General surgery in patients with a bleeding diathesis: how we do it.

Area of Science:

• Hematology
• Surgical Management
• Patient Outcomes

Background:

• Assessing perioperative management and postoperative complications in patients with bleeding disorders.
• Evaluating the adequacy of perioperative plasma factor levels in a regional hemophilia center.

Purpose of the Study:

• To evaluate the safety and efficacy of surgical and endoscopic procedures in patients with hemophilia.
• To determine the correlation between perioperative factor levels and postoperative complications.

Main Methods:

• Retrospective review of 113 consecutive patients with bleeding disorders undergoing 144 surgical and endoscopic procedures.
• Data collected from a regional hemophilia center database (1998-2008).
• Analysis of patient demographics, procedure types, postoperative complications, and factor replacement therapy.

Main Results:

• Two postoperative deaths occurred, both in urgent major procedures.
• Overall postoperative complications were 7.6% (4.0% hemorrhagic, 3.6% nonhemorrhagic).
• Hemorrhage was not attributed to inadequate factor replacement, with mean preoperative factor levels similar in patients with and without bleeding.

Conclusions:

• General surgical and endoscopic procedures are associated with low morbidity and mortality in patients with hemophilia.
• Appropriate factor replacement and multidisciplinary hemophilia team support are crucial for successful surgical outcomes.