Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, London, UK.
Clin Oral Investig. 2022 Apr;26(4):3765-3779. doi: 10.1007/s00784-021-04347-z. Epub 2022 Jan 11.
The objectives of this prospective cohort study were to establish gender-related differences in blood loss and haemostatic profiles associated with bimaxillary surgery. In addition, we aimed to identify if any gender differences could be established which might help predict blood loss volume.
Fifty-four patients (22 males; 32 females) undergoing bimaxillary surgery for skeletal dentofacial deformities were eligible for inclusion. Blood samples were taken 1 day preoperatively and 48 h postoperatively for detailed gender-specific coagulation analysis incorporating global coagulation assays (endogenous thrombin potential) and specific coagulation parameters. Blood loss was measured at two different time points: (1) the end of surgery, visible intraoperative blood loss (IOB) using 'subtraction method'; and (2) 48 h postoperatively perioperative bleeding volume (CBL-48 h) using 'haemoglobin-balance method' and Nadler's formula. Correlation and regression analyses were performed to identify relevant parameters affecting the amount of blood loss.
Significant differences in IOB and CBL-48 h were observed (p < 0.001). Men had higher IOB versus women, lacking statistical significance (p = 0.056). In contrast, men had significantly higher CLB-48 h (p = 0.019). Reduced CBL-48 h was shown to be most closely associated with the level of Antithrombin-III being decreased in females.
Male gender is associated with higher IOB and CBL-48 compared with females. Gender does not affect IOB regarding haemostatic profile but does correlate strongly with procedure length. Conversely, CBL-48 is closely associated with gender-specific imbalances in the anticoagulant system.
Knowledge of gender-related differences will help clinicians establish predictive factors regarding excessive blood loss in orthognathic surgery and identify at-risk patients.
本前瞻性队列研究的目的是确定与双颌手术相关的与性别相关的失血和止血特征差异。此外，我们旨在确定是否可以确定任何性别差异，这些差异可能有助于预测失血量。
54 名（22 名男性；32 名女性）因骨骼牙颌面畸形接受双颌手术的患者符合纳入标准。在术前 1 天和术后 48 小时采集血液样本，进行详细的性别特异性凝血分析，包括全局凝血测定（内源性凝血酶潜能）和特定凝血参数。在两个不同的时间点测量失血量：（1）手术结束时，使用“减法法”测量术中可见失血量（IOB）；（2）术后 48 小时使用“血红蛋白平衡法”和纳德尔公式测量围手术期失血总量（CBL-48h）。进行相关性和回归分析，以确定影响出血量的相关参数。
观察到 IOB 和 CBL-48h 存在显著差异（p<0.001）。与女性相比，男性的 IOB 更高，但无统计学意义（p=0.056）。相比之下，男性的 CBL-48h 显著更高（p=0.019）。结果表明，CBL-48h 减少与女性抗凝血酶 III 水平降低密切相关。
与女性相比，男性的 IOB 和 CBL-48h 更高。性别不会影响止血特征的 IOB，但与手术时间密切相关。相反，CBL-48h 与抗凝系统中性别特异性失衡密切相关。
了解与性别相关的差异将有助于临床医生确定正颌手术中过度失血的预测因素，并识别高风险患者。
