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Peng L, Wang W, Gao XS, Luo DY. Perioperative Safety of Bladder Hydrodistention in Patients on Antithrombotic Therapy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2022; 29:489-496. [PMID: 36944055 PMCID: PMC10144279 DOI: 10.1097/spv.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
IMPORTANCE Bladder hydrodistention (BH) is commonly used to diagnose and treat patients with interstitial cystitis/bladder pain syndrome (IC/BPS), but the overall assessment of bleeding complications for patients taking antithrombotics is lacking. OBJECTIVES The study aimed to investigate if perioperative complications were more common in patients with IC/BPS receiving antithrombotic therapy after BH. STUDY DESIGN We retrospectively reviewed patients with IC/BPS who underwent hydrodistention during January 2010 and May 2021. Patients with and without antithrombotic drugs were identified and grouped, and their medical records were reviewed. Perioperative data and symptom scores were assessed. The rates of complications in the 2 groups were recorded at 3 months and at the last visit postoperatively. RESULTS A total of 387 patients were eventually included. Among them, 29 (7.5%) patients were receiving systemic antithrombotic therapy and 358 (92.5%) were not. Compared with the non-antithrombotic group, patients receiving antithrombotic therapy demonstrated a longer hospital stay (P = 0.033) and a longer catheterization time (P = 0.034). Moreover, the patients with antithrombotic drugs had increased odds of bladder tamponade (odds ratio, 6.76; P = 0.019) and urinary retention (odds ratio, 5.79; P = 0.033) both 3 months postoperatively and last follow-up, but this is not statistically different between patients with and without Hunner lesions. No thromboembolic events were identified during the study period. CONCLUSIONS Although a small number of patients with IC/BPS needed anticoagulants, longer hospital stays, longer catheterization time, and increased odds of bladder tamponade and urinary retention were observed in patients receiving antithrombotic therapy. Still, a comprehensive management scheme to balance bleeding complications and antithrombotic agents is needed for individuals.
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Affiliation(s)
- Liao Peng
- From the Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Pearcy C, Almahmoud K, Jackson T, Hartline C, Cahill A, Spence L, Kim D, Olatubosun O, Todd SR, Campion EM, Burlew CC, Regner J, Frazee R, Michaels D, Dissanaike S, Stewart C, Foley N, Nelson P, Agrawal V, Truitt MS. Risky business? Investigating outcomes of patients undergoing urgent laparoscopic appendectomy on antithrombotic therapy. Am J Surg 2017; 214:1012-1015. [PMID: 28982518 DOI: 10.1016/j.amjsurg.2017.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population. METHODS From 2010 to 2014, seven institutions from the Southwest Surgical Multicenter Trials (SWSC MCT) group conducted a retrospective study to evaluate the clinical course of all patients on IAT who underwent urgent/emergent laparoscopic appendectomy. The IAT+ group was subdivided into IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix). These groups were matched 1:1 to controls. The primary outcomes were estimated blood loss (EBL) and transfusion requirement. Secondary outcomes included infections (SSI - Surgical Site Infection, DSI - Deep Space Infection, and OSI - Organ Space Infection), hospital length of stay (HLOS), complications, 30-day readmissions, and mortality. RESULTS Out of the 2903 patients included in the study, 287 IAT+ patients were identified and matched in a 1:1 ratio to 287 IAT-patients. In the IAT+ vs IAT-analysis, no significant differences in EBL (p = 1.0), transfusion requirement during the preoperative (p = 0.5), intraoperative (p = 0.3) or postoperative periods (p = 0.5), infectious complications (SSI; p = 1.0, DSI; p = 1.0, and OSI; p = 0.1), overall complications (p = 0.3), HLOS (p = 0.7), 30-day readmission (p = 0.3), or mortality (p = 0.1) were noted. Similarly, outcomes in the IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix) subgroups failed to demonstrate any significant differences when compared to controls. CONCLUSIONS Our analysis suggests that IAT is not associated with worse outcomes in urgent/emergent laparoscopic appendectomy. Prehospital use of IAT should not be used to delay laparoscopic appendectomy.
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Affiliation(s)
- Christopher Pearcy
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA
| | - Khalid Almahmoud
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA
| | - Theresa Jackson
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA
| | - Cassie Hartline
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA
| | - Anthony Cahill
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA
| | - Lara Spence
- Department of Graduate Medical Education, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dennis Kim
- Department of Graduate Medical Education, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Oluwabukola Olatubosun
- Department of Graduate Medical Education, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - S Rob Todd
- Department of Graduate Medical Education, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eric M Campion
- Department of Graduate Medical Education, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Clay Cothren Burlew
- Department of Graduate Medical Education, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Justin Regner
- Department of Graduate Medical Education, Department of Surgery, Baylor Scott and White Health - Central Texas, Temple, TX, USA
| | - Richard Frazee
- Department of Graduate Medical Education, Department of Surgery, Baylor Scott and White Health - Central Texas, Temple, TX, USA
| | - David Michaels
- Department of Graduate Medical Education, Department of Surgery, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Sharmila Dissanaike
- Department of Graduate Medical Education, Department of Surgery, Texas Tech Health Sciences Center, Lubbock, TX, USA
| | - Collin Stewart
- Department of Graduate Medical Education, Department of Surgery, University of Nevada - Mountain View Surgery Residency, Las Vegas, NV, USA
| | - Neal Foley
- Department of Graduate Medical Education, Department of Surgery, University of Nevada - Mountain View Surgery Residency, Las Vegas, NV, USA
| | - Paul Nelson
- Department of Graduate Medical Education, Department of Surgery, University of Nevada - Mountain View Surgery Residency, Las Vegas, NV, USA
| | - Vaidehi Agrawal
- Clinical Research Institution, Methodist Dallas Health System, Dallas, TX, USA
| | - Michael S Truitt
- Department of Graduate Medical Education, Department of Surgery, Methodist Dallas Health System, Dallas, TX, USA.
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