Identifying and Addressing the Problem of Perioperative Bleeding in General Surgery: A Multi-Methods Approach

Abstract

Background: The contemporary causes of perioperative mortality in general surgery is not well described. It is likely that major bleeding is underestimated in current literature, which may have contributed to the lack of progress made in reducing perioperative bleeding in general surgery. Existing noncardiac surgery data has been instrumental in the identification of common post-operative complications and evaluating promising interventions to address them. However, context-specific evidence is required for uptake of research findings into clinical practice. The present work distilled the existing noncardiac surgery data to focus on the field of general surgery. In doing so, we identified perioperative bleeding to be a common complication in general surgery and attempted to address this issue. Chapter 1 provides the background information and scientific framework that lay the foundation and justification for conducting the studies included in this work. Chapter 2 presents the results of a large international prospective cohort study describing the epidemiology of post-operative complications in a cohort of contemporary general surgery patients and identify the complications associated with 30-day mortality. Chapter 3 presents a study that was conducted with similar methodology as Chapter 2 but in the population of orthopedic surgery patients. The differences in the results as compared to the general surgery cohort highlights the importance of specialty-specific data to supplement noncardiac surgery data. Chapter 4 presents the results of the PeriOperative ISchemic Evaluation-3 (POISE-3) trial substudy to provide general surgery specific evidence on the safety and efficacy of prophylactic TXA to reduce perioperative bleeding. Chapter 5 summarizes the major findings of the thesis work and offer areas for future research.