Incidence and Risk Factors of Postoperative Bleeding After LLETZ

Background: Large loop excision of the transformation zone (LLETZ) is an established surgical procedure for cervical intraepithelial neoplasia; however, secondary postoperative bleeding may lead to unplanned outpatient visits, hospitalization, or surgical intervention. This study aimed to evaluate the incidence and risk factors of postoperative bleeding after LLETZ. Methods: We conducted a retrospective single-center cohort study comprising 1493 patients who underwent LLETZ for the treatment of cervical dysplasia between January 2008 and May 2023 at the Medical University of Vienna. Postoperative bleeding was defined as an unscheduled outpatient presentation for bleeding from the operative site within eight weeks after LLETZ requiring additional treatment. Clinical, surgical and histopathological parameters were analyzed. Univariable logistic regression was performed to identify factors associated with postoperative bleeding, with additional stratified analyses according to the use of intraoperative cervical infiltration. Results: Postoperative bleeding occurred in 56 patients (3.8%). The median time to bleeding was 13.5 days (IQR 9.0-17.0). Among patients with postoperative bleeding, 20 (35.7%) required hospitalization, 10 (50.0%) underwent operative intervention, and 2 (10.0%) required blood transfusion. In logistic regression, increasing cone length was associated with higher odds of postoperative bleeding (OR 1.83 per cm, 95% CI 1.06-3.18, p = 0.031). Anticoagulation and/or antiplatelet therapy was also associated with an increased bleeding risk (OR 3.61, 95% CI 1.46-8.96, p = 0.006). Higher BMI was associated with lower odds of postoperative bleeding (BMI per +5 kg/m²: OR 0.62, 95% CI 0.43-0.90, p = 0.011). Conclusions: LLETZ is associated with a low risk of clinically relevant postoperative bleeding, with an unplanned outpatient re-presentation rate of 3.8% and a re-operation rate of 0.7%. Increased cone length and anticoagulation and/or antiplatelet therapy were associated with higher bleeding rates. Larger prospective studies are needed to validate these findings and improve individualized perioperative risk assessment.