Surgery Intraoperative Blood Loss Research Articles

Prediction of massive bleeding in pancreatic surgery based on preoperative patient characteristics using a decision tree.

Massive intraoperative blood loss (IBL) negatively influence outcomes after surgery for pancreatic ductal adenocarcinoma (PDAC). However, few data or predictive models are available for the identification of patients with a high risk for massive IBL. This study aimed to build a model for massive IBL prediction using a decision tree algorithm, which is one machine learning method. One hundred and seventy-five patients undergoing curative surgery for resectable PDAC at our facility between January 2007 and October 2020 were allocated to training (n = 128) and testing (n = 47) sets. Using the preoperatively available data of the patients (34 variables), we built a decision tree classification algorithm. Of the 175 patients, massive IBL occurred in 88 patients (50.3%). Binary logistic regression analysis indicated that alanine aminotransferase and distal pancreatectomy were significant predictors of massive IBL occurrence with an overall correct prediction rate of 70.3%. Decision tree analysis automatically selected 14 predictive variables. The best predictor was the surgical procedure. Though massive IBL was not common, the outcome of patients with distal pancreatectomy was secondarily split by glutamyl transpeptidase. Among patients who underwent PD (n = 83), diabetes mellitus (DM) was selected as the variable in the second split. Of the 21 patients with DM, massive IBL occurred in 85.7%. Decision tree sensitivity was 98.5% in the training data set and 100% in the testing data set. Our findings suggested that a decision tree can provide a new potential approach to predict massive IBL in surgery for resectable PDAC.

Bisphosphonates May Reduce Intraoperative Blood Loss in Surgery for Metastatic Spinal Disease: A Retrospective Cohort Study.

PurposeThis study was undertaken to investigate the relationship between bisphosphonate use and intraoperative blood loss following surgery for metastatic spinal disease.MethodsWe retrospectively analyzed cancer patients who were treated by metastatic spinal tumor surgery at our institution. Recorded data included intraoperative blood loss, timing and duration of bisphosphonate use, and other important confounding factors. We showed the results of crude model, minimally adjusted model, and fully adjusted model to fully observe the effects of bisphosphonates under different adjustment strategies. The timing and duration of bisphosphonate exposure were assessed and statistical results were tested to identify a trend.ResultsA total of 467 patients were treated by metastatic spinal tumor surgery, with or without bisphosphonate treatments. In all adjustment strategies, intraoperative blood loss was lower in patients using bisphosphonates than in patients without bisphosphonate treatments. In the fully adjusted model, the effect size, confidence interval, and p value were −246.4, −447.0 to −45.8, and 0.017, respectively. In terms of duration, all three models showed the same duration–response relationship: a longer duration of bisphosphonate use accurately predicted a smaller amount of blood loss (p for trend <0.001). We observed an interaction between operative time and bisphosphonate use, the effect size in the bottom tertile group was significantly smaller than that in the other two groups.ConclusionWe found that the preoperative use of bisphosphonates could reduce the amount of intraoperative blood loss during metastatic spinal tumor surgery, especially for surgery with longer operative time.

Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis

BackgroundAdolescent idiopathic scoliosis (AIS) is a common spinal deformity. Posterior spinal fusion remains an important surgical treatment for AIS. This study aims to determine the predictive factors for intraoperative blood loss in AIS surgery.MethodsPatients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis in a single university hospital were reviewed over a 7-year period. Predictive factors for intra-operative blood loss were studied by multivariate analysis to derive a regression model. Receiver operating characteristic analysis was performed to determine the cut-off values of factors contributing to significant intraoperative blood loss (≥500 ml).ResultsTwo hundred and twelve patients were included. Intraoperative blood loss was found to be correlated with gender (rs = 0.30 (0.17–0.43)), preoperative hemoglobin level (rs = 0.20 (0.04–0.31)), preoperative Cobb angle (rs = 0.20 (0.02–0.29)), number of fused levels (rs = 0.46 (0.34–0.58)), operation duration (rs = 0.65 (0.54–0.75)), number of anchors (rs = 0.47 (0.35–0.59)), and p-value ranged from < 0.001 to < 0.05. Significant intraoperative blood loss was influenced by the male gender, operation duration greater than 257.5 min and more than 10 anchors used.ConclusionsMale gender, increased operation duration and higher number of anchors predicted higher intra-operative blood loss.

Bipolar sealing devices in video-assisted thoracic surgery.

Intraoperative bleeding is one of the main severe complications in complete video-assisted thoracic surgery (c-VATS) and post-operative air-leaks prevention still represents an important challenge. Usually, hemostasis is often difficult and unsafe when the VATS approach is performed and the potential role of bipolar sealing devices is still undefined, as proven by limited experiences reported in the literature. By introducing endostaplers in VATS surgery, it was possible to perform safe thoracoscopic resections of lung. On the other hand, several diathermy techniques have been proposed to reduce intraoperative blood loss in surgery. In particular, standard bipolar technology has proven to effect coagulation in small vessels. The aim of this study is to compare bipolar electro thermal devices to endostapler in VATS lung resections concerning intraoperative bleeding and post-operative air leaks.

Laparoscopy versus laparotomy in the treatment of benign ovarian cyst

Objective: To compare laparoscopy with laparotomy in the treatment of benign ovarian cyst in women under 40 years of age. Design: Experimental. Place and duration of study: The study was conducted over a period of one and half year from June 2003 to Nov 2004 in Obstetrics &amp; Gynaecology Department, Unit-III, Lady Willingdon Hospital, Lahore. Subjects &amp; Methods: The sixty consecutive patients of benign ovarian cysts who required surgical treatment underwent either Laparoscopy(group I). or laparotomy (group II). The laparoscopic fenestration, aspiration and cystectomies were performed in group I (30 patients). However, ovarian cystectomies, salpingo-oophorectomy and oophorectomy were performed by laparotomy in group II (30 patients). Results: The comparison was done with respect to duration of surgery intra-operative blood loss, time of mobilization, duration of hospital stay and amount of analgesia used, time to return to normal activity. The amount of analgesics used, time of mobilization, duration of hosp ital stay and time to return to normal activity was less (P&lt;0.05) in Laparoscopy as compared to Laparotomy. There was statistically no significant difference in the duration of surgery, blood loss and post operative morbidity (P&gt;0.05). Conclusion: With appropriate preoperative evaluation, laparoscopic surgery is safe and effective in treating benign ovarian cyst in women under 40 years of age where the risk of malignancy is low. It is associated with early mobilization, less use of analgesia, shorter hospital stay.

The role of preoperative vascular embolization in surgery for metastatic spinal tumours

To determine the effect of preoperative embolization on intraoperative blood loss in surgery for metastatic spinal tumours stratified by tumour type, type of surgical approach and extent of surgery. We retrospectively analysed 218 patients undergoing open surgery for metastatic spine tumours in our institution between 2005 and 2014. The cohort was divided to those who underwent preoperative embolization and those who did not. The patients were further stratified into different subgroups by tumour types, types of surgical procedure, levels of instrumentation and levels of decompression. Estimated blood loss, duration of surgery and length of hospital stay were compared between embolized and non-embolized cases in each subgroup. The impact of embolization extent, the time gap between embolization and index surgery on blood loss were also studied. Preoperative embolization was performed in 45 out of 218 patients. Non-embolized cases had insignificantly lesser blood loss and shorter duration of surgery compared to embolized cases in all subgroups. Embolization, however, conferred reduction in length of hospital stay in some of the subgroups, yet the differences were not significant. The patients who achieved total embolization bled less than those who achieved subtotal or partial embolization. The effectiveness of the embolization procedure in reducing intraoperative blood loss was found to be profound when the gap between embolization and surgery was within 24h. Our study demonstrated that success of embolization in reducing blood loss depends on the extent of embolization and time interval between embolization and index surgery.

Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy

<b>Introduction:</b> Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system (Ligasure) has been applied in various specialties of surgery. The objective of this randomized study was to compare the outcome of ligasure versus conventional clamping and tie in total thyroidectomy for benign thyroid diseases. <b>Patients and Methods:</b> A total of 200 patients diagnosed to have bilateral BMNG were subjected to primary total thyroidectomy and divided into two main groups Ligasure (L) and Suture-Ligation (SL). For detection of laryngeal nerves status, vocal cords were checked immediately postoperatively by laryngoscope and at the day 10 of postoperative period to assess the status of both laryngeal nerves. The function of the parathyroids was checked by detecting the serum calcium concentration and parathyroid hormone level. The following parameters were measured to compare the effect of ligasure versus conventional suture-ligation technique in decreasing the operative blood loss, operative time, securing laryngeal nerves and parathyroids, postoperative drainage and postoperative wound infection. <b>Results:</b> There was no statistical difference between the two groups regarding age, sex and body mass index and also there was no operative mortality. As regard the operative time, in ligasure group it was 115.54 &plusmn;15.35 minutes while in suture-ligation group was 127.1 &plusmn;7.95 minutes and intraoperative blood loss in group A was 62.06 &plusmn; 7.34 and in group B was 75.84± 9.21. Temporary RLN injury was detected in 3 patients (3%) in group A and in 5 patients in group B (5%). No permanent hypoparathyroidism was seen in group A patients but in one patient (1%) of group B, transient hypoparathyroidism occurred in 2 patients (2%) of both groups. The amount of fluid drained in group A was 54.16 &plusmn;9.21 and 66.28 &plusmn;8.99 in group B. <b>Conclusion:</b> The use of the Ligasure sealing system in total thyroidectomy is proved safe and effective in reducing the operative time, intraoperative blood loss together with reduction in postoperative fluid drainage. Owing to the ability to reduce energy spread profile, use of Ligasure sealing system is accompanied with better outcome regarding the function of laryngeal nerves and parathyroids.

ВЛИЯНИЕ МОРФОЛОГИЧЕСКИХ ОСОБЕННОСТЕЙ КОСТНОЙ И МЫШЕЧНОЙ ТКАНЕЙ НА ВЕЛИЧИНУ КРОВОПОТЕРИ В ХИРУРГИИ ИДИОПАТИЧЕСКОГО СКОЛИОЗА

Objective. To analyze morphological features of tissue structures (bone and muscle tissue) and their correlation with osteodensitometry data for predicting the volume of intraoperative blood loss in surgery for idiopathic scoliosis. Material and Methods. Articular processes of vertebrae and fragments of muscle tissue obtained from 50 patients undergoing surgery for idiopathic scoliosis were investigated. All patients underwent osteodensitometry before surgery. Data on the volume of intraoperative blood loss were analyzed. Results. Morphologic study of specimens (n = 21) revealed significant features: atrophy of bone trabeculae with irregular arrangement of osteocytes, widening of intertrabecular spaces, large number of hemosiderophages in the bone marrow, absence of the process of osteogenesis, atrophy of muscle fibers, and enlarged thin-walled vessels. Intraoperative blood loss in patients with these observations - from 30 to 50 % of total blood volume, and osteodensitometry revealed osteoporosis. The study found a weak correlation between indicators of bone density and volume of intraoperative blood loss. Conclusion. Morphological changes in bone and muscle tissue in patients with idiopathic scoliosis are risk factors for massive blood loss in surgery for scoliosis. Findings of preoperative osteodensitometry may be an indirect predictor of the volume of intraoperative blood loss.

Pre-operative gonadotrophin-releasing hormone agonist treatment in surgery for uterine leiomyomata

To determine whether pre-operative treatment with gonadotrophin-releasing hormone (GnRH) analogue may have a beneficial effect on surgery outcome, 53 patients with symptomatic fibroid uteri awaiting myomectomy or transabdominal hysterectomy (TAH), were randomly divided into a study group (n = 29) and a control group (n = 24). The study group of patients were treated by an i.m. injection of D-Trp6 LHRH microcapsules at 2 months and 1 month prior to surgery. The control group had no pre-operative treatment. Haemoglobin concentration and oestradiol, follicle-stimulating hormone and luteinizing hormone concentrations were measured at 2 months and 1 month prior to surgery, and at surgery. The duration of surgery was shorter in the study group (49 versus 70 min in the hysterectomy group) and intra-operative blood loss was less (208 versus 309 ml in the hysterectomies and 320 versus 476 ml in the myomectomies). Pre-operative treatment with GnRH-agonists which induces shrinkage of the uterus and fibroids is therefore efficient in shortening the duration of surgery, and diminishing the intra-operative blood loss in surgery for fibroid uteri. Such pre-operative treatment is therefore a useful addition to surgery in cases with symptomatic fibroid uteri.