Objectives

To describe the Indiana Hemophilia & Thrombosis Center (IHTC) surgical database, its key components, and exploratory analyses of surgeries conducted between 1998-2019.

Methods

Surgical data across bleeding disorders collected retrospectively (1998-2006) and prospectively (2006-2019) were analyzed. Perioperative hemostasis, complications, and surgical plan deviations were compared by bleeding disorder diagnosis and data collection period.

Results

Within the 21-year period, 3,246 procedures were conducted in 1,413 patients with a diagnosis of von Willebrand disease(vWD), hemophilia A(HA), hemophilia B(HB), and other bleeding disorders. Majority of the procedures were minor (63.3%), and median number of surgeries per patient was 1 (range;1-22). Adequate perioperative hemostasis was achieved in 90.9%, complications occurred in 13.6%, and surgical plan deviations occurred in 31.3% of procedures.

Inadequate perioperative hemostasis and surgical plan deviations occurred more frequently in procedures involving HB compared to other bleeding disorders. Complications were not significantly different across bleeding disorders (p=0.164). The prospective data collection period was associated with higher rates of hemostatic efficacy (92.4 vs 88.3%;p<.001), complications (14.3 vs 12.3%;p<.001), and plan deviations (34.2 vs 25.1%;p<.001).

Conclusion

The surgical database is an important resource in surgical management in bleeding disorders. Further evaluation will facilitate use for development of predictive models and principles of care.