In patients with bleeding disorders, including hemophilia, von Willebrand disease, and other congenital rare bleeding disorders who undergo a major surgical procedure, rates of bleeding and rehospitalization are similar to those in individuals without a bleeding disorder, according to findings from a retrospective study published in Clinical and Applied Thrombosis/Hemostasis.
Recognizing that the risk for bleeding among patients with a bleeding disorder who undergo major surgery at a hemophilia treatment center have not been well elucidated, the researchers sought to assess the outcomes among patients who underwent major elective surgeries at an academic hemophilia treatment center. With the use of a national surgical database from academic medical centers, they evaluated bleeding rates, hospital length of stay (LOS), and unanticipated use of factor replacement therapy in the study population. They compared bleeding rates and LOS in patients with a bleeding disorder with those in a control population without any bleeding disorders who were receiving the same surgeries.
A retrospective chart review was conducted at the Cardeza Hemophilia and Thrombosis Center—the hemophilia treatment center affiliated with Thomas Jefferson University in Philadelphia, Pennsylvania—to assess outcomes in patients with a bleeding disorder who had undergone elective major surgery from January 1, 2017, to December 31, 2019. All patients who had consulted at the hemophilia treatment center, and had received a diagnosis of hemophilia A, hemophilia B, von Willebrand disease, or other congenital rare bleeding disorders, were enrolled in the study.
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The primary study outcome was postoperative bleeding, which was evaluated based on the 2010 definition of the International Society of Thrombosis and Haemostasis Scientific and Standardization Committee. Secondary study outcomes were use of any unplanned postoperative hemostatic treatments or doses beyond those recommended by the treating physician, inpatient LOS, and rates of 30-day hospital readmission.
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During the study period, 50 individuals underwent 63 major surgeries. The mean participant age at surgery was 50.9 years. The most common diagnoses included von Willebrand disease in 64% of participants, hemophilia A in 20%, and other rare bleeding disorders in 16%. Orthopedic surgeries, mainly arthroplasties, were the most common surgical procedure and were performed in 33.3% of participants.
Mean patient LOS for all surgeries was 1.65 days, which was significantly lower among those in whom no complications of major bleeding occurred (mean, 1.37 vs 7.33 days in those with major bleeding; P <.001).
Following surgery, 4.8% of procedures were associated with major bleeding and 1.6% with nonmajor bleeding. Postsurgical bleeding rates were low both in individuals with bleeding disorders and in controls (5.0% vs 1.04%, respectively; P =.071).
The authors concluded, “This retrospective study at a single hemophilia treatment center suggests that, with comprehensive care and preoperative planning, [persons with bleeding disorders] can safely undergo major surgical procedures with risks of bleeding complications similar to those of a general, non-bleeding disorder population.”
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. Published online March 27, 2023. doi:10.1177/10760296231165056
