Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Management and Outcomes of Major Pelvic Hemorrhage in Complex Abdomino-Pelvic Surgery(2023) Aytac, Erman; Sokmen, Selman; Ozturk, Ersin; Rencuzogullari, Ahmet; Sungurtekin, Ugur; Akyol, Cihangir; Demirbas, Sezai; Leventoglu, Sezai; Karakayali, Feza; Korkut, Mustafa Ali; Oncel, Mustafa; Gulcu, Baris; Canda, Aras Emre; Eray, Ismail Cem; Ozgen, Utku; Ersoz, Siyar; Ozer, Tahir; Ozerhan, Ismail Hakki; Bozbiyik, Osman; Haksal, Mustafa; Oral, Berke Mustafa; 0000-0002-6481-1473; 37816336; HKO-5077-2023Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdomino-pelvic surgery.Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdomino-pelvic surgery at 11 tertiary referral centers between 1997-2017 were included. Patient characteristics, management strategies to control bleeding, short and long term postoperative outcomes were evaluated retrospectively.Results: There were 120 patients with a mean age of 56.6 +/- 2.4 years and a mean BMI of 28.3 +/- 1 kg/m(2). While 104 (95%) of the patients were operated for malignancy, 16(5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90(75%). Major pelvic hemorrhage was managed simultaneously in 114(95 %) patients. Electrocauterization 27(23%), pelvic packing 26(22%), suturing 7(6%), thumbtacks application 7(6%), muscle welding 4(4%), use of energy devices 2(2%) and topical hemostatic agents 2(2%) were the management tools. Combined techniques were used in 43(36%) patients. Short-term morbidity and mortality rates were 48(40%) and 2(2%), respectively. High preoperative CRP levels(p=0.04), history of preoperative radiotherapy (p=0.04), longer bleeding time (p=0.006) and increased blood transfusion (p=0.005) were the factors associated with postoperative morbidity.Discussion/Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdomino-pelvic surgery.Item In-Hospital Bleeding and Mortality in Acute Coronary Syndrome Patients Treated with Tirofiban and Potent P2Y12 Inhibitors(2022) Akinci, Sinan; Coner, Ali; Akbay, Ertan; Adar, Adem; Muderrisoglu, Haldun; 35860883Objective: In this study, we aimed to determine whether potent agents affect in-hospital bleeding and mortality compared to clopidogrel in patients with the acute coronary syndrome in whom tirofiban and P2Y12 inhibitor are used together. Methods: Patients who were treated interventionally between 2015 and 2020 and were using tirofiban were retrospectively screened. Clinical, laboratory, and angiographic findings were obtained from the hospital database. Patients were analyzed by dividing them into clopidogrel and prasugrel/ticagrelor groups. Results: Acute coronary syndrome patients (n = 227) who were treated interventionally were included in this retrospective study. Clopidogrel was given to 93 (41%), ticagrelor to 112 (49.3%), and prasugrel to 22 of the patients (9.7%). Compared to the ticagrelor/prasugrel group, the clopidogrel group was older and more were women, and the history of hypertension and previous coronary artery disease was higher (P, respectively: <.001; .001; .008; .0045). The creatinine value was higher, the basal hemoglobin was lower, and the GRACE (Global Registry of Acute Coronary Events) and CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) scores were higher (P, respectively:.026; .002;.002; <.001). The in-hospital bleeding rate was significantly higher in the clopidogrel group (P <.001). Although the in-hospital mortality rate was higher, it was not statistically significant (P = .07). Regression analysis showed that GRACE score and gender were associated with in-hospital mortality (P <.001; P = .031, respectively), and only age was associated with in-hospital bleeding (P <.001). No relationship was found with P2Y12 inhibitor. Conclusion: In our study, we found that the combined use of potent P2Y12 inhibitor with tirofiban in acute coronary syndrome patients treated interventionally was not different from the use of clopidogrel in terms of in-hospital bleeding and mortality.Item Predictiveness of different preoperative risk assessments for postoperative bleeding after coronary artery bypass grafting surgery(2020) Gunertem, Eren; Urcun, Salim; Pala, Arda Aybars; Budak, Ali Baran; Ercisli, Murat Abdulhamid; Gunaydin, Serdar; 32659163Aim: Postoperative bleeding is a significant cause of morbidity and mortality in patients undergoing cardiac surgery. Studies have been conducted, and guidelines have been published regarding patient blood management and aiming to prevent blood loss in the perioperative period. Various bleeding risk assessments were developed for preoperative period. We aimed to examine the correlations of scoring systems in the literature with the amount of postoperative bleeding in patients undergoing first time coronary artery bypass graft surgery, and to show the most suitable preoperative bleeding risk assessment for coronary artery bypass graft patients. Methods: The study included 550 consecutive patients who underwent coronary artery bypass graft operation. The inclusion criteria were considered as patients to be older than 18 years old and to undergo elective or emergent myocardial revascularization using cardiopulmonary bypass. All variables required for scoring systems were recorded. The initial results of the study were determined as the amount of chest tube drainage, the use of blood products, the change in hematocrit level, reoperation due to bleeding, duration of ventilation, duration of intensive care unit stay, and hospital stay. Mortality which occurred during first 30 days after operation was considered as operative mortality. Operative mortality was accepted as the primary endpoint. Secondary endpoints were massive bleeding and high amount of transfusion. Results: Data were obtained from a series of 550 consecutive patients treated with isolated coronary artery bypass graft. It was seen that PAPWORTH and WILL-BLEED risk assessments responded better for E-CABG grade 2 and 3 bleeding compared to other risk assessments. TRACK, TRUST, and ACTA-PORT scales were found to have low ability to distinguish patients with E-CABG bleeding grade 2 and 3. Conclusion: Predicting postoperative bleeding and transfusion rates with preoperative risk scores in patients undergoing coronary artery bypass graft surgery will provide valuable information to physicians for establishing a proper patient blood management protocol and this will decrease excessive transfusions, unnecessary reoperations as well as improve postoperative outcomes.