Postoperative haemorrhage following cleft surgery: A national survey of practice in Great Britain and Ireland.

Abstract

Postoperative haemorrhage following cleft palate and pharyngeal surgery is an uncommon but potentially life-threatening complication due to the risk of airway compromise. Within centralised cleft service models, patients may present outside specialist centres, making clear escalation pathways particularly important. We conducted a cross-sectional survey of cleft surgeons in Great Britain and Ireland to describe current approaches to classification and management of postoperative bleeding. Twenty-three current cleft surgeons representing 12 of 13 cleft services responded. Four respondents (17%) reported having a written local management pathway. Systemic tranexamic acid and direct pressure were consistently rated as the most important non-operative measures prior to return to theatre. Approaches to primary versus secondary bleeds varied, as did out-of-hours cover arrangements. While there was strong agreement that an active intraoral bleed should prompt early return to theatre, views differed regarding bedside packing and suctioning in awake paediatric patients. Although core management principles are widely shared, variation exists in escalation pathways and service structures. We present a structured framework to support local protocol development and multidisciplinary discussion. Clear, locally agreed management plans may help facilitate timely, coordinated response to this rare but high-risk complication.