Perioperative Outcomes of Patients with Bleeding Disorders Undergoing Major Surgery at an Academic Hemophilia Treatment Center

Abstract

Persons with bleeding disorders (PwBD) are at high risk for bleeding with invasive procedures. However, the risk of bleeding in PwBD undergoing major surgery and outcomes of patients managed perioperatively at a hemophilia treatment center (HTC) are not well described. We performed a retrospective review of surgical outcomes among PwBD undergoing major surgery between January 1st, 2017 and December 31st, 2019 at the Cardeza Foundation Hemophilia and Thrombosis Center in Philadelphia, PA. The primary outcome was postoperative bleeding, assessed according to the ISTH-SSC's 2010 definition. Secondary outcomes included use of unplanned postoperative hemostatic therapy, LOS, and 30-day readmission rate. Results were compared to non-PwBD population from a surgical database, matched for surgery, age, and sex. During the study period, 50 PwBD underwent 63 major surgeries. The most common diagnoses were VWD (64%) and hemophilia A (20.0%). The most common surgical procedure category was orthopedic (33.3%), predominantly arthroplasties. Postoperatively,4.8% of procedures were complicated by major bleeding and 1.6% by non-major bleeding. The mean LOS was 1.65 days, and 30-day readmission rate was 1.6%. In comparison to matched, non-PwBD patients in a national surgical database undergoing the same procedures, study patients had a similar rate of bleeding complications per procedure (5.0% vs 1.04% P = .071, Fisher's exact test). PwBD undergoing major surgeries have low rates of major bleeding when receiving comprehensive care at an HTC. Bleeding and hospital readmission rates were similar to non-PwBD baseline in a large database.

Successful transfemoral prosthesis in a patient with haemophilia A and factor VIII inhibitors: A case report

“…Moreover, our successful outcome is consistent with findings from another study that reported low rates of complications in patients with bleeding disorders undergoing major surgeries at a haemophilia treatment center. 12 Importantly, our case study emphasises the significance of using a collaborative team approach involving specialists to manage patients with haemophilia.…”

Multidisciplinary Management of Advanced Basal Cell Carcinoma in a Patient With Severe Congenital Hemophilia A

“…4,5 By contrast, MCC/BCC collision tumors are less frequently reported as metastatic on presentation. Case 1 reported herein represents a rare case of collision tumor with nodal presentation consisting solely of MCC and BCC, adding a 14th case to the existing series 1 and underscoring the unpredictable clinical behavior of these neoplasms. MCPyV testing was not performed in these 2 cases.…”

“…With proper prophylaxis, patients with congenital hemophilia A have been shown to be able to undergo minor and major surgeries safely. 1 Prophylactic, scheduled replacement of clotting factor concentrate has been shown to be superior to on-demand treatment for prevention of bleeding episodes. 2 One study of perioperative FVIII replacement in patients with hemophilia A without factor inhibitors revealed an average dosage of 34.26 u/kg in severe hemophiliacs, with no significant difference in intraoperative bleeding complications or postoperative outcomes compared with nonhemophiliacs.…”

“…Most of the data available in the literature on this entity come from case reports, case series, and a retrospective review of 20 patients in 1993. [1][2][3][4] The objective of this study was to describe the clinical, pathological, and patientrelated characteristics of patients with pilomatrix carcinoma.…”

“…Most pure MCCs stain positively for CK20 in a perinuclear dot pattern, chromogranin A, synaptophysin, and neurofilament (NF) and negatively for TTF-1 and cytokeratin 7. 1 In recent years, insulinoma-associated protein 1 (INSM1) has emerged as a promising solitary marker for neuroendocrine differentiation with high sensitivity and specificity for MCC. 3 In a recent review of 13 MCC collision tumors with lymph nodal presentation, SCC was implicated in 12 cases.…”