Risk factors for postoperative bleeding after tonsillectomy. Systematic review

BackgroundEndoscopic submucosal dissection (ESD) has become widely accepted as a standard treatment for gastric epithelial neoplasms. Antithrombotic agents are widely used to prevent thromboembolic disease. However, the feasibility of endoscopic procedures for patients using such agents has been rarely investigated. The aim of this study was to identify risk factors for post-operative bleeding after gastric ESD and to evaluate the relationship between the use of antithrombotic agents and post-operative bleeding.MethodsFrom June 2005 to March 2014, 413 patients with 425 gastric neoplasms were treated by ESD. The demographic and clinical parameters associated with post-operative bleeding were investigated. 83 patients receiving antithrombotic agents were separately assessed using various methods of administration during the ESD procedure. Post-operative bleeding that occurred within 5 days of ESD was defined as early post-operative bleeding, whereas subsequent bleeding was defined as delayed bleeding.ResultsThe overall post-operative bleeding rate was 4.7%. In patients with continued low-dose aspirin (LDA), heparin replacement (HR), or continued LDA along with HR, post-operative bleeding rates were 9.5%, 23.8%, and 25.0%, respectively. On multivariate analysis, a specimen size of ≥40 mm was a risk factor for early post-operative bleeding [odds ratio (OR) 6.08, 95% CI: 1.74–21.27], and HR and chronic kidney disease (CKD) requiring hemodialysis were risk factors for delayed bleeding (OR 12.23, 95% CI: 2.63–56.77 and OR 28.35, 95% CI: 4.67–172.11, respectively). Continued LDA was not a risk factor for post-operative bleeding.ConclusionsLarge specimen size is a risk factor for early post-operative bleeding, and HR and CKD requiring hemodialysis are risk factors for delayed bleeding. Patients with risk factors should be carefully watched, allowing for the timing of post-operative bleeding after ESD.

IMPORTANCE: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable. OBJECTIVE: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children. DESIGN: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding. SETTING: Tertiary pediatric otorhinolaryngology center. PARTICIPANTS: A total of 288 children aged 0–18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. MAIN OUTCOMES AND MEASURES: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy. RESULTS: Elevated systolic (p = 0.046), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.007) (Mann–Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery (p < 0.001) (Fisher’s exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon’s level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy. CONCLUSIONS AND RELEVANCE: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms

Background Cerebral palsy (CP) is one of the most common neuromuscular disorders in children, and spinal abnormalities are vastly more common in people with CP compared to the general population. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative complications.This study aims to investigate (1) whether pediatric CP patients have higher rates of postoperative complications after spinal fusion and (2) risk factors for postoperative bleeding, readmission, and reoperation. Methodology The 2019 American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used for this study. Chi-square tests were used to compare patient demographics, frequency of comorbidities, intraoperative factors, and postoperative complications between CP and non-CP patients. Multivariable logistic regression modeling was conducted to determine if CP was an independent risk factor for the composite variable that included postoperative bleeding, readmission, and reoperation. Results A total of 4,445 patients were included in the study, with 606 CP and 3,839 non-CP patients. Several comorbidities were more prevalent in the CP cohort, most notably asthma, gastrointestinal disease, previous cardiac surgery, and hematologic disorders. Multivariable logistic regression modeling revealed that CP, older age, non-Caucasian race, American Society of Anesthesiologists (ASA) class of 3 or higher, posterior surgical approach, previous cardiac surgery, and ostomy were significantly correlated with higher postoperative complications. Conclusions This study demonstrates that CP, older age, non-Caucasian race, ASA class of 3 or higher, posterior approach, previous cardiac surgery, and ostomy are independent risk factors for postoperative complications, including readmission, reoperation, and postoperative bleeding requiring transfusions. Consequently, there is a pressing need for additional research to establish perioperative strategies that reduce postoperative risks for these patients. Spine surgeons should consider the findings of this study when communicating the potential risks of spinal fusion surgery with patients and their families.

Postoperative bleeding after thyroid surgery is a feared and life-threatening complication. The aim of the study was to identify risk factors for postoperative bleeding, with special emphasis on the impact of the individual surgeon and the time to diagnosis of the complication. Data on consecutive thyroid operations were collected prospectively in a database over 30 years and analysed retrospectively for potential risk factors for postoperative bleeding. There were 30,142 operations and postoperative bleeding occurred in 519 patients (1·7 per cent). Risk factors identified were older age (odds ratio (OR) 1·03 per year), male sex (OR 1·64), extent of resection (OR up to 1·41), bilateral procedure (OR 1·99) and operation for recurrent disease (OR 1·54). The risk of complications among individual surgeons differed by up to sevenfold. Postoperative bleeding occurred in 336 (80·6 per cent) of 417 patients within the first 6 h after surgery. Postoperative bleeding was diagnosed after 24 h in ten patients (2·4 per cent), all of whom had bilateral procedures. Nine patients required urgent tracheostomy. Three patients died, giving a mortality rate of 0·01 per cent overall and 0·6 per cent among patients who had surgery for postoperative bleeding. Observation for up to 24 h is recommended for the majority of patients undergoing bilateral thyroid surgery in an endemic goitre area. Same-day discharge is feasible in selected patients, especially after a unilateral procedure. Quality improvement by continuous outcome monitoring and retraining of individual surgeons is suggested.

Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P < 0.001). The cutoff value for PT-INR was 2.11 based on a receiver-operating characteristic analysis. A multivariate analysis indicated that an elevated PT-INR value [hazard ratio (HR) 3.798, 95% confidence interval (CI) 1.400-10.467, P < 0.01], preoperative antibiotic administration (HR 4.434, 95% CI 1.591-14.775, P < 0.01), difficulties with intraoperative hemostasis (HR 16.298, 95% CI 2.986-110.677, P < 0.01), and higher serum creatinine levels (HR 7.465, 95% CI 1.616-39.576, P < 0.05) are significant predictors of postoperative hemorrhage after lower third molar extraction. Multivariate correlations were observed between risk factors including an elevated PT-INR value, preoperative antibiotic administration, and higher serum creatinine levels, and postoperative hemorrhage after lower third molar extraction in patients receiving warfarin therapy. Clinicians need to consider these risk factors for postoperative hemorrhage after the lower third molar extraction and monitor PT-INR in patients receiving warfarin therapy.

To identify the incidence of and risk factors for postoperative bleeding after ileocolic end-to-side anastomosis using a circular stapler. We analyzed, retrospectively, the risk factors for postoperative anastomotic bleeding in patients who underwent right-sided colectomy with end-to-side anastomosis done using a circular stapler during colon tumor surgery at our institute between January 2015 and March 2019. Anastomotic bleeding developed in 10 (3.6%) of the total 279 patients. Univariate analysis revealed that age ≥ 80years (8.8% vs. 1.9%; P = 0.008) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 1 (12.5% vs. 2.8%; P = 0.014) were significant risk factors for anastomotic bleeding. Postoperative anticoagulation therapy was not a risk factor for anastomotic bleeding. Multivariate analysis revealed that only age ≥ 80years was an independent risk factor (odds ratio 4.12, 95% confidence interval 1.02-16.68, P = 0.047). Six of the ten patients with anastomotic bleeding were treated conservatively, three were treated by colonoscopic clipping, and one required surgery. End-to-side anastomosis is safe and feasible, but must be performed carefully in the elderly, who are at higher risk of anastomotic bleeding.

This study investigates the impact of preoperative fasting time on patients undergoing partial nephrectomy and analyzes the risk factors for postoperative hemorrhage to provide clinical reference for physicians treating patients undergoing partial nephrectomy. A retrospective analysis was conducted on 74 patients who underwent partial nephrectomy for renal tumors between January 2022 and March 2024. Baseline and perioperative data were collected. The effects of long-term and short-term preoperative fasting on patients undergoing partial nephrectomy were compared. Additionally, univariate and multivariate logistic regression analyses were performed to identify risk factors for hemorrhagic complications following partial nephrectomy. Among the patients in this study, 26 (35.14%) underwent short-term preoperative fasting, while 48 (64.86%) underwent long-term preoperative fasting. The hemoglobin difference in the short-term fasting group was 21.08 ± 12.44 ml, compared to 13.65 ± 11.69 ml in the long-term fasting group, showing a statistically significant difference (p = 0.020). Differences in serum calcium (p = 0.003), serum magnesium (p = 0.031), and serum phosphorus (p = 0.001) between the short-term and long-term fasting groups were also statistically significant. Univariate and multivariate regression analyses identified the type of surgery (p = 0.050) and preoperative fasting time (p < 0.001) as independent risk factors for postoperative hemorrhage following partial nephrectomy. Patients undergoing partial nephrectomy with short-term preoperative fasting experience a more significant decrease in hemoglobin compared to those with long-term fasting. The type of surgery and preoperative fasting time are independent risk factors for postoperative hemorrhage in patients undergoing partial nephrectomy.

Reports on postoperative bleeding after esophageal endoscopic resection are limited. This study aimed to identify the clinical characteristics and risk factors for postoperative bleeding following endoscopic resection of esophageal neoplasms. This single-center, retrospective study included consecutive patients who underwent endoscopic resection for esophageal squamous cell carcinoma or squamous intraepithelial neoplasm between January 2018 and December 2022. We investigated the incidence, timing, severity, and risk factors for postoperative bleeding. Of 1288 patients, 1062 (82%) underwent endoscopic submucosal dissection, and 226 (18%) underwent endoscopic mucosal resection. Postoperative bleeding occurred in seven (0.5%) patients (95% confidence interval [CI] 0.2-1.1%; median postoperative day 8 [range, 4-17 days]). In these seven patients, hemoglobin concentration decreased by a median of 3.0g/dL (range, 1.6-6.8g/dL). Antithrombotic agent use, resection wound circumference, and specimen size were significantly associated with postoperative bleeding (P < 0.001, P = 0.002, and P = 0.024, respectively). Among 43 patients who received direct oral anticoagulants (DOACs), postoperative bleeding occurred in four (9%) patients (95% CI 2.6-22.1%). DOACs were significantly associated with postoperative bleeding even after propensity score matching (4/40 [10%] vs. 0/80 [0%], respectively; P = 0.011). The overall bleeding rate following esophageal endoscopic resection was 0.5%, with a delayed onset, leading to anemia. DOACs emerged as the most significant risk factor for postoperative bleeding.

A multivariate logistic regression model was developed to identify the risk factors for postoperative bleeding in patients undergoing endoscopic submucosal dissection (ESD) for early esophageal cancer. The clinical data of 258 patients with early esophageal cancer who received ESD in Jiujiang Number One People's Hospital from April 2019 to March 2022 were retrospectively analyzed. Patients with or without postoperative bleeding were included into a bleeding group and a control group, respectively, and general information with statistically significant difference between the two groups was included in the multivariate logistic regression model to screen the risk factors for postoperative bleeding in the patients. The risk factors were then used to construct a nomogram prediction model for postoperative bleeding, and internal (training set) and external (validation set) validation was performed. (1) The incidence of post-ESD bleeding was 12.02% in the 258 patients with early esophageal cancer. (2) History of hypertension, lesion diameter, submucosal fibrosis, C-reactive protein (CRP), and albumin (ALB) were independent risk factors for postoperative bleeding after ESD in the patients (P<0.05). (3) The results of receiver operator characteristic curve (ROC) showed that the area under the curve (AUC) was 0.821 for the training set and 0.740 for the validation set. (4) The correction curve showed that the actual and predicted values of the training and validation sets were well fitted. Hypertension history, lesion diameter, submucosal fibrosis, CRP, and ALB are risk factors for postoperative bleeding in patients with early esophageal cancer undergoing ESD. The nomograms established based on these factors has good predictive value for postoperative bleeding in these patients.

BackgroundIn Asia, the incidence of uterine fibroids (UFs) in women is as high as 1.278%. However, there are few analyses of the prevalence and independent risk factors for bleeding and recurrence after laparoscopic myomectomy (LM). This study aimed to analyze the clinical characteristics of patients with UF and identify the independent risk factors for postoperative bleeding and recurrence after LM, so as to provide a reference basis for improving the quality of life of patients.MethodsBased on our exclusion and inclusion criteria, we retrospectively analyzed a total of 621 patients who developed UF from April 2018 to June 2021. The t-test, analysis of variance (ANOVA), and chi-square test were used to analyze the relationship between the clinical characteristics of the patients and postoperative bleeding as well as recurrence. Binary logistic regression was used to analyze the independent risk factors for the occurrence of postoperative bleeding and fibroid recurrence in patients.ResultsThe rates of postoperative bleeding and recurrence after LM for uterine fibroids were 4.5% and 7.1%, respectively. Binary logistic regression analysis showed that fibroid size [odds ratio (OR) =5.502, P=0.003], maximum fibroid type (OR =0.293, P=0.048), pathological type (OR =3.673, P=0.013), preoperative prothrombin time level (OR =1.340, P=0.003), preoperative hemoglobin level (OR =0.227, P=0.036), surgery time (OR =1.066, P=0.022), intraoperative bleeding (OR =1.145, P=0.007), and postoperative infection (OR =9.540, P=0.010) were independent risk factors for postoperative bleeding; meanwhile, body mass index (BMI) (OR =1.268, P=0.001), age of menarche (OR =0.780, P=0.013), fibroid size (OR =4.519, P=0.000), fibroid number (OR =2.381, P=0.033), maximum fibroid type (OR =0.229, P=0.001), pathological type (OR =2.963, P=0.008), preoperative delivery (OR =3.822, P=0.003), preoperative C-reactive protein (CRP) level (OR =1.162, P=0.005), intraoperative ultrasonography (OR =0.271, P=0.002), postoperative gonadotropin-releasing hormone agonist treatment (OR =2.407, P=0.029), and postoperative infection (OR =7.402, P=0.005) were independent risk factors for recurrence.ConclusionsAt present, there is still a high probability of postoperative bleeding and recurrence after LM for UF. Clinical work should pay close attention to clinical features. Adequate preoperative examination to improve surgical precision, and strengthen postoperative care and education, thus reducing the probability of postoperative bleeding and recurrence in patients.

This is a retrospective analysis of administrative database. To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery. Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery. Previous studies may have reported higher than true rates of complications for controlled diabetic patients, who are the majority of diabetic patients. The Nationwide Inpatient Sample was queried from years 2002 to 2011. We extracted idiopathic scoliosis patients older than 45 years of age that received spinal fusion and analyzed complications and outcomes variables among 3 cohorts: nondiabetic patients, controlled diabetics, and uncontrolled diabetics. Multivariate analyses were used to assess whether glycemic control was a risk factor for adverse postoperative outcomes. Controlled diabetics had significantly increased rates of acute renal failure (ARF), while uncontrolled diabetics had significantly increased rates of acute postoperative hemorrhage. In multivariate analyses controlling for patient factors and comorbidities, controlled DM was found to be an independent predictor of ARF [odds ratio (OR), 1.863; 95% confidence interval (CI), 1.346-2.579; P=0.0002), and uncontrolled DM was found to be a significant risk factor for acute postoperative hemorrhage (OR, 2.182; 95% CI, 1.192-3.997; P=0.0115), ARF (OR, 4.839; 95% CI, 1.748-13.392; P=0.0024), deep vein thrombosis (OR, 5.825; 95% CI, 1.329-25.522, P=0.0194) and in-patient mortality (OR, 8.889; 95% CI, 1.001-78.945; P=0.0499). Controlled DM was found to be a risk factor for ARF in adult idiopathic scoliosis patients undergoing spinal fusion surgery, while uncontrolled DM was shown to be a risk factor for postoperative hemorrhage, ARF, deep vein thrombosis, and mortality. The present study provides valuable data for better informed consent for patients with diabetes considering surgery for idiopathic scoliosis. Level III.

Background: Ovarian endometriomas are a common gynecological disease in women of childbearing age. Laparoscopic surgery is the gold standard surgical procedure for treating patients with ovarian endometriomas. However, laparoscopic postoperative bleeding, recurrence, and pregnancy failure are still unavoidable problems for many patients. Methods: A retrospective analysis was performed of 212 patients with ovarian endometriomas treated by laparoscopic surgery in our hospital from January 2016 to December 2020, with postoperative follow-up for 2 years. The researchers completed the follow-up by telephone, email, and outpatient review. Chi-square test was used to analyze the relationship between their clinical characteristics and postoperative bleeding, recurrence, and pregnancy along with logistic regression analysis of the risk factors for postoperative bleeding and recovery. Also, the use of logistic regression analysis may influence the factors influencing pregnancy outcome after laparoscopy. Results: The postoperative pregnancy success rate in 212 patients with ovarian endometriomas was 63.7%. The incidence of bleeding after surgery was 31.6% and the recurrence rate was 21.2%. The results of the logistic-regression analysis demonstrated that, age (odds ratio (OR) = 1.208, p = 0.001), combined with deep infiltrating endometriosis (DIE) (OR = 5.18, p = 0.023), cystic diameter ≥5 cm (OR = 0.076, p = 0.005), bleeding during the operation ≥50 mL (OR = 25.769, p = 0.000) and intraoperative bleeding (OR = 1.295, p = 0.000) were independent risk factors for postoperative bleeding. Severe dysmenorrhea (OR = 6.189, p = 0.004), cystic diameter ≥5 cm (OR = 8.502, p = 0.001), bilaterality (OR = 85.214, p = 0.001) and intraoperative bleeding (OR = 0.911, p = 0.003) were independent risk factors for the recurrence of ovarian endometriomas. By logistic regression analysis, age, bilaterality, the revised American Fertility Society (r-AFS) stage ≥Ⅲ were all related factors for postoperative pregnancy (p &lt; 0.05). Conclusions: Age, combined with deep infiltrating endometriosis, cystic diameter, bleeding during the operation and intraoperative bleeding were all independent risk factors for postoperative bleeding. Severe dysmenorrhea, bilaterality, cystic diameter and intraoperative bleeding were independent risk factors for the recurrence of ovarian endometriomas. Age, bilaterality, r-AFS stage ≥Ⅲ were related factors for postoperative pregnancy.

To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection (ESD) based on the latest guidelines. A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for post-ESD bleeding. Of the 48 (18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases (8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group (6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin time-international normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement (OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding. Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.

Background Although there has been progress in improving endoscopic sinus surgery (ESS), patients undergoing ESS are still at risk of postoperative bleeding. Little attention has been given to identifying specific risk factors for postoperative bleeding after ESS to treat chronic rhinosinusitis (CRS). Objectives The aim of this study was to identify the incidence and risk factors associated with postoperative bleeding in patients who underwent ESS to treat CRS. Materials and methods Six hundred and five patients with CRS who underwent ESS between 2017 and 2020 were included in this retrospective analysis. Univariate and multivariate analysis was performed to assess the association between the incidence of postoperative bleeding and the background characteristics. Results Out of 605 ESSs, 36 (6.0%) patients developed postoperative bleeding. Multiple logistic regression revealed that the use of antiplatelet and/or anticoagulant drugs, the presence of hypertension and the Lund-Mackay CT score were significantly correlated with the occurrence of postoperative bleeding. Conclusion Postoperative bleeding is a common complication following ESS. The risk factors for postoperative bleeding were as follows: the use of antiplatelet and/or anticoagulant drugs, hypertension and the Lund-Mackay CT score.