Predictive risk factors for postoperative hemorrhage in patients with transoral robotic tongue base surgery

It is a difficult anatomical area for obstructive sleep apnea surgeons due to tongue base, vision problems, and limited manipulation of surgical instruments. Hemorrhage is a rare complication seen after tongue base surgery. Many factors in the evaluation and management of patients that undergo tongue base surgery may affect the risk of primary postoperative hemorrhage. The aim of this study is to evaluate and define predictive risk factors that may be associated with postoperative hemorrhage; so high-risk patients can be identified before hemorrhage. The file records of patients who underwent transoral robotic tongue base surgery between September 2015 and June 2019 due to the diagnosis of obstructive sleep apnea syndrome in Ankara Yıldırım Beyazıt University Otorhinolaryngology Clinic were examined and the data of 106 patients were included in the study. The following data were obtained from each record; preoperative apnea-hypopnea index, patient's age and gender, total operation time, intraoperative bleeding amount, body mass index, preoperative and postoperative blood pressure, resected tissue volume, and the day of bleeding. While there was no significant difference in other factors, there was a statistically significant difference in the volume of resected tissue between the bleeding group and the non-bleeding group (p < 0.005). In the correlation test performed between the resected tissue volume and the amount of intraoperative bleeding amount, showed a statistically positive correlation (p<0.05). The volume of tissue resected for major and severe bleeding and the amount of intraoperative bleeding can help us identify high-risk patients as a predictive risk factor. This study is limited due to the small sample size and retrospective nature of patients experiencing postoperative hemorrhage. Larger-scale studies of complications are needed to ensure continuous improvement in TORS results.