Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study

Abstract

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.

Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study

“…The study revealed significant associations between postoperative bleeding and factors such as hemorrhoid surgery, anticoagulant treatment (particularly direct oral anticoagulants), and an ASA score of 3. Notably, active smoking exhibited a protective effect, consistent with previous findings by other authors (28), likely attributed to smoking-induced vasoconstriction at the surgical site.…”

Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients

“…Secondary bleeding after hemorrhoid surgery occurs in 0.6-2.4% of cases, with the highest probability on the sixth to ninth postoperative day [34]. Severe postoperative bleeding is recognized in 0.7% of patients only [60].…”

Effect Of Intravenous Vs Topical Tranexamic Acid On Bleeding During Endoscopic Sinus Surgery

“…Undoubtedly, heightened intraoperative haemorrhaging can impede the attainment of a lucid surgical field, thereby extending the duration of the operation and augmenting the likelihood of complications including dural injury and damage to adjacent anatomical components. [5] Hematoma formation may result from postoperative bleeding; hematomas may develop a secondary infection, thereby inducing delayed bleeding. Patients who experience delayed bleeding may develop symptomatic anaemia, which would necessitate the administration of a blood transfusion.…”