Summary

Post-operative bleeding is bleeding that occurs after surgery, which can range from minor oozing to life-threatening hemorrhage. Think of post-operative bleeding as blood loss after surgery—this can occur from the surgical site, from vessels that weren't properly controlled, or from coagulopathy (bleeding disorder). Post-operative bleeding is a serious complication that can occur after any surgery, but is more common after major surgery, vascular surgery, or in patients with bleeding disorders. The severity ranges from minor (minimal blood loss, no symptoms) to severe (massive blood loss, shock, death). The key to management is recognizing the bleeding (obvious bleeding, signs of blood loss, signs of shock), assessing severity (vital signs, blood loss amount), providing resuscitation (IV fluids, blood transfusion), and urgent surgical intervention if needed (return to theater to control bleeding). Most minor bleeding can be managed conservatively, but significant bleeding requires urgent surgical intervention to save life.

Key Facts

• Definition: Bleeding that occurs after surgery
• Incidence: Common (5-10% of surgeries)
• Mortality: Low (<1%) if treated promptly, higher if delayed
• Peak age: All ages
• Critical feature: Blood loss, signs of shock
• Key investigation: Clinical assessment, blood tests (FBC, coagulation)
• First-line treatment: Resuscitation, urgent surgery if significant bleeding

Clinical Pearls

"Shock = urgent surgery" — If a patient is in shock from bleeding, they need urgent surgery to control the bleeding. Don't delay—bleeding can kill quickly.

"Check coagulation" — Always check coagulation (INR, APTT) in post-operative bleeding. Coagulopathy can cause or worsen bleeding.

"Early vs late bleeding" — Early bleeding (within 24 hours) is usually from vessels. Late bleeding (days-weeks) may be from infection, pseudoaneurysm, or other causes.

"Don't underestimate blood loss" — Blood loss can be underestimated, especially if internal. Look for signs of shock, not just visible bleeding.

Why This Matters Clinically

Post-operative bleeding is a serious complication that can be life-threatening if not treated promptly. Early recognition (especially signs of shock), prompt resuscitation, and urgent surgical intervention if needed are essential. This is a condition that surgeons manage frequently, and prompt treatment saves lives.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: May have difficulty breathing (if shock)
• Listen: Usually normal
• Measure: SpO2 (may be low if shock)
• Action: Support if needed

C - Circulation

• Look: Signs of shock (pale, sweaty)
• Feel: Pulse (fast, weak), BP (low)
• Listen: Heart sounds (usually normal)
• Measure: BP (low), HR (fast)
• Action: Resuscitate urgently

D - Disability

• Assessment: Mental status (may be altered if shock)
• Action: Assess if severe

E - Exposure

• Look: Wound examination, look for bleeding
• Feel: Check for hematoma
• Action: Complete examination

Specific Examination Findings

Wound Examination:

• Inspection:
  • Active bleeding: Obvious bleeding
  • Hematoma: Swelling, bruising
  • Drainage: Blood in drains
• Palpation:
  • Swelling: Hematoma
  • Tenderness: May have

Signs of Shock:

• Tachycardia: Fast heart rate
• Hypotension: Low blood pressure
• Pale, sweaty: Poor perfusion
• Weak pulses: Poor perfusion

Special Tests

Natural History (Without Treatment)

Untreated Post-Operative Bleeding:

• Shock: Almost certain if significant
• Death: High risk if massive
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Minor bleeding: Usually resolves
• No shock: Better outcomes
• Young, healthy: Better outcomes

Poor Prognosis:

• Delayed treatment: Higher mortality
• Massive bleeding: Higher mortality
• Shock: Higher mortality
• Older, comorbidities: May have worse outcomes

Prognostic Factors

Key Guidelines

1. NICE Guidelines (2015) — Blood transfusion. National Institute for Health and Care Excellence

Key Recommendations:

• Resuscitate first
• Urgent surgery if significant bleeding
• Evidence Level: 1A

Landmark Trials

Multiple studies on resuscitation, surgical control.

Evidence Strength

What is Post-Operative Bleeding?

Post-operative bleeding is bleeding that occurs after surgery. Think of it as blood loss after surgery—this can occur from the surgical site or from vessels that weren't properly controlled. Most bleeding is minor and stops on its own, but some bleeding is serious and needs urgent treatment.

In simple terms: You're bleeding after surgery. Most bleeding is minor, but some is serious and needs urgent treatment.

Why does it matter?

Post-operative bleeding can be life-threatening if not treated promptly. Early recognition and urgent treatment are essential. The good news? With prompt treatment, most people recover well.

Think of it like this: It's like bleeding after surgery—it needs to be controlled, but once it's controlled, most people recover well.

How is it treated?

1. Immediate Care (Most Important):

• IV fluids: You'll get fluids through a drip to support your circulation
• Blood: You may need a blood transfusion if you've lost a lot of blood
• Why: To support your body while the bleeding is controlled

2. Assessment:

• Examination: Your doctor will examine you to see how serious the bleeding is
• Tests: You'll have blood tests to check your blood count and clotting
• Why: To see how serious it is and plan treatment

3. Control Bleeding:

• If minor: The bleeding may stop on its own, or pressure may be applied
• If significant: You'll need to go back to the operating room to control the bleeding
• Why: To stop the bleeding and prevent serious complications

4. Correct Clotting Problems:

• If you have a clotting problem: Your doctor will correct it (vitamin K, blood products)
• Why: To help your blood clot and stop bleeding

The goal: Stop the bleeding, support your body, and help you recover.

What to expect

Recovery:

• Minor bleeding: Usually stops on its own or with pressure
• Significant bleeding: Usually needs surgery, recovery takes longer
• Full recovery: Most people recover completely

After Treatment:

• Monitoring: Your doctor will monitor to make sure the bleeding has stopped
• Blood tests: You may have blood tests to check your blood count
• Recovery: You'll recover from the surgery to control bleeding
• Follow-up: Regular follow-up to monitor recovery

Recovery Time:

• Minor cases: Usually days
• Significant cases: Usually days to weeks

When to seek help

Call 999 (or your emergency number) immediately if:

• You're bleeding heavily after surgery
• You feel weak, dizzy, or faint after surgery
• You have a fast heart rate and low blood pressure after surgery
• You feel very unwell after surgery

See your doctor if:

• You have bleeding after surgery that concerns you
• You have symptoms that concern you
• You're worried about your recovery

Remember: If you're bleeding after surgery, especially if you feel weak, dizzy, or have a fast heart rate, call 999 immediately. Post-operative bleeding is serious, but with prompt treatment, most people recover well. Don't delay—if you're worried, seek help immediately.