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Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control
Sarah Taieb1, Patrick Atienza1, Jean-David Zeitoun1
1Proctologic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
Insights
Severe bleeding after proctological surgery affects 0.7% of patients, varying by procedure type. Adherence to new anticoagulant and antiplatelet guidelines did not increase bleeding severity, indicating safe management.
Area of Science:
- Colorectal Surgery
- Surgical Complications
- Hemorrhage Management
Background:
- Postoperative bleeding is a significant concern following proctological surgery.
- French guidelines for anticoagulant and platelet-inhibitor therapy have been updated.
- Assessing bleeding risk factors and management strategies is crucial for patient safety.
Purpose of the Study:
- To determine the frequency of severe bleeding requiring hemostatic surgery after proctological procedures.
- To identify risk factors associated with severe postoperative bleeding.
- To evaluate the impact of updated anticoagulant and antiplatelet guidelines on bleeding complications.
Main Methods:
- A retrospective analysis of 8,890 patients undergoing proctological surgery between January 2012 and March 2017.
- Patients experiencing severe bleeding requiring hemostatic surgery were matched 2:1 with controls.
- Data collected included bleeding delay, severity, need for blood transfusion, and patient characteristics.
Main Results:
- Severe bleeding requiring hemostatic surgery occurred in 0.7% of patients.
- Hemorrhoidal surgery, particularly Milligan-Morgan hemorrhoidectomy, showed a significantly higher risk (1.9%) compared to other procedures (0.5%).
- Active smokers had a significantly lower risk of severe bleeding (OR 0.31). Anticoagulant and antiplatelet treatments, when managed per guidelines, did not increase bleeding severity.
Conclusions:
- Severe postoperative bleeding is infrequent (0.7%) but procedure-dependent.
- Current anticoagulant and antiplatelet treatments, managed according to updated guidelines, do not elevate the risk of severe bleeding.
- Risk stratification and adherence to management protocols are key in preventing severe bleeding post-proctological surgery.
Purpose:
The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment.
Methods:
All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery.
Results:
Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10-4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14-0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding.
Conclusion:
Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.
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