Unplanned reoperation for bleeding

Thirty (0.46%) patients required one or more reoperations to control bleeding after 6499 elective surgical procedures. A specific bleeding site was identified in 10 (0.15%), and bleeding was diffuse in 20 (0.31%). Bleeding occurred despite normal prothrombin and partial thromboplastin times and adequate platelet counts in all 30 cases. Diffuse bleeding was associated with the preoperative use of aspirin alone or in combination with other nonsteroidal anti-inflammatory drugs (NSAIDS) in 19 of 20 patients (95%). None of the patients with a discrete bleeding point identified at reoperation were taking these products (P < 0.001). More than one reoperation was more often required in the patients with diffuse postoperative bleeding than those with a specific site of hemorrhage. Many of these subsequent procedures were required to manage infections that developed after the first reoperation to control bleeding. Intensive care unit use, length of intensive care unit stay, total hospital stay, and hospital charges were all significantly increased when diffuse postoperative bleeding was noted. Postoperative bleeding, especially when it is diffuse rather than from a specific bleeding point, significantly prolongs hospital stay and increases costs. Bleeding is not prevented by obtaining routine screening coagulation profiles. A medication history with special attention to the recent use of aspirin and NSAIDS is advised before elective operations. Delaying surgery until the antiplatelet effects of these drugs have worn off may be advisable.