UNPLANNED REOPERATION FOR BLEEDING

Thirty (0.46%) patients required one or more reoperations to control b leeding after 6499 elective surgical procedures. A specific bleeding s ite was identified in 10 (0.15%), and bleeding was diffuse in 20 (0.31 %), Bleeding occurred despite normal prothrombin and partial thrombopl astin times and adequate platelet counts in all 30 cases. Diffuse blee ding was associated with. the preoperative use of aspirin alone or in combination with other nonsteroidal anti-inflammatory drugs (NSAIDS) i n 19 of 20 patients (95%). None of the patients with a discrete bleedi ng point identified at reoperation were taking these products (P < 0.0 01). More than one reoperation was more often required in the patients with diffuse postoperative bleeding than those with a specific site o f hemorrhage. Many of these subsequent procedures were required to man age infections that developed after the first reoperation to control b leeding. Intensive care unit use, length of intensive care unit stay, total hospital stay, and hospital charges were all significantly incre ased when diffuse postoperative bleeding was noted. Postoperative blee ding, especially when it is diffuse rather than from a specific bleedi ng point, significantly prolongs hospital stay and increases costs. Bl eeding is not prevented by obtaining routine screening coagulation pro files. A medication history with special attention to the recent use o f aspirin and NSAIDS is advised before elective operations. Delaying s urgery until the antiplatelet effects of these drugs have worn off may be advisable.