Postoperative haemorrhage following aortic aneurysm repair

Between 1988 and 1993, 17 (3%) out of a total 654 patients underwent reoperation for control of haemorrhage following repair of abdominal aortic aneurysm in a vascular surgery unit. The first operation was performed for rupture in 12 cases and electively in five. The incidence of reoperation for postoperative bleeding was 1.7% following elective operation and 3.3% following emergency operation. Case-controls, matched for sex and primary operation, were identified. The mortality rate in those requiring reoperation was 58% compared with 23% in the control group (p = 0.037). Seven patients suffered progressive deterioration and died in the early postoperative period. Of the remaining ten patients, four suffered unexpected serious complications; two a fatal cerebro-vascular accident (CVA), one a fatal myocardial infarction (MI) and the fourth a non-fatal CVA. The patients requiring reoperation had greater blood loss (p < 0.05), greater transfusion requirements and lower core temperatures (p < 0.05) at the end of their first operation than the control group. All except one of the patients who bled had evidence of coagulopathy and had lower platelet counts than the control group both before and after the first operation. At reoperation there were multiple minor bleeding points in 11 patients, no active bleeding points in two patients and a discrete bleeding point in four patients. In conclusion, re-operation for control of postoperative haemorrhage is an uncommon complication which is strongly associated with coagulopathy, may predispose to "rebound" postoperative thrombotic episodes, and carries a poor prognosis.