title: Postoperative gastrointestinal bleeding in orthognathic surgery patients: its estimated prevalence and possible association to known risk factors.
abstract: OBJECTIVE
  To assess the prevalence of gastrointestinal (GI) bleeding in patients after orthognathic surgery and its relation to known risk factors.
  
  
  METHODS
  With institutional review board approval, a single-center case series was conducted with data collected retrospectively from orthognathic surgical patients' medical records from 1990 to 2010. All patients were treated by 1 primary surgeon, were limited to 21 years or younger at the time of surgery, and had no coagulopathy. The authors' hypothesis was that patients concurrently exposed to mechanical ventilation and dual anti-inflammatory drugs in the postoperative period would be at a greater risk for clinically significant GI bleeding according to the American Society of Health-System Pharmacists guideline compared with those exposed to fewer risk factors. Its prevalence and relation to known risk factors were analyzed.
  
  
  RESULTS
  In total 498 orthognathic cases consisting of 220 male patients (median age, 17 yr; age range, 3 to 21 yr) and 262 female patients (median age, 17 yr; age range, 10 to 21 yr) were reviewed. Of 17 patients admitted to intensive care unit level of care postoperatively, 4 patients were exposed to concomitant administration of ketorolac and steroids while being mechanically ventilated. Two of these 4 patients developed esophagogastroduodenoscopy-confirmed upper GI bleeding (UGIB). There was no incidence of UGIB in patients not exposed to all 3 risk factors concurrently.
  
  
  CONCLUSIONS
  Postoperative GI bleeding complication is rare in orthognathic surgical patients, with an estimated prevalence of 0.4%. Based on these observations, orthognathic surgical patients who require mechanical ventilation and are receiving anti-inflammatory medications may have an increased risk of GI bleeding. In the absence of active bleeding from the surgical site, persistent decrease in hemoglobin concentration should alert one to consider the possibility of UGIB.
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: han.james@mayo.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Han
authors.affiliation: Consultant, Division of Oral and Maxillofacial Surgery, Department of Surgery; Professor of Surgery, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Eugene E
authors.initials: EE
authors.lastname: Keller
authors.affiliation: Chair, Pediatric Gastroenterology, Pediatric and Adolescent Medicine; Assistant Professor of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Rayna M
authors.initials: RM
authors.lastname: Grothe
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016025:Bone Transplantation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D056948:Orthognathic Surgical Procedures / Q000706:statistics & numerical data*; D019340:Osteotomy, Le Fort / Q000706:statistics & numerical data; D059229:Osteotomy, Sagittal Split Ramus / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D015995:Prevalence; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac