Long-term postoperative bleeding after dentoalveolar surgery in the pretransplant liver failure patient

Abstract

Purpose: A retrospective review of a protocol-driven single institutional experience for treatment of pretransplant liver failure patients requiring dentoalveolar procedures for transplant clearance.

Materials and methods: Between January 2003 and June 2005, 30 liver failure patients requiring pretransplant dentoalveolar surgery at the University of Michigan Hospital were treated in the Department of Oral and Maxillofacial Surgery/Hospital Dentistry undergoing 35 total procedures. These patients were stratified preoperatively into 3 different "risk" groups (minimal, moderate, high) based on number and complexity of teeth to be extracted as well as any planned adjunctive preprosthetic procedures.

Results: Analysis of variance (ANOVA) comparison of groups was conducted, as well as logistic regression analysis and 2-tailed Pearson correlation using chi2 and the Fisher exact test. The only statistically significant (P < .05) predictors of long-term postoperative bleeding were surgeon-defined "risk," the number of simple extractions, and quadrants of alveoplasty. Additional postoperative correlations were found between long-term bleeding and the need for hospital admission as well as the use of blood products for treatment. Model for end-stage liver disease (MELD), preoperative prothombin time (PT), preoperative partial thromboplastin time (PTT), preoperative international normalized ratio (INR), and preoperative platelet count were not statistically significant in predicting postoperative bleeding. Despite a more aggressive protocol for preoperative management of "high risk" patients, 5/10 (50%) experienced prolonged postoperative bleeding, with 3/5 (60%) requiring admission, while 1/5 (20%) experienced significant prolongation of their current inpatient stay. Review of the data showed that 5/9 (56%) of patients with 10 or more simple extractions developed long-term postoperative bleeding, all of whom had been classified in the "high risk" grouping. Admitted patients remained hospitalized an average of 4 days (range of 1-6 days).

Conclusion: Even with aggressive preoperative management, pretransplant liver failure patients requiring extraction of at least 10 teeth prior to placement on the liver transplant list are at significant risk of long-term postoperative bleeding and hospital admission for its management.