Abstract：
BACKGROUND: Abdominal wall reconstruction requires extensive dissection of the abdominal wall, exposure of the retroperitoneum, and aggressive chemoprophylaxis to reduce the risk of thromboembolic complications. The need for early anticoagulation puts patients at risk for bleeding. We aimed to quantify postoperative blood loss, incidence of transfusion and reoperation, and associated risk factors in patients undergoing complex abdominal wall reconstruction.
METHODS: All patients underwent a posterior component separation with transversus abdominis release and placement of retromuscular mesh for ventral hernias <20 cm wide and were enrolled in a clinical trial assessing the utility of trans-fascial mesh fixation. A post hoc analysis was performed to quantify postoperative hemoglobin drop, blood transfusions, and procedural interventions for ongoing bleeding during the first 30 postoperative days. Multivariate logistic regression was used to identify predictors of transfusion.
RESULTS: In 325 patients, hemoglobin decreased by 3.61 (±1.58) g/dL postoperatively. Transfusion incidence was 9.5% (n = 31), and 3.1% (n = 10) required a surgical intervention for bleeding. Initiation of therapeutic anticoagulation postoperatively resulted in a higher likelihood of requiring surgical intervention for bleeding (odds ratio 10.4 [95% confidence interval 2.75-43.8], P < .01). Use of perioperative therapeutic anticoagulation was associated with higher rates of transfusion (odds ratio 3.51 [95% confidence interval 1.34-8.53], P < .01). Neither intraoperative blood loss nor operative times were associated with an increased transfusion requirement or need for operative intervention.
CONCLUSIONS: Patients undergoing transversus abdominis release are at a high risk of postoperative bleeding that can require transfusion and reoperation. Patients requiring postoperative therapeutic anticoagulation are at particularly high risk.
METHODS: All patients underwent a posterior component separation with transversus abdominis release and placement of retromuscular mesh for ventral hernias <20 cm wide and were enrolled in a clinical trial assessing the utility of trans-fascial mesh fixation. A post hoc analysis was performed to quantify postoperative hemoglobin drop, blood transfusions, and procedural interventions for ongoing bleeding during the first 30 postoperative days. Multivariate logistic regression was used to identify predictors of transfusion.
RESULTS: In 325 patients, hemoglobin decreased by 3.61 (±1.58) g/dL postoperatively. Transfusion incidence was 9.5% (n = 31), and 3.1% (n = 10) required a surgical intervention for bleeding. Initiation of therapeutic anticoagulation postoperatively resulted in a higher likelihood of requiring surgical intervention for bleeding (odds ratio 10.4 [95% confidence interval 2.75-43.8], P < .01). Use of perioperative therapeutic anticoagulation was associated with higher rates of transfusion (odds ratio 3.51 [95% confidence interval 1.34-8.53], P < .01). Neither intraoperative blood loss nor operative times were associated with an increased transfusion requirement or need for operative intervention.
CONCLUSIONS: Patients undergoing transversus abdominis release are at a high risk of postoperative bleeding that can require transfusion and reoperation. Patients requiring postoperative therapeutic anticoagulation are at particularly high risk.
摘要：
背景：腹壁重建需要广泛解剖腹壁，腹膜后暴露，积极的化学预防，以降低血栓栓塞并发症的风险。早期抗凝的需要使患者有出血的风险。我们的目的是量化术后失血量,输血和再次手术的发生率，复杂腹壁重建术患者的相关危险因素。
方法：所有患者均接受了腹侧疝的后段分离术，并在<20cm宽的腹侧疝中放置了后肌网片，并纳入了一项临床试验，评估了跨筋膜网片固定术的实用性。进行事后分析以量化术后血红蛋白下降，输血,以及术后前30天持续出血的手术干预。采用多因素logistic回归分析确定输血的预测因子。
结果：在325名患者中，术后血红蛋白下降3.61(±1.58)g/dL。输血发生率为9.5%（n=31），3.1%(n=10)需要手术治疗出血.术后开始治疗性抗凝治疗导致需要手术干预出血的可能性更高(比值比10.4[95%置信区间2.75-43.8],P<.01)。围手术期抗凝治疗的使用与较高的输血率相关(比值比3.51[95%置信区间1.34-8.53],P<.01)。术中失血或手术时间均与输血需求增加或需要手术干预无关。
结论：腹横肌松解术患者术后出血风险较高，需要输血和再次手术。需要术后治疗性抗凝的患者风险特别高。
方法：所有患者均接受了腹侧疝的后段分离术，并在<20cm宽的腹侧疝中放置了后肌网片，并纳入了一项临床试验，评估了跨筋膜网片固定术的实用性。进行事后分析以量化术后血红蛋白下降，输血,以及术后前30天持续出血的手术干预。采用多因素logistic回归分析确定输血的预测因子。
结果：在325名患者中，术后血红蛋白下降3.61(±1.58)g/dL。输血发生率为9.5%（n=31），3.1%(n=10)需要手术治疗出血.术后开始治疗性抗凝治疗导致需要手术干预出血的可能性更高(比值比10.4[95%置信区间2.75-43.8],P<.01)。围手术期抗凝治疗的使用与较高的输血率相关(比值比3.51[95%置信区间1.34-8.53],P<.01)。术中失血或手术时间均与输血需求增加或需要手术干预无关。
结论：腹横肌松解术患者术后出血风险较高，需要输血和再次手术。需要术后治疗性抗凝的患者风险特别高。
