Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-19T01:07:15.923Z Has data issue: false hasContentIssue false
  • English
  • Français

Determinants of re-operation for bleeding in head and neck cancer surgery

Published online by Cambridge University Press:  08 March 2018

E Haapio ,
I Kinnunen ,
J K E Airaksinen ,
H Irjala  and
T Kiviniemi
E Haapio*
Affiliation:
Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Finland
I Kinnunen
Affiliation:
Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Finland
J K E Airaksinen
Affiliation:
Heart Center, Turku University Hospital and University of Turku, Finland
H Irjala
Affiliation:
Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Finland
T Kiviniemi
Affiliation:
Heart Center, Turku University Hospital and University of Turku, Finland
*
Address for correspondence: Dr Eeva Haapio, Department of Otorhinolaryngology, Turku University Hospital, Kiinamyllynkatu 4-8, FIN-20521, Turku, Finland Fax: +358 2 3132030 E-mail: eeva.haapio@tyks.fi
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Post-operative bleeding in the head and neck area is potentially fatal. This ‘real world’ study sought to assess factors that increase the risk of re-operation for post-operative bleeding in head and neck cancer surgery.

Methods:

A total of 456 patients underwent surgery for head and neck cancer (591 operations). The primary endpoint was re-operation for bleeding.

Results:

The rate of re-operation for bleeding was 5 per cent of all operations. Re-operation for bleeding was an independent risk factor for 30-day mortality (odds ratio = 5.27, p = 0.014). Risk factors for re-operation because of bleeding included excessive (more than 4000 ml) fluid administration (over 24 hours) (p < 0.001), heavy alcohol consumption (p = 0.014), pre-operative oncological treatment (p = 0.017), advanced disease stage (p = 0.020) and higher tumour (T) classification (p = 0.034). Operations with more excessive bleeding (700 ml or more) were associated with an increased risk (p = 0.001) of re-operation for post-operative bleeding. Moreover, the risk of re-operation was significantly higher in patients undergoing microvascular surgery compared to those who had no oncological treatment pre-operatively (18 vs 6 per cent, p = 0.001).

Conclusion:

The 30-day mortality risk increased over 5-fold in patients undergoing re-operation for bleeding.

Keywords

ReoperationSurgeryPostoperative HemorrhageMortalityHead And Neck Cancer
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 4 , April 2018 , pp. 336 - 340
Copyright
Copyright © JLO (1984) Limited 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Laccourreye, O, Malinvaud, D, Garcia, D, Ménard, M, Hans, S, Cauchois, R et al. Postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. Ann Otol Rhinol Laryngol 2015;124:361–7.Google Scholar
2Pollei, TR, Hinni, ML, Moore, EJ, Hayden, RE, Olsen, KD, Casler, JD et al. Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol Head Neck Surg 2013;139:1212–18.Google Scholar
3Rosato, L, Avenia, N, Bernante, P, De Palma, M, Gulino, C, Nasi, PG et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–6.Google Scholar
4Godballe, C, Madsen, AR, Pedersen, HB, Sørensen, CH, Pedersen, U, Frisch, T et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol 2009;266:1945–52.Google Scholar
5Farwell, DG, Reilly, DF, Weymuller, EA, Greenberg, DL, Staiger, TO, Futran, NA. Predictors of perioperative complications in head and neck patients. Arch Otolaryngol Head Neck Surg 2002;128:505–11.CrossRefGoogle ScholarPubMed
6Lautamäki, A, Kiviniemi, T, Biancari, F, Airaksinen, JK, Juvonen, T, Gunn, J. Outcome after coronary artery bypass grafting and percutaneous coronary intervention in patients with stage 3b–5 chronic kidney disease. Eur J Cardiothorac Surg 2016;49:926–30.Google Scholar
7Nordling, P, Kiviniemi, T, Strandberg, M, Strandberg, N, Airaksinen, JK. Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide. BMJ Open 2016;6:e009416.Google Scholar
8Haapio, E, Kiviniemi, T, Irjala, H, Airaksinen, JK, Kinnunen, I. Incidence and predictors of 30-day cardiovascular complications in patients undergoing head and neck cancer surgery. Eur Arch Otorhinolaryngol 2016;273:4601–6.CrossRefGoogle ScholarPubMed
9Folkman, J. Tumor angiogenesis: therapeutic implications. N Engl J Med 1971;285:1182–6.Google ScholarPubMed
10Song, W, Yuan, Y, Peng, J, Chen, J, Han, F, Cai, S et al. The delayed massive hemorrhage after gastrectomy in patients with gastric cancer: characteristics, management opinions and risk factors. Eur J Surg Oncol 2014;40:1299–306.Google Scholar
11Yi, HW, Kim, SM, Kim, SH, Shim, JH, Choi, MG, Lee, JH et al. Complications leading reoperation after gastrectomy in patients with gastric cancer: frequency, type, and potential causes. J Gastric Cancer 2013;13:242–6.Google Scholar
12Weiss, A, Lee, KC, Brumund, KT, Chang, DC, Bouvet, M. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014;156:399–404.CrossRefGoogle ScholarPubMed
13Martin, AN, Das, D, Turrentine, FE, Bauer, TW, Adams, RB, Zaydfudim, VM. Morbidity and mortality after gastrectomy: identification of modifiable risk factors. J Gastrointest Surg 2016;20:1554–64.Google Scholar
14Fröjd, V, Jeppsson, A. Reexploration for bleeding and its association with mortality after cardiac surgery. Ann Thorac Surg 2016;102:109–17.Google Scholar
15Girod, DA, McCulloch, TM, Tsue, TT, Weymuller, EA Jr. Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck 1995;17:7–13.CrossRefGoogle ScholarPubMed
16Pieters, M, de Maat, MP. Diet and haemostasis – a comprehensive overview. Blood Rev 2015;29:231–41.Google Scholar
17Liu, L, Chen, M, Zhao, L, Zhao, Q, Hu, R, Zhu, J et al. Ethanol induces platelet apoptosis. Alcohol Clin Exp Res 2017;41:291–8.CrossRefGoogle ScholarPubMed
18Haut, MJ, Cowan, DH. The effect of ethanol on hemostatic properties of human blood platelets. Am J Med 1974;56:22–33.Google Scholar
19Kim, SH, Lee, JH, Joo, W, Chough, CK, Park, HK, Lee, KJ et al. Analysis of the risk factors for development of post-operative extradural hematoma after intracranial surgery. Br J Neurosurg 2015;29:243–8.Google Scholar
20Aditianingsih, D, George, YW. Guiding principles of fluid and volume therapy. Best Pract Res Clin Anaesthesiol 2014;28:249–60.Google Scholar
21Haapio, E, Kinnunen, I, Airaksinen, JK, Irjala, H, Kiviniemi, T. Excessive intravenous fluid therapy in head and neck cancer surgery. Head Neck 2017;39:37–41.Google Scholar