Postoperative hemorrhage and hospital revisit after transoral robotic surgery

Abstract

4. Laryngoscope, 127:2287-2292, 2017.

Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors

“…The readmission rate among the subset of patients who underwent TORS was similar to those undergoing non‐TORS procedures. This rate of rehospitalization is comparable to the few prior studies of TORS, which range from 7.7% to 10.4% . Transoral robotic techniques reduce the need for high‐morbidity surgical maneuvers like pharyngotomy or mandibulotomy and have been associated with decreased length of hospital stay, total costs, and rates of gastrostomy tube and tracheostomy tube placement compared to other surgical techniques .…”

“…Bleeding is a potentially life‐threatening complication of oropharyngeal surgery that can lead to airway compromise, asphyxiation, or cardiopulmonary arrest, particularly when severe. An oncologic indication for surgery significantly increases the risk of bleeding, as resection of a known primary cancer may necessitate a deeper plain of resection than required for other surgical indications, thereby placing vascular structures at risk . Strategies to reduce postoperative bleeding are not well‐defined, but have included discontinuation of antithrombotic medications and prophylactic transcervical arterial ligation of branches of the external carotid system .…”

Prophylactic arterial ligation following transoral robotic surgery: A systematic review and meta‐analysis

“…However, postoperative hemorrhage remains the most formidable complication with potentially life‐threatening implications . In a statewide database review of 509 patients undergoing TORS, bleeding was the single most common indication for postoperative hospital readmissions and emergency department visits . Similarly, in a survey of 45 surgeons that perform TORS, postoperative bleeding was the most common self‐reported complication and was responsible for all mortalities .…”

First bite syndrome following transcervical arterial ligation after transoral robotic surgery

“…Perhaps the most formidable complication after TORS is postoperative hemorrhage, owing to the risk of possible airway compromise and death. Previously published large retrospective studies report postoperative bleeding rates after TORS ranging from 3.1% to 13.2% . Of these, 2% to 5% are major or severe bleeds, defined as brisk or copious bleeding requiring vessel ligation or embolization; or bleeding resulting in life‐threatening medical complications such as airway compromise, hemodynamic instability, and cardiopulmonary arrest .…”

“…Previously published large retrospective studies report postoperative bleeding rates after TORS ranging from 3.1% to 13.2%. 9,[11][12][13][14][15][16] Of these, 2% to 5% are major or severe bleeds, defined as brisk or copious bleeding requiring vessel ligation or embolization; or bleeding resulting in life-threatening medical complications such as airway compromise, hemodynamic instability, and cardiopulmonary arrest. 11,[13][14][15] A study by Chia et al 9 queried 45 TORS surgeons throughout the United States to evaluate postoperative complications with a reported 30-day mortality of 0.3%; however, all six deaths were secondary to postoperative hemorrhage.…”