🩸 Postoperative Bleeding

🩸 Postoperative Bleeding

📌 Definition

Postoperative bleeding refers to any hemorrhagic event that occurs after a surgical procedure. It can be external (wound site) or internal (intracranial, intrathoracic, intra-abdominal, etc.), and ranges from minor oozing to life-threatening hemorrhage.

In neurosurgery, intracranial postoperative bleeding is a major cause of morbidity and may require urgent reoperation.

🧩 Classification

Type	Description	Examples in Neurosurgery
Superficial bleeding	External bleeding from incision or subgaleal hematoma	Wound ooze, subcutaneous hematoma
Intracranial bleeding	Hemorrhage inside the skull	Epidural hematoma, subdural hematoma, intracerebral hemorrhage
Rebleeding	New or worsened bleeding at the surgical site	Tumor bed hemorrhage, aneurysm clip failure
Remote bleeding	Hemorrhage at a site distant from the surgical field	Contralateral EDH, cerebellar hemorrhage after supratentorial surgery

⏱️ Timing

Immediate: within 6 hours post-op
Early: 6–72 hours post-op
Delayed: after 3 days; often due to coagulopathy, infection, or CSF drainage

📉 Risk Factors

Inadequate intraoperative hemostasis
Coagulopathy (congenital, acquired, medication-induced)
Hypertension
Use of anticoagulants or antiplatelet agents
NSAIDs (theoretical risk, under evaluation)
Excessive CSF drainage (may cause brain shift and vessel tearing)
Hypothermia and acidosis during surgery

🩺 Clinical Presentation

Wound swelling, drainage, or hematoma
Neurological deterioration (headache, confusion, vomiting, seizures, anisocoria)
Hypotension, tachycardia, pallor (in systemic bleeding)
Drop in hemoglobin/hematocrit

🖼️ Imaging in Neurosurgery

CT scan is the modality of choice for early detection
Typical findings:
1. Epidural hematoma: biconvex, hyperdense
2. Subdural hematoma: crescent-shaped
3. Intracerebral hemorrhage: localized parenchymal bleed
4. Midline shift or ventricle compression

🛠️ Management

Surgical intervention if mass effect or neurological decline
1. Craniotomy, burr holes, decompression
Hemodynamic support: fluids, blood transfusion
Reversal of anticoagulation (vitamin K, PCC, platelets)
Blood pressure control
Monitoring in ICU
Identify and correct underlying cause (e.g., coagulopathy)

📋 Prevention

Meticulous intraoperative hemostasis
Judicious use of NSAIDs and anticoagulants
Blood pressure control in the perioperative period
Careful management of CSF drainage
Early postoperative imaging in high-risk cases

📌 Summary

Postoperative bleeding is a critical complication that must be promptly recognized and managed. In neurosurgery, intracranial bleeding can be fatal and requires high vigilance, particularly in the first 24–48 hours after surgery.

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