help clinicians establish predictive factors regarding excessive blood loss in orthognathic surgery and identify at-risk patients.
Highlights
While generally considered to be a safe surgical field, orthognathic surgical procedures continue to be linked to large intra- and perioperative bleeding volumes conferring various negative effects for a patient [1,2,3]
Patient gender has frequently been proposed as a contributing factor in terms of blood loss in numerous surgical specialties, with the male gender being associated with higher bleeding volumes when compared with the female gender [45,46,47]
No effects of gender-based peculiarities in terms of the haemostatic profile on intraoperative blood loss (IOB) were observed. This is in marked contrast to the findings reported by Olsen et al who stated a significant correlation between IOB and an ampler haemostatic profile [14]
Summary
While generally considered to be a safe surgical field, orthognathic surgical procedures continue to be linked to large intra- and perioperative bleeding volumes conferring various negative effects for a patient [1,2,3]. With regard to bimaxillary surgery, involving skeletal repositioning of the upper and lower jaw, blood loss has frequently been described as excessive [4,5,6] Reasons for this refer to the rich vascular anatomy of the midface, the limited surgical accessibility to this area, in combination with the complexity of the procedure and the wide surgical exposure needed [6]. Orthognathic surgical procedures are elective by nature; a high quality of care with minimum associated risks is a necessity Against this backdrop, elaborate research into how to prevent and reduce blood loss in this surgical field has been conducted [7, 8]. The underlying mechanisms potentially affecting blood loss in this regard have scarcely been investigated
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