Management for Postoperative Bleeding after Neck Surgery

Abstract Purpose Tonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid tonsillectomies and might reduce postoperative pain, but comparative studies to assess performance are warranted. Methods This randomized self-controlled clinical trial was conducted from October 2019 to October 2020 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Vienna. Forty-eight patients underwent a tonsillectomy with the device on one side and using cold-steel with localized bipolar cauterization on the other side (control). Main outcomes were the time for tonsil removal (per side) and the time to stop bleeding (per side). Secondary measurements were postoperative pain, assessed once on day 0 and five times on days 1, 3, 5, 7, and 10. Postoperative bleeding episodes and consequences were recorded. Results Device tonsillectomies were performed significantly faster than controls; the mean surgical time difference was 209 s (p < 0.001, 95% CI 129; 288). Intraoperative blood loss was significantly lower on the device side (all p < 0.05). Postoperative measurements of pain and bleeding were similar for both sides. Two return-to-theatre secondary bleeding events were recorded for the control side. Conclusion The novel electrosurgical temperature-controlled divider reduced the tonsillectomy surgical time and intraoperative blood loss, with no apparent negative effects on postoperative pain or bleeding, compared to a cold-steel tonsillectomy with localized bipolar cauterization. In time-restricted settings, the device could be beneficial, particularly after familiarization with device handling. Trial registration ClinicalTrials.gov Identifier: < Blinded for review >

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Implementation of a Novel Protocol for Preventing Venous Thromboembolism in Otolaryngology Patients

Otolaryngology ◽

10.1177/01945998211024923 ◽

2021 ◽

pp. 019459982110249

Author(s):

Lirit Levi ◽

Galia Spectre ◽

Ofir Nesichi ◽

Avi Leader ◽

Pia Raanani ◽

...

Keyword(s):

Venous Thromboembolism ◽

Head And Neck ◽

Care Center ◽

Tertiary Care ◽

Postoperative Bleeding ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Assessment Model ◽

Sinus Surgery ◽

Secondary Outcome

Objective Venous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality. The Caprini risk assessment model (CRAM) is a validated tool for estimating the risk for postoperative VTE. Previous studies demonstrated a low risk of VTE among otorhinolaryngology–head and neck surgery (ORL-HNS). Hence, our objective was to modify the CRAM-based protocol to be applicable for otolaryngology patients and assess protocol efficacy and safety. Study Design Observational pilot study conducted on ORL-HNS patients undergoing surgery. Setting University-affiliated tertiary care center. Methods We constructed a modified protocol based on the CRAM and previous reports in the ORL-HNS literature using a reduced postoperative anticoagulation regimen. Primary end point was symptomatic VTE up to 3 months after surgery. Main secondary outcome was postoperative bleeding. Results A total of 508 patients were enrolled. Of them, 48% underwent head and neck surgery, 18% direct laryngoscopy and transoral robotic surgery, 15% endoscopic sinus surgery, and 11% otology surgery. Adherence to the protocol was 79%. Mean follow-up time was 115 days (range, 30-448 days). Only 1 patient developed deep vein thrombosis, and none developed pulmonary embolism. Two patients had major bleeding not related to the use of anticoagulation. Conclusions Our novel CRAM-based protocol appears to be efficacious and safe for VTE prevention in otolaryngology. A larger-scale study is required to validate these findings. Level of Evidence Level 2b.

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Post-Operative Bleeding in Tonsillectomy versus Tonsillectomy with Fossa Closure in a Tertiary Military Hospital: A Cohort Study

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v35i1.1277 ◽

2020 ◽

Vol 35 (1) ◽

pp. 36-38

Author(s):

Niel Khangel Reyes

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Medical Records ◽

Retrospective Cohort ◽

Medical Center ◽

Postoperative Bleeding ◽

Neck Surgery ◽

Military Hospital ◽

Significant Difference ◽

Keywords Tonsillectomy

ABSTRACT Objective: To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017. Methods: Design: Retrospective Cohort Study Setting: Tertiary Military Hospital Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test. Results: There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two. Conclusion: Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure. Keywords: tonsillectomy; postoperative bleeding; tonsil pillars; suturing

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Management of Post Tracheotomy Hemorrhage and Evaluation of Causing Factors

10.53350/pjmhs211571854 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1854-1856

Author(s):

Bakht Zada ◽

Zafar Iqbal ◽

Tahir Muhammad ◽

Rehan Saleem ◽

Muhammad Tayyab Rasheed ◽

...

Keyword(s):

Prospective Study ◽

Postoperative Bleeding ◽

Innominate Artery ◽

Neck Surgery ◽

Medical College ◽

Life Threatening ◽

Cardiac Surgeon ◽

One Year ◽

A Prospective Study ◽

Surgery Department

Objective: To understand the frequency, causes, and treatment of post-tracheostomy hemorrhage. Study Design: A prospective study of tracheostomy cases. Place and duration: ENT, Head & Neck Surgery department of Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for duration of one year from July 2019 to June 2020. Methodology: All hospitalized patients who underwent tracheostomy and had bleeding during this period were included. The parameters specified were demographics, time since surgery, degree of bleeding, causes of bleeding, and treatment. A total of 208 patients who have done with tracheostomy were selected. Results: Tracheostomy was performed in a total of 208 patients, 142 men and 66 women. Their ages ranged from 20 to 70 years old. 22 patients (10.6%) had postoperative bleeding, most of them have oozingfrom or around the stoma, but 5 patients were taken to the operating room for hemostasis. Three of them had Tracheo- innominate artery fistula and two died before undergoing surgery. One of the three trachea-innominatefistulae were successfully treated by a cardiac surgeon. The remaining cases required diathermy, transfixing thyroid isthmus or vein descent or relegation of veins. Conclusions: Hemorrhage after tracheostomy is not uncommon in intensive practice, bleeding occurred in 10.5% of our cases. Hemorrhage occurs because of inadequate hemostasis, aspiration trauma, infection, coagulopathy and granulation. Rarely, there may be massive and life-threatening bleeding from tracheo-innominate fistula that requires aggressive and urgent exploration. In such a situation, an experienced cardiac surgeon and anesthesiologist is very important and can lead to a better result. Key words: Tracheostomy, post-tracheostomy hemorrhage, Tracheo-innominate artery fistula (TIF)

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