Unexpected bleeding after elective nasal surgery.

In 780 patients undergoing elective nasal surgery, the incidence of excessive bleeding was 3.6% (28 patients); of severe bleeding, 0.9% (7 patients). In most patients, effective treatment was to repack the nose and cauterize a bleeding site, or to suture an open area either in the incision or at the columella-septum junction. Contributing to the hemorrhage in 1 patient was aspirin ingestion, and in another, an unrecognized Factor XI deficiency. Although the excessive bleeding in these patients could probably have been prevented by obtaining a better history, in others it could not have been. Because of its unpredictability, bleeding as a complication must be discussed frankly with the patient.