Risk factors for bleeding and perioperative bleeding complications in oculoplastic surgery: a prospective pilot study

Clear guidelines for managing patients on antiplatelet (AP) or anticoagulant (AC) therapy undergoing oculoplastic surgery are lacking. This study investigates bleeding risk factors and evaluates the effectiveness of a standardised bleeding risk assessment in extraocular surgery.

In this prospective study, a standardised questionnaire (SQ) was employed to gather patients' bleeding histories. Associations between SQ scores and preoperative/demographic factors (AP/AC use, age, sex, comorbidities), and surgical factors (blood pressure, surgery type, primary vs revision surgery, anaesthesia type, duration, pain management) were assessed. A scoring system quantified bleeding severity. Patients were monitored postoperatively for 24 hours (eyelid procedures) to 3 or 4 days (orbital/nasolacrimal surgery).

A total of 324 patients (aged 18-92) were included (252 eyelid, 56 orbital and 16 nasolacrimal surgeries). 87 patients were using AP, AC and/or herbal supplements. Severe bleeding occurred in 35 patients, four required revision surgery, though none suffered permanent damage. Bleeding complications were significantly associated with higher SQ scores (p=0.048), acetylsalicylic acid use in eyelid surgery (p=0.038), diabetes mellitus (p=0.016), renal disease (p=0.044), general anaesthesia (p=0.001) and longer surgery duration (p=0.007). Local anaesthesia, AC use and systolic hypertension were not significantly associated with bleeding risk.

The SQ is a valuable tool for assessing bleeding risk in oculoplastic patients. Findings support future multicentre studies to develop evidence-based perioperative guidelines for AP and AC management. Limitations include cohort heterogeneity, small sample size, non-blinded design and subjective bleeding scores affecting comparability.