Hidden Blood Loss Research Articles

Bibliometric analysis of transforaminal lumbar interbody fusion in lumbar spine surgery.

The objective of this study is to conduct a bibliometric analysis to examine the current condition, areas of interest, and rising trends of transforaminal lumbar interbody fusion in lumbar spine surgery (TLIF), as well as its importance in associated research domains. An extensive collection of academic papers on the use of TLIF was obtained from the Web of Science between January 1, 2000, and November 5, 2023. Then, using a variety of tools like HisCite, VOSviewer, CiteSpace, and the bibliometrix package, a bibliometric study was carried out. This study included the collection of information on country, institution, author, journal, and keywords. A comprehensive analysis was undertaken on a total of 1,907 publications obtained from 181 journals, encompassing the contributions of 7,232 authors affiliated with 1,775 institutes spanning 57 countries/regions. Notably, the USA exhibited the highest number of publications, with 763 (40.03%) articles on TLIF. The most productive institution was Rush University, with 96 (5.03%) publications. The author with the highest publication output was Singh, Kern with 75 (3.93%) publications. World Neurosurgery demonstrated the highest level of productivity, having published a total of 211 (11.06%) articles. The most frequently used keywords were "TLIF", "spondylolisthesis" and "complication". Meanwhile, "workflow", "technical note" and "hidden blood loss" have been identified as the research frontiers for the forthcoming years. This paper provides a thorough evaluation of current research trends and advancements in TLIF. It includes relevant research findings and emphasizes collaborative efforts among authors, institutions, and countries.

Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies.

Spinal osteotomies are often essential in the treatment of congenital scoliosis. Risk factors for bleeding in these patients needing extracavitatory approaches, especially hidden blood loss, are sparsely investigated. We aimed to investigate the bleeding characteristics and hidden blood loss in paediatric patients undergoing spinal osteotomies for congenital scoliosis. A retrospective analysis identified all patients with congenital scoliosis were retrospectively identified from the prospectively collected spine register from 2010 to 2022. Operative technique, perioperative laboratory results and imaging studies were extracted. The primary outcome was total blood loss including intraoperative, drain output and hidden blood loss. Fifty-seven children (32 boys) with a mean age of 8.3 years underwent spinal osteotomy for congenital scoliosis. Posterolateral hemivertebrectomy was sufficient in 34 (59%) patients, while vertebral column resection (VCR) was required in 23 patients. Total bleeding averaged 792 (523) ml accounting for 42% of the estimated blood volume. Hidden blood loss accounted for 40% of total bleeding and 21% of estimated blood volume with a mean of 317 (256) ml. VCR was associated with greater intraoperative and total bleeding than hemivertebrectomies (p = 0.001 and 0.007, respectively). After adjusting for patient weight and fusion levels, hidden blood loss was larger in hemivertebrectomies (4.18 vs. 1.77 ml/kg/fused level, p = 0.049). In multivariable analysis, intraoperative blood loss was inversely correlated with preoperative erythrocyte levels. Younger age was associated with significantly greater drain, hidden and total blood loss. Hidden blood loss constitutes a significant portion (40%) of total bleeding in congenital scoliosis surgery. Younger age is a risk factor for bleeding and the hidden blood loss should be taken into consideration in their perioperative management.

The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis.

This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). One hundred thirty patients undergoing THA were prospectively enrolled in the study. According to the intravenous infusion TXA dose, patients were divided into single-dose (n=65; mean age=60.8 ± 8.1 years) and triple-dose groups (n=65; mean age=61.8 ± 8.6 years). Complete blood count (CBC), conventional coagulation tests (CCT), and TEG were conducted 1 day before the operation, on postoperative day 1 (POD1), and postoperative day 7 (POD7). Color Doppler ultrasonography was performed 1 day before the operation and on POD7. Drainage blood loss, total blood loss (TBL), hidden blood loss (HBL), deep vein thrombosis (DVT) incidence, and blood transfusion rates were calculated and recorded. The CCT, CBC, and TEG parameters were compared between the 2 groups. Single- and triple-dose groups had significantly different hematocrit on POD7 (P < .05). No significant differences were found in CCT and hemoglobin at any corresponding time point between the 2 groups (P > .05). Despite the reaction time (R) on POD1 (P < .05), there were no significant differences in other TEG parameters at any other time point between the 2 groups (P > 0.05). For drainage blood loss and TBL, the triple-dose group had lesser blood loss than the single-dose group (P < .05). However, no significant differences were found for blood transfusion rate, HBL, or incidence of DVT (P > .05). Compared with single-dose, triple-dose TXA can be more effective in decreasing blood loss without increasing DVT incidence in patients undergoing THA. Although there is a notable disparity in the R time on POD1, the administration of triple-dose TXA does not substantially impact the coagulation status as assessed by TEG and CCT.

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty

To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05). The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Risk Factors Analysis and Nomogram Model Establishment of Hidden Blood Loss in Overweight and Obese Elderly Patients After Total Hip Arthroplasty.

Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA. A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample T-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). HBL was 911±438 mL, accounting for 79.5±13.1% of the total perioperative blood loss (1104±468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥1000 ml in both the training and validation groups. HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.

A Comparison of Hidden Blood Loss Between Multilevel Posterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in Adult Spinal Deformity Patients.

Retrospective cohort study. This study aimed to compare transfusion and blood loss volumes, particularly hidden blood loss volume, in adult spinal deformity patients undergoing lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF). Corrective surgery for adults with spinal deformity patients can be performed via the traditional posterior approach (PLIF) or minimally invasive lateral approach (LLIF). LLIF is associated with longer or comparable operation times and lower intraoperative blood loss. However, hidden blood loss has not been compared between the two procedures. We compared hidden blood loss and other blood loss volumes, transfusion volume, operation time, and radiographic surgical outcomes between LLIF patients (n = 71) and PLIF patients (n = 33) who underwent surgery in our institution from September 2011 to June 2018. All patients provided informed consent in accordance with the Declaration of Helsinki. Institutional ethics committee conducted this study approval was obtained. Transfusion volume and intraoperative and total blood loss volumes were significantly higher in the PLIF group. Operation time and HBL did not significantly differ. The hidden blood loss-to-intraoperative blood loss ratio was significantly higher in the LLIF group (113% vs 60%; P = .004). Radiographic measures of outcome were significantly better after surgery than before in both groups. Although intraoperative blood loss was less with LLIF than PLIF, HBL was similar between the approaches. Patients undergoing LLIF should be followed closely for postoperative anemia even if intraoperative blood loss is low.

Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures

Introduction and aimMinimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. Materials and methodsThis was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume (TBV), total bleeding (TB), HBL, and Hb drop were calculated. This was followed by a comparative analysis between HBL (<500mL vs. ≥500mL) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors. ResultsA total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5mL. An HBL greater than 500mL is found to be an independent risk factor for torpid postoperative evolution (p=0.035), while it does not predict a longer hospital stay (p=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time. ConclusionsAlthough MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.

A comparative study on hemostasis effect of different application methods and time of tranexamic acid in total hip arthroplasty.

To analyze the hemostatic effect of different application methods and time of tranexamic acid (TXA) on primary unilateral total hip arthroplasty. A total of 126 patients with primary unilateral total hip replacement admitted between January 2019 and January 2021 were recruited. The patients were divided into three groups (42 people in each group) by random number table method. In group I, 2.0g TXA was perfused locally into the hip joint cavity through the drainage tube for 2h. Group II was perfused locally with the same method for 4h. Group III was given TXA 15mg/kg intravenously 5-10min before surgical incision. The hemoglobin concentration, red blood cell (RBC) count, international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D), intraoperative blood loss, postoperative blood loss, implicit blood loss, total blood loss, postoperative blood transfusion and complications were compared. The postoperative drainage volume of group I (195.07 ± 34.65) mL and group II (199.62 ± 38.07) mL was significantly lower than that of group III (213.12 ± 25.05) mL (P = 0.037). There was no significant difference in postoperative drainage between group I and group II (P > 0.05). There was no significant difference in intraoperative blood loss, hidden blood loss and total blood loss between the three groups (P > 0.05). There was no difference in the incidence of deep vein thrombosis among the three groups (P > 0.05). TXA is a safe and effective way of hemostasis in total hip arthroplasty. Local intraarticular application of TXA can reduce the postoperative drainage, but the difference is not clinically significant, probably due to the number of samples. There is no difference in the postoperative drainage after local application of 2 or 4h, and there is no difference in the overall hemostasis effect between intravenous or local application of TXA.

Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial

BackgroundThe use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.MethodsIn this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.ResultsNo statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).ConclusionTXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.

Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty.

Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate. A retrospective chart review was conducted for 64 patients who underwent total ankle arthroplasty with (n = 32) and without (n = 32) intraoperative tranexamic acid from 2014 to 2023 at a single academic medical center. Recorded blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss, and complication rates were recorded and compared. There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference, hidden blood loss, or overall complications between the groups (all, P > .05). A lower rate of wound complications was observed in the tranexamic acid group, but the difference between each group was not statistically significant (P > .05). Tranexamic acid did not decrease blood loss during total ankle arthroplasty, as measured in our study. Tranexamic acid was not associated with any increase in overall complications. Based on our findings, tranexamic acid may be a safe intervention in total ankle arthroplasty, but further studies are needed to better elucidate its clinical impact.Level of Evidence: Level 3.

Decoding the immune landscape following hip fracture in elderly patients: unveiling temporal dynamics through single-cell RNA sequencing

BackgroundHip fractures in the elderly have significant consequences, stemming from the initial trauma and subsequent surgeries. Hidden blood loss and stress due to concealed injury sites could impact the whole osteoimmune microenvironment. This study employs scRNA-seq technique to map immune profiles in elderly hip fracture patients from post-trauma to the recovery period, investigating the dynamic changes of immune inflammation regulation subgroups.MethodsWe collected peripheral blood samples from four elderly hip fracture patients (two males and two females, all > 75 years of age) at three different time points (24 h post-trauma, 24 h post-operation, and day 7 post-operation) and applied scRNA-seq technique to analyze the cellular heterogeneity and identify differentially expressed genes in peripheral blood individual immune cells from elderly hip fracture patients.ResultsIn this study, we analyzed the composition and gene expression profiles of peripheral blood mononuclear cells (PBMCs) from elderly hip fracture patients by scRNA-seq and further identified new CD14 monocyte subpopulations based on marker genes and transcriptional profiles. Distinct gene expression changes were observed in various cell subpopulations at different time points. C-Mono2 monocyte mitochondria-related genes were up-regulated and interferon-related and chemokine-related genes were down-regulated within 24 h post-operation. Further analysis of gene expression profiles at day 7 post-operation showed that C-Mono2 monocytes showed downregulation of inflammation-related genes and osteoblast differentiation-related genes. However, the expression of these genes in cytotoxic T cells, Treg cells, and B cell subsets exhibited a contrasting trend. GZMK+CD8+ cytotoxic T cells showed downregulation of chemokine-related genes, and Treg cells showed upregulation of genes related to the JAK/STAT signaling pathway. Furthermore, we examined interactions among diverse immune cell subsets, pinpointing specific ligand-receptor pairs. These findings imply cross-talk and communication between various cell types in the post-traumatic immune response.ConclusionsOur study elucidates the notable alterations in immune cell subpopulations during different stages of hip fracture in elderly patients, both in terms of proportions and differential gene expressions. These changes provide significant clinical implications for tissue repair, infection prevention, and fracture healing in clinic.

Perioperative safety and efficacy of robot-assisted total hip arthroplasty in ERAS-managed patients: a pilot study

AimsRobot-assisted total hip arthroplasty (rTHA) boasts superior accuracy in implant placement, but there is a lack of effective assessment in perioperative management in the context of enhanced recovery after surgery (ERAS). This study aimed to compare the effectiveness and safety of rTHA versus conventional total hip arthroplasty (cTHA) in ERAS-managed patients.MethodsIn this prospective trial, a total of 60 eligible patients aged between 18 and 80 years were randomly divided into two groups to undergo either rTHA or cTHA. The primary outcomes included blood loss parameters. Secondary outcomes were the duration of the operation, surgical time, WOMAC pain score, WOMAC stiffness score, WOMAC physical function score, Harris score, and postoperative complications.ResultsThe study cohort analyzed 59 eligible participants, 30 of whom underwent rTHA and 29 of whom underwent cTHA. Analysis could not be conducted for one patient due to severe anemia. Notably, the cTHA group had a significantly shorter surgical time than the rTHA group (69.49 ± 18.97 vs. 104.20 ± 19.63 min, P < 0.001). No significant differences were observed between the rTHA and cTHA groups for blood loss parameters, including total blood loss (1280.30 ± 404.01 vs. 1094.86 ± 494.39 ml, P = 0.137) and drainage volume (154.35 ± 121.50 vs. 159.13 ± 135.04 ml, P = 0.900), as well as intraoperative blood loss (126.67 ± 38.80 vs. 118.52 ± 60.68 ml, P = 0.544) and hidden blood loss (982.43 ± 438.83 vs. 784.00 ± 580.96 ml, P = 0.206). Only one patient in the cTHA group required allogeneic blood transfusion. At 3 months postoperatively, both groups showed improvements in WOMAC pain score, WOMAC stiffness score, WOMAC physical function score, and Harris score, with no significant differences found between the two groups. Few complications were reported in both groups without significant differences.ConclusionsDespite the longer surgical time, rTHA did not negatively affect blood loss, pain, or functional recovery or lead to an increased risk of complications in ERAS-managed patients, suggesting that rTHA can be safely and effectively incorporated into an ERAS program for primary THA.

Efficacy of gelatin-thrombin matrix sealants for blood loss in single-level transforaminal lumbar interbody fusion.

Although gelatin-thrombin matrix sealants have been used successfully in other surgery types, their effect on reducing blood loss during single-level transforaminal lumbar interbody fusion is unclear. We thus examined the efficacy of gelatin-thrombin matrix sealants for reducing blood loss during such surgery. We analyzed 102 patients who underwent single-level transforaminal lumbar interbody fusion for lumbar degenerative disease. We compared body mass index, surgical time, intraoperative blood loss, postoperative blood loss, true total blood loss, hidden blood loss, the proportion of blood transfusion, blood pressure pre- and post-surgery (systolic and diastolic), and pre-and post-surgery laboratory data (hemoglobin, hematocrit, platelets, prothrombin time, activated partial thromboplastin time, and D-dimer) between patients in whom gelatin-thrombin matrix sealants were (GTMS group) or were not (control group) used during surgery. One-week postoperative epidural hematoma size was measured using magnetic resonance imaging. The GTMS and control groups included 54 (24 males and 30 females) and 48 patients (19 males and 29 females). Intraoperative, true total, and hidden blood loss; epidural hematoma size; and hospitalization duration were significantly lower in the GTMS than in the control group. Intraoperative blood loss correlated with surgical time (R = 0.523, P = .001), body mass index (R = 0.221, P = .036), and the amount of gelatin-thrombin matrix sealant used (r = -0.313, P = .002). In multivariate linear regression analysis using intraoperative blood loss as the dependent variable, surgical time (standardization coefficient 0.516, P = .001) and amount of gelatin-thrombin matrix sealant used (standardization coefficient -0.220, P = .032) were independently related factors. In our study, the GTMS group had significantly less intraoperative true total and hidden blood loss than did the control group. Thus, use of gelatin-thrombin matrix sealants reduce perioperative blood loss in transforaminal lumbar interbody fusion.

The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study.

Tranexamic acid (TXA) is safe and effective in preventing bleeding during spinal surgery. However, there is currently no relevant research on the efficacy and safety of adding TXA to the saline irrigation fluid in percutaneous endoscopic interlaminar diskectomy (PEID). This study aimed to evaluate the efficacy and safety of topical saline irrigation with TXA for PEID in the treatment of lumbar disk herniation. In this single-center, retrospective cohort study, patients who underwent PEID for L5-S1 lumbar disk herniation were included and allocated to two groups according to whether they had been administered TXA. PEID was performed with saline irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n = 38). In the control group (n = 51), the saline irrigation fluid was injected with the same volume of normal saline. All PEIDs were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index, and complication rate were compared between the two groups. The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and the operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate, and perioperative complications between the two groups. In PEID, the addition of TXA to topical saline irrigating fluid can significantly reduce the HBL, IBL, and TBL. The addition of TXA to topical saline irrigating fluid can improve visual clarity in the surgery and reduce operation time, but it does not change the coagulation function or the complication rate.

Assessment of Hidden Blood Loss in Spinal Metastasis Surgery: A Comprehensive Approach with MRI-Based Radiomics Models.

Patients undergoing surgery for spinal metastasis are predisposed to hidden blood loss (HBL), which is associated with poor surgical outcomes but unpredictable. To evaluate the role of MRI-based radiomics models for assess the risk of HBL in patients undergoing spinal metastasis surgery. Retrospective. 202 patients (42.6% female) operated on for spinal metastasis with a mean age of 58 ± 11 years were divided into a training (n = 162) and a validation cohort (n = 40). 1.5T or 3.0T scanners. Sagittal T1-weighted and fat-suppressed T2-weighted imaging sequences. HBL was calculated using the Gross formula. Patients were classified as low and high HBL group, with 1000 mL as the threshold. Radiomics models were constructed with radiomics features. The radiomics score (Radscore) was obtained from the optimal radiomics model. Clinical variables were accessed using univariate and multivariate logistic regression analyses. Independent risk variables were used to build a clinical model. Clinical variables combined with Radscore were used to establish a combined model. Predictive performance was evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, and F1 score. Calibration curves and decision curves analyses were produced to evaluate the accuracy and clinical utility. Among the radiomics models, the fusion (T1WI + FS-T2WI) model demonstrated the highest predictive efficacy (AUC: 0.744, 95% confidence interval [CI]: 0.576-0.914). The Radscore model (AUC: 0.809, 95% CI: 0.664-0.954) performs slightly better than the clinical model (AUC: 0.721, 95% CI: 0.524-0.918; P = 0.418) and the combined model (AUC: 0.752, 95% CI: 0.593-0.911; P = 0.178). A radiomics model may serve as a promising assessment tool for the risk of HBL in patients undergoing spinal metastasis surgery, and guide perioperative planning to improve surgical outcomes. 3 TECHNICAL EFFICACY: Stage 2.

Analysis of risk factors for postoperative delirium in middle-aged and elderly fracture patients in the perioperative period

To investigate the incidence rate and risk factors of postoperative delirium in middle-aged and elderly patients with fracture. A total of 648 middle-aged and elderly fracture patients who underwent surgical treatment in our hospital from January 2018 to December 2020 were included in the study, aged 50–103 years, mean 70.10 ± 11.37 years. The incidence of postoperative delirium was analyzed. Univariate analysis was used to screen the risk factors of gender, age, interval between injury and operation, preoperative complications, fracture site, anesthesia method, operation time, intraoperative blood loss, hidden blood loss and hormone use. For the factors with P < 0.05, multivariate logistic regression analysis was used to determine the main independent risk factors. 115 cases (17.74%) of 648 patients had postoperative delirium. Univariate analysis showed that patients with delirium and patients without delirium had significant correlation in age, medical disease comorbidity, fracture type, anesthesia method, operation time and perioperative blood loss (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 1.061), preoperative complications (OR = 1.667), perioperative blood loss (OR = 1.002) were positively correlated with postoperative delirium. It shows that older age, more preoperative complications, longer operation time and more perioperative bleeding are more likely to lead to postoperative delirium; patients with general anesthesia were more likely to develop postoperative delirium than patients with local anesthesia (OR = 1.628); and patients with hip and pelvic fractures are more likely to develop a postoperative delirious state (OR = 1.316). Advanced age, complex orthopedic surgery, more medical comorbidities, general anesthesia and greater perioperative blood loss may be independent risk factors for the development of delirium after internal fixation of fractures in middle-aged and elderly patients.

The effect of sequential perioperative intravenous tranexamic acid in reducing postoperative blood loss and hidden blood loss after posterior lumbar interbody fusion: a randomized controlled trial.

Tranexamic acid (TXA) has previously been shown to be effective in reducing intraoperative blood loss (IBL) and transfusion requirements in spine surgery. A conventional TXA regimen is a simple preoperative or intraoperative administration. However, the hyperfibrinolysis caused by surgical trauma lasts at least 24 h, and a single dose of TXA cannot cover the whole process of hyperfibrinolysis. Moreover, its ability to control postoperative blood loss (PBL) may be insufficient. Therefore, this study aimed to explore the effects and safety of sequential perioperative intravenous TXA for reducing bleeding after posterior lumbar interbody fusion (PLIF). Patients requiring PLIF were randomly divided into two groups. All patients were intravenously injected with 1 g of TXA 15 min before skin resection. Every day after the surgery, 200 ml saline was intravenously injected for 1-3 days in Group A, while Group B received 1 g of TXA instead of saline. The total blood loss (TBL), IBL, PBL, HCT, Hb, blood transfusion volume, inflammation-related indicators, and complications were recorded. TBL, PBL, and hidden blood loss (HBL) in Group B were significantly lower than those in Group A (P < 0.05). The maximum decreases in HCT and Hb in Group B were also significantly lower than those in Group A (P < 0.05), and the drainage removal time (DRT) was sooner in Group B than in Group A (P = 0.003). On the 3rd and 5th days after surgery, the level of CRP in Group B was significantly lower than that in Group A (P < 0.05). Similarly, IL-6 levels were significantly lower in Group B for the first 5 days postoperatively (P < 0.001). Sex, operation time, level of decompression, length of incision, and change in HCT were significant predictors of both TBL and HBL. TBL was also significantly associated with BMI and preoperative fibrinogen, while postoperative TXA was a significant predictor of HBL only. Intravenous injection of 1 g of TXA 15 min before skin resection combined with continuous intravenous injection of 1 g of TXA 1 to 3 days after PLIF can reduce postoperative bleeding and shorten the time to drainage tube removal. In addition, it can also inhibit the postoperative inflammatory response. ChiCTR2200056210.

Early Posttraumatic Antifibrinolysis Reduces Perioperative Hidden Blood Loss in Elderly Patients with an Intertrochanteric Fracture: A Randomized Controlled Trial.

This study aimed to determine the efficacy and safety of posttraumatic antifibrinolysis with multidose tranexamic acid (TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric fracture patients. Ninety-six elderly intertrochanteric fracture patients admitted to our department from June 2021 to September 2022 were randomized into two groups. The control group (Group A) received 100 mL of normal saline, while the experimental group (Group B) received 1.5 g of TXA intravenously q12 h from postadmission Day 1 (PAD1) to the day before surgery, and both groups received 1.5 g of TXA q12 h from postoperative Day 1 (POD1) to POD3. Haemoglobin (Hb), haematocrit (Hct), coagulation parameters, fibrinogen degradation product (FDP), and D-dimer (D-D) were recorded from PAD1 to POD3. HBL was calculated using the gross formula and recorded as the primary outcome. In all-over analyses, the patients in Group B had lower perioperative HBL (on PAD3, POD1, and POD3), preoperative HBL (HBLpre), decline of haemoglobin (ΔHb-on PAD3), allogeneic blood transfusion (ABT) rate, FDP (on PAD3), and D-D (on PAD3) compared with Group A. No significant differences were exhibited in postoperative HBL (HBLpost) between the 2 groups. In subgroup analyses, for patients who received intervention within 24 h, the result is consistent with the whole. For patients who received intervention over 72 h of injury, there were no significant differences in perioperative HBL, ΔHb, ABT rate, FDP, and D-D between the 2 groups. There were no significant differences in APTT, PT, the rate of venous thromboembolism, wound complications, or 90-day mortality between the 2 groups. For elderly intertrochanteric fracture patients, early posttraumatic antifibrinolysis with multidose TXA is effective in reducing perioperative HBL, which mainly manifests as the reduction of preoperative HBL, especially for patients injured within 24 h. Application of TXA beyond 72 h of injury was ineffective.

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

BackgroundMeta-analyses on the use of tranexamic acid (TXA) in intertrochanteric fractures have shown inconsistent results due to variations in inclusion criteria and clinical heterogeneity. To address these limitations, we conducted a rigorous analysis of recent randomized controlled trials (RCTs) with strict inclusion criteria. The aim of this study was to objectively evaluate the effects and safety of intravenous TXA administration in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing.MethodsPubMed, Embase, and the Cochrane Library were searched for RCTs published from the database inception to August 2022. The date of total blood loss (TBL), intra-operative blood loss (IBL), hidden blood loss (HBL), transfusion rate, transfusion units, thromboembolic events, and mortality were extracted. Review Manager 5.3 was used for the analysis.ResultsA total of six RCTs involving 689 patients were included. Meta-analyses indicated that TXA can significantly reduce TBL (WMD = -232.82; 95% CI -312.81 to -152.84; p < 0.00001), IBL (WMD = -36.33; 95% CI -51.38 to -21.28; p < 0.00001), HBL (WMD = -189.23; 95% CI -274.92 to -103.54; p < 0.0001), transfusion rate (RR = 0.53; 95% CI 0.33 to 0.85; p = 0.008), and transfusion units (WMD = -0.58; 95% CI -0.75 to -0.41; p < 0.01). No increase in thromboembolic events rate (RR = 0.75; 95% CI 0.38 to 1.50; p = 0.42) and mortality (RR = 1.36; 95% CI 0.61 to 3.04; p = 0.45) was observed.ConclusionsOur meta-analysis provides robust evidence supporting the efficacy and safety of intravenous TXA administration in treating geriatric intertrochanteric femoral fractures with intramedullary nailing. TXA significantly reduces blood loss and transfusion requirements without increasing the risk of thromboembolic events or mortality.

Efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism after revision hip arthroplasty: a retrospective cohort study.

The purpose of the study is to determine the efficacy and safety of postoperative single-dose anticoagulant treatment in preventing venous thromboembolism (VTE) after revision THA, in comparison with a multiple-dose chemoprophylaxis protocol. We retrospectively compared 295 patients undergoing revision THA who received multiple-dose chemoprophylaxis protocol (40mg low-molecular-weight heparin once and oral rivaroxaban for 10days) or single-dose chemoprophylaxis protocol (40mg low-molecular-weight heparin once) for VTE. The patients in both groups performed active lower limb exercises. Each group was further stratified into subgroups based on the aetiology of revision. The incidence of VTE, wound complications within threemonths, hidden blood loss (HBL), transfusion rate, and surgical drainage duration were recorded. The incidence rates of VTE (P = 0.870) did not differ between the two prophylaxis protocols. However, significant differences were observed in wound complications within threemonths (P = 0.002), HBL (P = 0.015), transfusion rate (P = 0.028). Surgical drainage duration was also shorter in the single-dose chemoprophylaxis group (P = 0.0023). In the subgroup analysis, the use of single-dose chemoprophylaxis protocol cannot significantly reduce HBL and transfusion rate after septic revision THA. The use of multiple-dose chemoprophylaxis protocol (OR = 2.89, P = 0.002) and high BMI (OR = 1.09, P = 0.037) were independent risk factors of wound complications. Single-dose chemoprophylaxis protocol effectively and safely prevented VTE after revision THA compared with multiple-dose chemoprophylaxis protocol. The effect in reducing HBL and postoperative transfusion rate was limited in septic revision.