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. 2022 Oct;38(5):370-375.
doi: 10.3393/ac.2021.00122.0017. Epub 2021 Jul 27.

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

Sarah Taieb  1 , Patrick Atienza  1 , Jean-David Zeitoun  1 , Milad Taouk  1 , Josée Bourguignon  1 , Christian Thomas  1 , Nabila Rabahi  1 , Saliha Dahlouk  1 , Anne-Carole Lesage  1 , David Lobo  2 , Isabelle Etienney  1
Affiliations

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

Sarah Taieb et al. Ann Coloproctol. 2022 Oct.

Abstract

Purpose: 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.

Keywords: Colorectal surgery; Complications; Morbidity; Postoperative hemorrhage.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Number of cases according to the time after surgery.
Fig. 2.
Fig. 2.
Number of packed red blood cell (RBC) units according to the time after surgery.
See this image and copyright information in PMC

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