title: Hemorrhage after transoral robotic-assisted surgery.
abstract: OBJECTIVE
  An increasing number of head and neck surgeons have begun using transoral robotic-assisted surgery. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Medical records were reviewed in 147 consecutive patients undergoing transoral robotic-assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011.
  
  
  RESULTS
  Eleven of 147 (7.5%) patients undergoing transoral robotic-assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients requiring reoperation for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 ± 9.2 days after initial operation. Eight of 11 (72%) patients who bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. The postoperative hemorrhage rate in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P = .0057. While the bleeding rate in salvage surgery (3/29 = 10.3%) was slightly higher than in primary surgery (8/118 = 6.8%), this difference did not reach statistical significance.
  
  
  CONCLUSIONS
  Potential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic-assisted surgery should be recognized. Various effective techniques for management of these patients without robotic assistance were demonstrated.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Asher
authors.forename: Hilliary N
authors.initials: HN
authors.lastname: White
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Kejner
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants
keywords: TORS; head and neck cancer; oropharyngeal hemorrhage; postoperative hemorrhage; robotic surgery