🩸 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:
- Epidural hematoma: biconvex, hyperdense
- Subdural hematoma: crescent-shaped
- Intracerebral hemorrhage: localized parenchymal bleed
- Midline shift or ventricle compression
🛠️ Management
- Surgical intervention if mass effect or neurological decline
- 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.