Migliorelli Andrea, Biancoli Elia, Manuelli Marianna, Caranti Alberto, Ciorba Andrea, Bianchini Chiara, Meccariello Giuseppe, Vicini Claudio
ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy.
Otolaryngology Unit, Department of Neurosciences (DNS), University of Padova, 35128 Padua, Italy.
J Pers Med. 2025 May 16;15(5):201. doi: 10.3390/jpm15050201.
Postoperative hemorrhage is the most common complication after Trans-Oral Robotic Surgery (TORS) described in the literature. The aim of this study is to assess the presence of any risk factors that may impact postoperative bleeding. : This was a retrospective study based on the analysis of patient data. Patients undergoing TORS procedures at the ENT Unit of Forlì Hospital from 2008 to 2022 for OSA (obstructive sleep apnea) or oncological disease and with a minimum follow-up of 30 days were included. The comorbidities analyzed were perioperative anticoagulant/antiplatelet therapy and clinicopathological features concerning the pathology. Total bleeding and severe bleeding (which required management in the operating room) were included. : A total of 414 patients (106 oncological TORS and 308 OSA TORS patients) were included. Post-TORS bleeding occurred in 47 cases (11.3%) and severe bleeding in 18 cases (4.3%). The pathology (oncology vs. OSA) treated with TORS did not represent a risk factor ( = 0.466). Antiplatelet intake represented an important risk factor ( = 0.002). Postoperative hemorrhage for oncological TORS occurred in 11.3% patients; of these, 6.6% had severe bleeding. Artery ligation during neck dissection prevented the risk of severe bleeding ( < 0.001). In TORS for OSA, postoperative hemorrhage was found in 11.4% cases, of which 3.6% were major bleeding. Neither the degree of OSA nor the association with other concurrent procedures were risk factors for postoperative bleeding in this study. : Patients taking perioperative antiplatelet therapy have an almost 5-fold increased risk of developing postoperative bleeding. The pathology (oncology vs. OSA) does not influence the risk of bleeding. Prophylactic arterial ligation during neck dissection significantly decreases the risk of severe bleeding.
术后出血是文献中描述的经口机器人手术（TORS）后最常见的并发症。本研究的目的是评估可能影响术后出血的任何风险因素。 ：这是一项基于患者数据分析的回顾性研究。纳入2008年至2022年在弗利医院耳鼻喉科接受TORS手术治疗阻塞性睡眠呼吸暂停（OSA）或肿瘤疾病且随访至少30天的患者。分析的合并症包括围手术期抗凝/抗血小板治疗以及与病理相关的临床病理特征。纳入总出血量和严重出血（需要在手术室处理）情况。 ：共纳入414例患者（106例肿瘤TORS患者和308例OSA TORS患者）。TORS术后出血47例（11.3%），严重出血18例（4.3%）。TORS治疗的病理类型（肿瘤与OSA）不是风险因素（P = 0.466）。服用抗血小板药物是一个重要风险因素（P = 0.002）。肿瘤TORS术后出血发生率为11.3%的患者；其中，6.6%有严重出血。颈部清扫术中动脉结扎可预防严重出血风险（P < 0.001）。在OSA的TORS手术中，术后出血发生率为11.4%，其中3.6%为大出血。在本研究中，OSA的严重程度以及与其他同期手术的联合均不是术后出血的风险因素。 ：围手术期接受抗血小板治疗的患者发生术后出血的风险几乎增加5倍。病理类型（肿瘤与OSA）不影响出血风险。颈部清扫术中预防性动脉结扎可显著降低严重出血风险。
