RESUMEN
To investigate the safety of pancreatic body suspension (PBS) technique in laparoscopic splenectomy combined with pericardial devascularization for patients. A retrospective study inclusive of 16 patients who underwent laparoscopic splenectomy combined with pericardial devascularization from 2017 to 2022 was performed. A total of 5 patients underwent PBS technique and 11 underwent the traditional technique. There was no significant difference in age, sex, body mass index (BMI), preoperative serum white cell count (WBC), platelets (PLT), hemoglobin (HB), albumin (ALB), prothrombin time (PT), total bilirubin (TBIL), or spleen size between the 2 groups (Pâ >â .05). In the PBS group, the operation time was 280 minutes. The estimated intraoperative blood loss (EBL) was 250 mL. The mean postoperative hospitalization length was 11.2 days. There was no conversion to an open procedure or postoperative bleeding. In the traditional method group, the mean operation time was 240.91 minutes. The EBL was 290.91 mL. There were 2 cases of conversion to open, 3 cases of postoperative bleeding, and 1 reoperation. The incidence of postoperative short-term complications (postoperative bleeding, reoperation) was significantly higher in the traditional method group than in the PBS group (36.36% vs 0%, Pâ =â .034). PBS technique improved the safety of laparoscopic splenectomy combined with pericardial dissection and is worthy of clinical promotion.
Asunto(s)
Laparoscopía , Tempo Operativo , Pericardio , Esplenectomía , Humanos , Esplenectomía/métodos , Esplenectomía/efectos adversos , Masculino , Femenino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Pericardio/trasplante , Pericardio/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Páncreas/cirugía , Páncreas/irrigación sanguínea , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Tiempo de Internación/estadística & datos numéricosRESUMEN
BACKGROUND: This study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications. METHODS: Data from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics. RESULTS: In total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery. CONCLUSION: The risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients.
Asunto(s)
Neoplasias de la Mama , Fibrinolíticos , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Hemorragia Posoperatoria , Humanos , Femenino , Estudios Retrospectivos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/tratamiento farmacológico , Persona de Mediana Edad , Fibrinolíticos/efectos adversos , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/inducido químicamente , Anciano , Mastectomía Segmentaria/efectos adversos , Mastectomía Segmentaria/métodos , Escisión del Ganglio Linfático/efectos adversos , Estudios de Seguimiento , Adulto , Pronóstico , Axila , Biopsia del Ganglio Linfático Centinela/efectos adversos , Anciano de 80 o más Años , Factores de RiesgoRESUMEN
Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. TRIAL REGISTRATION: www. CLINICALTRIALS: gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic. CLINICALTRIALS: gov/ct2/show/NCT04533698.
Asunto(s)
Puente de Arteria Coronaria , Fluidoterapia , Reoperación , Humanos , Femenino , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Masculino , Fluidoterapia/métodos , Anciano , Estudios Retrospectivos , Incidencia , Persona de Mediana Edad , Resucitación/métodos , Resucitación/efectos adversos , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/terapia , Factores de RiesgoRESUMEN
The risk factors for immediate post-polypectomy bleeding (IPPB) after cold snare polypectomy (CSP) are not well-known. We sought to define such risk factors and develop a predictive risk-scoring model. This prospective observational study included 161 polyps (4-9 mm in diameter) that were removed via CSP from 118 patients during the period from June to September 2019 in 2 tertiary hospitals. IPPB was defined as post-polypectomy bleeding within 24 hours or grade 3 or 4 intraprocedural bleeding requiring endoscopic hemostasis. IPPB incidences according to grade were 13.0% (21/161) (grade 3) and 0% (grade 4). Univariate analysis showed that the polyp size and morphology, as well as iatrogenic ulcer size and shape, were significantly associated with IPPB. Multivariate analysis showed that polyp size [6-9 mm vs 4-5 mm, odds ratio (OR) 3.72, 95% confidence interval (CI) 1.28-10.79], polyp morphology (polypoid vs non-polypoid, OR: 3.93, 95% CI: 1.22-12.64), and iatrogenic ulcer size (≥10 vs ≤â 9 mm, OR: 3.12, 95% CI: 1.04-9.38) were significantly associated with IPPB. We created a four-marker risk-scoring model to predict IPPB after CSP; we summed the points assigned for the 4 factors. At a cutoff of 2, the sensitivity was 85.7% and the specificity was 65.0%; at a cutoff of 3, the sensitivity was 65% and the specificity was 90.0%. Polyp size and morphology, as well as iatrogenic ulcer size and shape, were associated with IPPB after CSP. The four-marker risk-scoring model appears to effectively predict IPPB after CSP (Clinical Research Information Service: KCT0004375).
Asunto(s)
Pólipos del Colon , Hemorragia Posoperatoria , Humanos , Femenino , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Pólipos del Colon/cirugía , Anciano , Factores de Riesgo , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/epidemiología , Colonoscopía/efectos adversos , Colonoscopía/métodos , Medición de Riesgo/métodosRESUMEN
This study aims to analyze the risk factors associated with delayed postoperative bleeding (DPPB) following colorectal polyp surgery, develop a dynamic nomogram and evaluate the model efficacy, provide a reference for clinicians to identify the patients at high risk of DPPB. Retrospective study was done on patients who underwent endoscopic colorectal polypectomy at the First Hospital of Lanzhou University from January 2020 to March 2023. Differences between the group with and without DPPB were compared, and independent risk factors for DPPB occurrence were identified through univariate analysis and combination LASSO and logistic regression. A dynamic nomogram was constructed based on multiple logistic regression to predict DPPB following colorectal polyp surgery. Model evaluation included receiver operating characteristic (ROC), Calibration curve, Decision curve analysis (DCA). DPPB occurred in 38 of the 1544 patients included. multivariate analysis showed that direct oral anticoagulants (DOACs), polyp location in the right hemi colon, polyp diameter, drink, and prophylactic hemoclips were the independent risk factors for DPPB and dynamic nomogram were established. Model validation indicated area under the ROC curve values of 0.936, 0.796, and 0.865 for the training set, validation set, and full set, respectively. The calibration curve demonstrated a strong alignment between the predictions of the column-line diagram model and actual observations. The decision curve analysis (DCA) displayed a significant net clinical benefit across the threshold probability range of 0-100%. The dynamic nomogram aids clinicians in identifying high-risk patients, enabling personalized diagnosis and treatment.
Asunto(s)
Pólipos del Colon , Nomogramas , Hemorragia Posoperatoria , Humanos , Masculino , Femenino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/diagnóstico , Hemorragia Posoperatoria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Pólipos del Colon/cirugía , Anciano , Curva ROC , AdultoRESUMEN
Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48 h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.
Asunto(s)
Antifibrinolíticos , Pérdida de Sangre Quirúrgica , Escoliosis , Fusión Vertebral , Ácido Tranexámico , Humanos , Ácido Tranexámico/uso terapéutico , Escoliosis/cirugía , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Adolescente , Estudios Prospectivos , Adulto , Transfusión Sanguínea/estadística & datos numéricos , Resultado del Tratamiento , Periodo Posoperatorio , Tiempo de Internación , Adulto Joven , Hemorragia Posoperatoria/epidemiologíaRESUMEN
BACKGROUND: Congenital portosystemic shunts (CPSS) are rare congenital abnormalities causing abnormal blood flow between the portal vein and systemic circulation. This study reports on the peri-operative anticoagulation management of CPSS patients post closure, focusing on the incidence of thrombotic and bleeding complications. METHODS: This is a single-center retrospective analysis of CPSS patients who underwent surgery or endovascular intervention between 2005 and 2021. The protocol included unfractionated heparin (UFH) during and immediately after surgery, followed by either warfarin or low molecular weight heparin (LMWH) postoperatively. Outcomes assessed included postoperative thrombotic and bleeding complications. RESULTS: A total of 44 patients were included. Postoperatively, 89% received treatment-dose UFH, transitioning to warfarin or LMWH at discharge. Thrombotic complications occurred in 16% of patients, predominantly in the superior mesenteric vein. Surgical interventions and continuous infusion of tissue plasminogen activator (tPA) were used for clot resolution. Bleeding complications were observed in 64% of patients, primarily managed with transfusions and temporary UFH interruption. No deaths related to thrombotic, or bleeding events were reported. CONCLUSIONS: Our findings underscore the delicate balance required in anticoagulation management for CPSS patients, revealing an occurrence of both thrombotic and bleeding complications postoperatively. LEVELS OF EVIDENCE: Level II, retrospective study.
Asunto(s)
Anticoagulantes , Heparina de Bajo-Peso-Molecular , Trombosis , Warfarina , Humanos , Estudios Retrospectivos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Femenino , Masculino , Lactante , Heparina de Bajo-Peso-Molecular/uso terapéutico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Preescolar , Warfarina/uso terapéutico , Warfarina/efectos adversos , Warfarina/administración & dosificación , Trombosis/etiología , Trombosis/prevención & control , Trombosis/epidemiología , Niño , Vena Porta/anomalías , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Heparina/uso terapéutico , Heparina/administración & dosificación , Heparina/efectos adversos , Recién Nacido , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/prevención & control , Atención Perioperativa/métodos , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/cirugía , Sistema Porta/anomalías , AdolescenteRESUMEN
Importance: Direct oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism. Observations: For elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures). For patients undergoing minimal bleeding risk procedures, DOACs may be continued, or if there is concern about excessive bleeding, DOACs may be discontinued on the day of the procedure. Patients undergoing a low to moderate bleeding risk procedure should typically discontinue DOACs 1 day before the operation and restart DOACs 1 day after. Patients undergoing a high bleeding risk procedure should stop DOACs 2 days prior to the operation and restart DOACs 2 days after. With this perioperative DOAC management strategy, rates of thromboembolism (0.2%-0.4%) and major bleeding (1%-2%) are low and delays or cancellations of surgical and nonsurgical procedures are infrequent. Patients taking DOACs who need emergent (<6 hours after presentation) or urgent surgical procedures (6-24 hours after presentation) experience bleeding rates up to 23% and thromboembolism as high as 11%. Laboratory testing to measure preoperative DOAC levels may be useful to determine whether patients should receive a DOAC reversal agent (eg, prothrombin complex concentrates, idarucizumab, or andexanet-α) prior to an emergent or urgent procedure. Conclusions and Relevance: When patients who are taking a DOAC require an elective surgical or nonsurgical procedure, standardized management protocols can be applied that do not require testing DOAC levels or heparin bridging. When patients taking a DOAC require an emergent, urgent, or semiurgent surgical procedure, anticoagulant reversal agents may be appropriate when DOAC levels are elevated or not available.
Asunto(s)
Anticoagulantes , Reversión de la Anticoagulación , Pérdida de Sangre Quirúrgica , Atención Perioperativa , Hemorragia Posoperatoria , Humanos , Administración Oral , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/sangre , Fibrilación Atrial/tratamiento farmacológico , Atención Perioperativa/métodos , Piridinas/administración & dosificación , Piridinas/efectos adversos , Piridinas/sangre , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Rivaroxabán/sangre , Tromboembolia Venosa/tratamiento farmacológico , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Dabigatrán/sangre , Tiazoles/administración & dosificación , Tiazoles/efectos adversos , Tiazoles/sangre , Pérdida de Sangre Quirúrgica/prevención & control , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/prevención & control , Procedimientos Quirúrgicos Electivos/efectos adversos , Reversión de la Anticoagulación/métodosRESUMEN
Postoperative hemorrhage can severely affect the patients' neurological outcome after awake craniotomy. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. In this retrospective analysis, we included patients who underwent awake surgery at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 h. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. We included 48 patients with a median age of 39 years. 9 patients (19%) required further treatment due to postoperative hemorrhage, which was surgery in 2 cases and intensive blood pressure measurements in 7 cases. However, with early treatment, no significant difference in Performance scores at follow-up could be found. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p < 0.05) as well as intraoperatively throughout the procedure (p < 0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140mmHg during the early postoperative course could be shown. Postoperative hemorrhage is a rare but possible complication in awake surgery glioma patients. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140mmHg for the postoperative course.
Asunto(s)
Presión Sanguínea , Neoplasias Encefálicas , Craneotomía , Glioma , Hemorragia Posoperatoria , Vigilia , Humanos , Craneotomía/efectos adversos , Masculino , Glioma/cirugía , Glioma/complicaciones , Femenino , Adulto , Persona de Mediana Edad , Presión Sanguínea/fisiología , Neoplasias Encefálicas/cirugía , Vigilia/fisiología , Estudios Retrospectivos , Hemorragia Posoperatoria/epidemiología , Anciano , Adulto Joven , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversosRESUMEN
OBJECTIVE: Aim: To improve the management of morbidly obese patients who undergo gastric bypass surgery to reduce the number of postoperative complications, in particular, bleeding. PATIENTS AND METHODS: Materials and Methods: From 2011 to 2022, a total of 348 patients with morbid obesity (MO) underwent laparoscopic gastric bypass treatment at the clinical base of the Department of General Surgery â2 of Bogomolets National Medical University. The retrospective group included 178 patients who received treatment between 2011 and 2019. 170 patients were enrolled in the prospective group for the period from 2019 to 2022. RESULTS: Results: Retrospective group had 8 episodes of postoperative bleeding, representing a rate of 4.49%, prospective group - 3 episodes of postoperative bleeding, representing a rate of 1.76% Four factor characteristics associated with the probability of bleeding were identified: "number of comorbid conditions", "arterial hypertension", "chronic liver diseases" and "chronic obstructive pulmonary disease". CONCLUSION: Conclusions: The factors responsible for the occurrence of postoperative bleeding in morbidly obese patients after laparoscopic gastric bypass surgery were the number of comorbid conditions, the presence of arterial hypertension, the presence of chronic liver diseases, and chronic obstructive pulmonary disease. A new strategy for the management of morbidly obese patients after laparoscopic gastric bypass was developed. This strategy involves changing cassettes to create gastroentero- and enteroenteroanastomoses, reducing the period of use of the nasogastric tube, drains, and urinary catheter from 3-4 days to 1 day, and resuming the drinking regimen 6 hours after extubation.
Asunto(s)
Derivación Gástrica , Obesidad Mórbida , Hemorragia Posoperatoria , Humanos , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Derivación Gástrica/efectos adversos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Persona de Mediana Edad , Laparoscopía/efectos adversos , Estudios ProspectivosRESUMEN
The complications anticipated in the postoperative period after surgical resection of lateral ventricular neoplasms (LVN) are hemorrhage, hydrocephalus. At the N.N. Burdenko Neurosurgery Center, 48 patients with LVN underwent surgical resection. We focused on the correlation between approaches to the ventricular system on one hand and the extent of resection and incidence of complications on the other based on anatomical and perfusion characteristics estimated via preoperative magnetic resonance imaging (MRI) with arterial spin labeling perfusion. By eliminating the surgical approach as a potential risk factor, we were able to demonstrate the correlation between the frequency of postoperative hemorrhage, the Evans index value, patient's gender, tumor blood flow (nTBF) and the location of the mass in the anterior horn of the lateral ventricle. The risk of hemorrhage depends on the patient's gender, presence of hydrocephalus, location of the mass and tumor blood flow values. The risk increases along with increase in Evance index and nTBF values.
Asunto(s)
Neoplasias del Ventrículo Cerebral , Hidrocefalia , Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Neoplasias del Ventrículo Cerebral/cirugía , Adulto , Anciano , Hidrocefalia/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Ventrículos Laterales/cirugía , Adolescente , Adulto Joven , Estudios Retrospectivos , Niño , Hemorragia Posoperatoria/epidemiologíaRESUMEN
BACKGROUND: We investigate the effect of antiplatelet and anticoagulant medications on bleeding complications in patients undergoing ventral hernia repair. METHODS: The Abdominal Core Health Quality Collaborative registry was queried from 2013 to 2022 for patients who underwent ventral hernia repair, evaluating the association between antiplatelet or anticoagulant use and bleeding complications. RESULTS: 37,973 patients underwent ventral hernia repair: 11.5 â% on antiplatelet therapy alone and 5.8 â% on anticoagulation alone. Despite being held, an adjusted regression analysis showed that anticoagulation was associated with an increased risk for postoperative bleeding requiring transfusion (OR 2.4 [1.7-3.4], p â< â0.0001), reoperation for postoperative bleeding (OR 6.3 [3.9-10.0], p â< â0.0001), and readmission for bleeding complications (OR 4.9 [2.9-8.2], p â< â0.0001). Antiplatelet use was not a risk factor for any postoperative bleeding complication. CONCLUSION: Despite being held preoperatively, patients on anticoagulants are at an increased risk for postoperative hemorrhagic complications. Antiplatelet therapy does not pose the same risk.
Asunto(s)
Anticoagulantes , Hernia Ventral , Herniorrafia , Inhibidores de Agregación Plaquetaria , Hemorragia Posoperatoria , Humanos , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Femenino , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Masculino , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/inducido químicamente , Herniorrafia/efectos adversos , Hernia Ventral/cirugía , Persona de Mediana Edad , Anciano , Factores de Riesgo , Sistema de Registros , Estudios RetrospectivosRESUMEN
Because of its superior safety profile and improved outcomes, trans-radial percutaneous coronary intervention (TRI) has become the preferred access in percutaneous coronary intervention (PCI) of native coronary disease. This study investigated the impact of TRI on in-hospital outcomes after PCI for coronary artery bypass graft vessels (GV-PCI). We analyzed patients who underwent GV-PCI in 2019-2022 from the Japanese nationwide registry. Patients were categorized into the TRI and trans-femoral PCI (TFI) groups. We assessed the association between TRI and in-hospital outcomes. The primary outcome was a composite of in-hospital death and major bleeding. In this study, 2,295 patients were analyzed.. The primary outcomes occurred in 29 patients (1.3%), including 17 deaths (0.7%). Major bleeding occurred in 12 patients (0.5%), and access site bleeding in 7 patients (0.3%). The TRI group (n = 1,521) showed lower crude rates of the primary outcome (0.9% vs 1.9%, p = 0.039), major bleeding (0.3% vs 1.0%, p = 0.027), and access site bleeding (0.1% vs 0.6%, p = 0.047) compared with the TFI group (n = 774). Univariable logistic regression demonstrated a significant association of TRI with reduced primary outcome (odd ratio [OR] 0.47, 95% confidence interval [CI] 0.22 to 0.98), major bleeding (OR 0.25, 95% CI 0.07 to 0.80), and access site bleeding (OR 0.20, 95% CI 0.03 to 0.94). In the multivariable analysis, TRI was still significantly associated with a decrease in major bleeding events (OR 0.29, 95% CI 0.07 to 0.93). In conclusion, the use of TRI was associated with a reduction in bleeding events when referenced to TFI in the context of GV-PCI.
Asunto(s)
Puente de Arteria Coronaria , Mortalidad Hospitalaria , Intervención Coronaria Percutánea , Arteria Radial , Sistema de Registros , Humanos , Masculino , Femenino , Intervención Coronaria Percutánea/métodos , Japón/epidemiología , Anciano , Puente de Arteria Coronaria/métodos , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/cirugía , Arteria Femoral , Bases de Datos Factuales , Resultado del Tratamiento , Hemorragia Posoperatoria/epidemiología , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: To better understand the incidence and timing of thrombotic and hemorrhagic complications in anticoagulated patients undergoing elective surgery. METHODS: Using institutional American College of Surgeons National Surgical Quality Improvement Program data, we identified patients receiving preoperative anticoagulation undergoing elective surgery between 2011 and 2021. Medical records review supplemented National Surgical Quality Improvement Program data to detail complication and anticoagulation type and timing. Outcomes for postoperative hemorrhage, acute venous thromboembolism (VTE), and cerebrovascular accident (CVA) were collected. RESULTS: A total of 1442 patients met inclusion criteria, and 84 patients (5.8%) experienced 1 or more complications. There were 4 CVA (0.3%), 16 VTE (1.1%), and 68 bleeding (4.7%) events postoperatively. Three patients (75%) with CVA, 10 patients (62.5%) with VTE, and 18 patients (26.5%) with postoperative bleeding had resumed therapeutic anticoagulation before the complication. In terms of long-term sequelae in the CVA cohort, there was 1 mortality (25%), and an additional patient (25%) continues to experience long-term physical and mild cognitive impairments. Patients who experienced postoperative VTE required only anticoagulation adjustments. In patients who experienced bleeding complications, 6 (8.8%) required intensive care unit admissions, and there was 1 mortality (1.5%). CONCLUSION: Despite the increased use of anticoagulation over time, balancing postoperative bleeding and thrombotic risks remains challenging. Bleeding complications were most common in preoperatively anticoagulated patients undergoing elective surgery. Earlier postoperative resumption of anticoagulation is unlikely to prevent thrombotic events as 65% of patients had already resumed therapeutic anticoagulation.
Asunto(s)
Anticoagulantes , Procedimientos Quirúrgicos Electivos , Hemorragia Posoperatoria , Humanos , Procedimientos Quirúrgicos Electivos/efectos adversos , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Femenino , Masculino , Anciano , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/prevención & control , Persona de Mediana Edad , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Tromboembolia Venosa/epidemiología , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , IncidenciaRESUMEN
BACKGROUND: The efficacy of postoperative tranexamic acid (TXA) administration in mitigating bleeding after primary laparoscopic Roux-en-Y gastric bypass (RYGB), a prevalent complication associated with significant morbidities and mortality, and the use of sequential laboratory parameter changes in bleeding screening and TXA impact tracking were investigated. METHODS: This retrospective analysis included RYGB patients (aged 18-65 years, with a body mass index of 35-50 kg/m2) over 5 years who were categorized into three groups by evolving treatment regimens: Group A (n = 42) received standard pre- and postoperative enoxaparin (30 mg) every 12 h; Group B (n = 160) received enoxaparin and postoperative TXA (250 mg every 6 h); and Group C (n = 73) received TXA alone. Postoperative bleeding-related adverse events, vital signs, and laboratory changes were compared. RESULTS: Postoperative hemorrhage occurred in 3.6% (10/275) of patients, with no significant intergroup differences. Patients who experienced bleeding had greater decreases in hemoglobin (∆Hb) (2.1 vs. 1.4; p = 0.003), greater ∆Hb > 2 (50% vs. 15%; p = 0.013), and greater use of staples than did those who did not experience bleeding (8 vs. 7; p = 0.001). The ∆Hb values were lower in Groups B (1.4) and C (1.3) than in Group A (1.7, p = 0.011). No significant difference was noted between Groups C and B. CONCLUSION: This study emphasizes the potential of TXA to mitigate postoperative bleeding after RYGB, with no added benefit from excluding enoxaparin. Monitoring patients with a ∆Hb > 2 mg/dl and increased stapler usage is crucial. Further research is needed to validate routine TXA use across different procedures.
Asunto(s)
Antifibrinolíticos , Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Hemorragia Posoperatoria , Ácido Tranexámico , Humanos , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/uso terapéutico , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Femenino , Estudios Retrospectivos , Adulto , Masculino , Hemorragia Posoperatoria/prevención & control , Hemorragia Posoperatoria/epidemiología , Persona de Mediana Edad , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/uso terapéutico , Obesidad Mórbida/cirugía , Enoxaparina/administración & dosificación , Adulto Joven , Anciano , Resultado del Tratamiento , AdolescenteRESUMEN
BACKGROUND: Various scoring systems have been developed to assess the risk of bleeding in medical settings. HAS-BLED and HEMORR2HAGES risk scores are commonly used to estimate bleeding risk in patients receiving anticoagulation for atrial fibrillation, but data on their predictive value in patients undergoing percutaneous coronary intervention (PCI) are limited. METHODS: This study evaluated and compared the predictive abilities of the HAS-BLED and HEMORR2HAGES bleeding risk scores in all-comer patients undergoing PCI. The PARIS score, specifically designed for patients undergoing PCI, was used as a comparator. The scores were calculated at baseline and compared with the occurrence of events during a 2-year clinical follow-up period. Between 2015 and 2017, all consecutive patients undergoing PCI we re prospectively enrolled and divided into risk tertiles based on bleeding risk scores. The primary end points were hierarchical major bleeding events, defined by Bleeding Academic Research Consortium types 3 through 5, and patient-oriented composite end points according to Bleeding Academic Research Consortium classification, which were assessed during the 2-year follow-up period. RESULTS: A total of 1,080 patients completed the follow-up period. Two years after index, 189 patients (17.5%) had experienced any bleeding, with 48 events (4.4%) classified as Bleeding Academic Research Consortium types 3 to 5. All bleeding risk scores showed statistically significant predictive ability for bleeding events. The HEMORR2HAGES score (C statistic, 0.73) was more effective than the HAS-BLED score (C statistic, 0.66; P = .07) and the PARIS score (C statistic, 0.66; P = .06) in predicting risk of major bleeding. Patients in high-risk bleeding groups also experienced a higher incidence of patient-oriented composite end points. CONCLUSIONS: The HEMORR2HAGES, HAS-BLED, and PARIS risk scores exhibited good predictive abilities for bleeding events following PCI. Patients at high risk of bleeding also demonstrated increased ischemic risk and higher mortality during the 2-year follow-up period.
Asunto(s)
Intervención Coronaria Percutánea , Humanos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Masculino , Femenino , Medición de Riesgo/métodos , Factores de Riesgo , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios de Seguimiento , Incidencia , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/terapia , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/diagnóstico , Factores de Tiempo , Hemorragia/inducido químicamente , Hemorragia/epidemiologíaRESUMEN
BACKGROUND: Delayed bleeding (DB) is a serious complication after cold snare polypectomy (CSP) for polyps in the colon. The present study aimed to investigate the incidence and risk factors of DB after CSP and to develop a risk-scoring model for predicting DB. METHODS: A retrospective study was conducted in four Chinese medical institutions. 10650 patients underwent CSP from June 2019 to May 2023. The study analyzed the rate of DB and extracted the general clinical information and polyp-related information of patients with postoperative DB. As a control, non-DB patients who received CSP at the same 4 hospitals were analyzed. A multivariate Cox regression analysis was performed to develop the prediction model. The model was further validated using a Kaplan-Meier log-rank analysis, receiver operating characteristic curve (ROC) plot and risk plot. RESULTS: In our study, we found a 0.24% rate of DB and the risk factors were history of hypertension, hyperlipidemia, antithrombotics use, antiplatelet use, anticoagulant use, abdominal operation, sigmoid colon lesion, hematoma, cold snare defect protrusion, polyp size, wound size, the grade of wound bleeding, and morphology of Ip. These factors were incorporated into the prediction model for DB after CSP. For 1, 3, and 5 days of bleeding, the AUC of the ROC curve was 0.912, 0.939, and 0.923, respectively. The Kaplan-Meier analysis indicated that the high-risk group had a significantly higher risk of DB than the low-risk group. CONCLUSIONS: This study screened the risk factors and established a prediction model of DB after CSP. The results may help preventing and reducing the DB rate after CSP of colorectal polyps.
Asunto(s)
Pólipos del Colon , Humanos , Factores de Riesgo , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Pólipos del Colon/cirugía , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/epidemiología , Curva ROC , Anciano , Factores de Tiempo , Adulto , Colonoscopía/efectos adversosRESUMEN
INTRODUCTION: Sleeve gastrectomy (SG) is currently the most frequently performed procedure for obesity worldwide. Staple line reinforcement (SLR) has been suggested as a strategy to reduce the risk of staple line leak or bleeding; however, its use for SG in the United Kingdom (UK) is unknown. This study examined the effect of SLR on the development of postoperative complications from SG using a large national dataset from the UK. METHODS: Patients undergoing either primary or revision SG over 10 years from Jan 2012 to Dec 2021 were identified by the National Bariatric Surgery Registry. Comparative and logistic regression analyses were undertaken to determine the effect of SLR on staple line leak and bleeding. RESULTS: During this time, 14,231 patients underwent SG for whom there were complete data. Of these, 76.5% were female and the median age was 46 years (IQR: 36-53). The rate of surgical complications was 2.3% (n = 219/14,231). The incidence of bleeding was 1.3% (n = 179/14,231) and leak was 1.0% (n = 140/14,231). Over time, the use of SLR of any variety declined significantly from 99.7% in 2012 to 57.3% in 2021 (p < 0.001). Multivariable (adjusted) regression analysis demonstrated that neither the use of nor the type of reinforcement had any effect on the rate of bleeding or leaking. CONCLUSION: SLR for SG has declined in the UK since 2012. There were no differences in staple line leak or bleed with or without reinforcement.
Asunto(s)
Fuga Anastomótica , Cirugía Bariátrica , Gastrectomía , Hemorragia Posoperatoria , Sistema de Registros , Grapado Quirúrgico , Humanos , Femenino , Persona de Mediana Edad , Masculino , Reino Unido/epidemiología , Adulto , Gastrectomía/efectos adversos , Gastrectomía/métodos , Grapado Quirúrgico/efectos adversos , Grapado Quirúrgico/métodos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/prevención & control , Fuga Anastomótica/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Obesidad Mórbida/cirugía , Incidencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Tranexamic acid (TXA) is a widely employed intervention in orthopedic surgeries to minimize blood loss and the need for postoperative transfusions. This study focuses on assessing the efficacy and safety of TXA specifically in undernourished older adults undergoing hip fracture procedures. METHODS: A total of 216 patients were classified into two groups based on the Geriatric Nutritional Risk Index: undernourished and normal. In total, 82 patients received intravenous TXA at a dosage of 15 mg/kg before incision, with an additional 1 g administered intravenously over a 3-hour period postoperatively. Postoperative hemoglobin (Hb) drop, blood transfusion rate, and the incidence of deep venous thrombosis (DVT) were assessed in each group according to the presence or absence of TXA. Additionally, demographic factors including age, sex, body mass index, and serum albumin were investigated. RESULTS: 51.9% patients were identified as undernourished, experiencing progressive anemia (Hb: 10.9 ± 1.5 g/dL) and hypoalbuminemia (serum albumin: 31.9 ± 8 g/L). In comparison with the normal group, undernourished individuals were more likely to sustain femoral neck fractures (undernutrition vs. normal: 56.2 vs. 42.3%) and less likely to incur trochanteric fractures (undernutrition vs. normal: 43.8 vs. 57.7%) (P = 0.043). TXA administration significantly reduced the transfusion rate (P = 0.014) and Hb drop (P = 0.001) in the normal nutritional group, while its impact on the undernourished group remained less pronounced. There was no significant association between TXA administration and the rate of DVT complications, irrespective of the nutritional status. CONCLUSIONS: Undernutrition not only diminishes muscle strength and gait function, leading to various types of hip fractures, but it may also hinder the efficacy of TXA in reducing blood transfusion rates and blood loss.
Asunto(s)
Antifibrinolíticos , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea , Fracturas de Cadera , Estado Nutricional , Ácido Tranexámico , Humanos , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/efectos adversos , Femenino , Masculino , Anciano , Anciano de 80 o más Años , Fracturas de Cadera/cirugía , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/uso terapéutico , Antifibrinolíticos/efectos adversos , Transfusión Sanguínea/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/prevención & control , Resultado del Tratamiento , Trombosis de la Vena/epidemiología , Trombosis de la Vena/prevención & control , Desnutrición/epidemiología , Hemoglobinas/análisis , Hemoglobinas/metabolismo , Estudios Retrospectivos , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/prevención & control , Hemorragia Posoperatoria/etiologíaRESUMEN
OBJECTIVES: To estimate the incidence of post tonsillectomy bleeding and to identify its predisposing factors among the pediatric population. METHODS: A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia between 2019 and 2020. The study sample was divided into 2 groups based on the development of postoperative bleeding and were compared using Chi-square test and independent t-test. Significant variables (p-value ≤0.05) were included in the logistic regression model to determine the predictors of bleeding following tonsillectomy. RESULTS: The bleeding rate following tonsillectomy was 3.4% in 43 (95% confidence interval [CI] 2.4-4.5) patients. In the multivariable logistic regression model, the significant predictors of post tonsillectomy bleeding were age ≥12 years (odds ratio [OR]: 2.685, p=0.027), decreased postoperative oral intake (OR: 4.244, p=0.042), and single use of postoperative analgesia (OR: 53.124, p<0.001). Out of the 43 patients, 39 (90.7%) patients experienced secondary bleeding, and more than half of the patients who developed bleeding required surgical intervention 27 (62.8%). CONCLUSION: Tonsillectomy is a safe and common surgical procedure but carries risks for postoperative bleeding. Age ≥12 years, poor postoperative oral intake, and the use of a single postoperative analgesic increase the risk of bleeding. We encourage healthcare providers to ascertain early resumption of oral intake and ensure effective pain management. We recommend a dual alternating analgesic regimen with weight-based dosing for optimal pain control. Furthermore, educating caregivers about the importance of adequate oral intake following tonsillectomy may improve patient outcomes.