Risk factors for bleeding and perioperative bleeding complications in oculoplastic surgery: a prospective pilot study.

BACKGROUND/AIMS: Clear guidelines for managing patients on antiplatelet (AP) or anticoagulant (AC) therapy undergoing oculoplastic surgery are lacking. This study investigates bleeding risk factors and evaluates the effectiveness of a standardised bleeding risk assessment in extraocular surgery.

METHODS: In this prospective study, a standardised questionnaire (SQ) was employed to gather patients' bleeding histories. Associations between SQ scores and preoperative/demographic factors (AP/AC use, age, sex, comorbidities), and surgical factors (blood pressure, surgery type, primary vs revision surgery, anaesthesia type, duration, pain management) were assessed. A scoring system quantified bleeding severity. Patients were monitored postoperatively for 24 hours (eyelid procedures) to 3 or 4 days (orbital/nasolacrimal surgery).

RESULTS: A total of 324 patients (aged 18-92) were included (252 eyelid, 56 orbital and 16 nasolacrimal surgeries). 87 patients were using AP, AC and/or herbal supplements. Severe bleeding occurred in 35 patients, four required revision surgery, though none suffered permanent damage. Bleeding complications were significantly associated with higher SQ scores (p=0.048), acetylsalicylic acid use in eyelid surgery (p=0.038), diabetes mellitus (p=0.016), renal disease (p=0.044), general anaesthesia (p=0.001) and longer surgery duration (p=0.007). Local anaesthesia, AC use and systolic hypertension were not significantly associated with bleeding risk.

CONCLUSION: The SQ is a valuable tool for assessing bleeding risk in oculoplastic patients. Findings support future multicentre studies to develop evidence-based perioperative guidelines for AP and AC management. Limitations include cohort heterogeneity, small sample size, non-blinded design and subjective bleeding scores affecting comparability.