Low Postoperative Bleeding Rates in Patients at Hemophilia Treatment Center

An analysis of postoperative outcomes found low rates of bleeding in patients with bleeding disorders who underwent major surgery at an academic hemophilia treatment center. Researchers published their study in Clinical and Applied Thrombosis/Hemostasis.

“We demonstrated that with comprehensive care and preoperative planning, persons with bleeding disorders can undergo elective major surgeries with risks of major bleeding complications similar to those of the general, nonbleeding disorder population,” wrote corresponding author Ruben Rhoades, MD, of the hematology division at Thomas Jefferson University Department of Medicine, Philadelphia, Pennsylvania, and coauthors. 

The retrospective study investigated outcomes for 50 patients with bleeding disorders who underwent 63 major surgeries at the Cardeza Hemophilia and Thrombosis Center, which is affiliated with Thomas Jefferson University, between 2017 and 2019. Researchers also compared rates of postoperative bleeding in the study population with control patients without bleeding disorders matched for surgery, age, and sex from a surgical database.

Among patients with bleeding disorders, 64% had Willebrand disease and 20% had hemophilia A. One-third of patients had orthopedic surgery, 22.2% had head and neck surgery, and 12.7% had abdominal surgery. Postoperative major bleeding, as defined by the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee, occurred in 4.8% of procedures, and nonmajor bleeding occurred in 1.6%, according to the study. The average length of stay was 1.65 days, and the 30-day readmission rate was 1.6%.

In the control population without bleeding disorders, the rate of major postoperative bleeding, as defined by the American College of Surgeons National Surgical Quality Improvement Program, was 1.04% for all procedures, researchers reported, compared with 5% in patient population with bleeding disorders.

“We observed few bleeding complications or inpatient readmissions,” researchers added, “and while length of stay was significantly longer in persons with bleeding disorders than control patients, overall it remained relatively short despite most patients being planned for postoperative hemostatic therapy.”

Reference:
Rhoades R, French Z, Yang A, Walsh K, Drelich DA, McKenzie SE. perioperative outcomes of patients with bleeding disorders undergoing major surgery at an academic hemophilia treatment center. Clin Appl Thromb Hemost. 2023;29:10760296231165056. doi: 10.1177/10760296231165056