Intraoperative Blood Transfusion Requirements Research Articles

Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis.

To evaluate the effectiveness of the use of topical tranexamic acid (tTXA) in spinal deformity correction in AIS patients METHODS: Sixty consecutive operative AIS patients were reviewed from a single institution and divided into two groups with similar demographics. Standardized peri-operative blood salvage techniques were utilized in all 60 patients. In the latter 30 patients, tTXA soaked sponges (1g mixed in 500ml Normal Saline) was utilised for wound packing during the entire surgical procedure compared to dry sponges as used in the former 30 patients. Both the groups were compared for the magnitude of deformity corrected, EBL per level fused, total EBL, blood transfused, drain output and peri-operative events. Sixty AIS patients (mean age 14.4 yrs, 43 females, mean BMI 21.5, mean levels 10.7) were included. Both groups achieved similar change in Coronal Cobb correction. The EBVL (Estimated blood volume loss) % lost in the topical TXA group was 38% less than the control group (11.2 vs. 18.3%, p = 0.006). Similarly, the EBL/level was significantly lower in the topical TXA group (41 ± 30ml vs. 57 ± 26ml, p = 0.03). Three of 30 patients in the control group required at least 1 unit of blood transfusion, whereas only 1 patient in the topical TXA group required transfusion (10 vs. 3.3%, p = 0.001). No differences were noted in post-operative drain output, change in hemoglobin levels, and peri-operative complication rates. When used as an adjunct to the conventional blood salvage techniques in spinal deformity correction procedures, the use of tTXA resulted in reduced operative blood loss, and blood transfusion requirements.

Defining high volume center for minimally invasive distal pancreatectomy

Introduction: Minimally Invasive Distal Pancreatectomy (MIDP) is associated with reduced intra-operative blood loss, transfusion requirement, and shorter length of stay compared to open distal pancreatectomy (ODP). Several studies have outlined the relationship between hospital volume and postoperative mortality for patients undergoing pancreatic surgery,but the exact effect of centralization of care for MIDP still needs to be determined.The purpose of this study is to evaluate the association between hospital-procedure-volume and mortality for patients undergoing MIDP to determine an evidence-based threshold of hospital volume associated with improvement in mortality.

Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta.

Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000–4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500–10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200–8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800–15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.

Outcomes of press-fit uncemented versus cemented hip arthroplasty in the oncologic patient

Background and objectivesCemented hip arthroplasty is considered the standard of care for treating both osteoporotic femoral neck fractures and pathologic disease of the proximal femur due to the ability to achieve strong fixation in poor quality bone. There is minimal literature evaluating uncemented arthroplasty for pathologic disease of the proximal femur. This objective of this study is to compare outcomes of patients undergoing cemented and uncemented arthroplasty of the proximal femur for an oncologic indication. MethodsPatients who underwent hip arthroplasty procedures in one health system for an oncologic indication were identified. Demographics, cancer history, operative history, and complications were collected retrospectively. Harris Hip Scores (HHS) and Musculoskeletal Tumor Society Scores (MSTS) were prospectively collected via telephone. Results41 patients met criteria for review. 18 underwent cemented and 23 underwent uncemented arthroplasty. There were no significant differences in age, demographics, complications, 30-day mortality, intraoperative blood loss, transfusion requirements, average HHS, or average MSTS. ConclusionNo significant differences were found for patients undergoing hip arthroplasty for an oncologic indication regardless of whether or not the femoral component was cemented. Our results suggest that cemented and uncemented techniques are both safe and effective methods to be used at the oncologic surgeon's discretion.

Effect of tranexamic acid use on blood loss in hip surgeries: A prospective randomized controlled study

Major orthopedic surgeries are usually associated with high blood loss and the need for blood transfusions. Blood transfusion has got its disadvantages so also the various blood conservation techniques described so far. A prospective, randomized, double-blind, comparative study was done to study the role of tranexamic acid in 60 adults undergoing elective hip surgeries, viz. total hip replacement, hemiarthroplasty hip, intertrochanteric fracture fixation. The patients were grouped into group ‘T’ (Tranexamic acid group) and group ‘S’ (Normal Saline group). Bolus preoperative dose followed by continuous intraoperative infusion was given. The mean blood loss was 412 ± 129.49 ml among ‘T’ group which was less than 528± 117.16 ml in ‘S’ group. The total number of patients who required blood transfusion was higher (26.7%) in ‘S’ group than those in ‘T’ group (16.07%). Thus, preoperative tranexamic acid is effective in reducing intraoperative blood loss and blood transfusion requirements in elective hip surgeries.

Perioperative Comparison of Preemptive and Non-Preemptive Renal Transplant Recipients.

ObjectivePreemptive transplantation cannot be performed for all patients because of the limited number of donors. This study aimed to evaluate the perioperative effects of dialysis before renal transplantation.MethodsIn this study, we retrospectively investigated 666 patients who underwent kidney transplantation at our centre. We divided patients into two groups: patients with pre-transplant dialysis (67.3%, n=448) and patients with preemptive transplant (32.7%, n=218). We carried out preoperative, intraoperative and postoperative comparisons between groups.ResultsNo difference was observed in terms of intraoperative blood transfusion, crystalloid and colloid requirement, inotropic-vasopressor agent administration and hemodynamic parameters between the patients with pre-transplant dialysis and preemptive transplant. It was observed that dialysis requirement, delayed graft function and acute rejection development were significantly higher during the postoperative period in patients who underwent dialysis before transplantation. In patients with non-preemptive transplant, the decrease of serum creatinine levels at the first postoperative month was more prominent when compared to patients with preemptive transplant; however, that difference disappeared in the first year follow-up. No significant difference was found for serum albumin levels and proteinuria alterations of the patients in long-term follow-up. Additionally, patient and graft survival comparisons between patients with non-preemptive and preemptive transplant on three-year follow-up revealed no significant difference.ConclusionWe think that preemptive transplantation treatment is a better option for patients with end-stage renal failure since patients with preemptive transplantation appear to have less metabolic function impairment, complication risk and more successful outcomes in terms of cost-effectiveness.

The Use of Tranexamic Acid (TXA) in Neuromuscular Hip Reconstruction: Can We Alter the Need for Blood Transfusion?

Children with neuromuscular complex chronic conditions (NMCCC) frequently undergo hip reconstruction surgery requiring blood transfusion. The purpose of this study is to examine the efficacy of tranexamic acid (TXA) to reduce blood loss and transfusion requirement in NMCCC children undergoing hip reconstruction surgery. Children with NMCCC undergoing hip reconstruction surgery between 2013 and 2018 were identified. Two cohorts were identified: those who received TXA and those who did not. Patient and surgical characteristics between cohorts were used for propensity matching. Patients were matched on the basis of comorbid factors, bilateral involvement, pelvic osteotomy, open reduction, and surgeon. Comparative outcomes between cohorts were analyzed for intraoperative and postoperative blood loss and transfusion requirements and length of hospital stay (LOS). A total of 166 patients underwent hip surgery at an average of 9.6 years (SD, 4.0). Propensity matching utilized 72% of the cohort including 47 TXA and 72 non-TXA subjects. There were no differences in patient or surgical characteristics across matched groups. Fifteen (15/47, 32%) TXA subjects required a postoperative blood transfusion compared with the 47% (34/72) of non-TXA subjects who required a transfusion and intraoperative transfusion rates were similar between the 2 groups. There was no significant difference in complication rate (TXA, 79%; non-TXA, 86%), reported estimated blood loss (median=200 mLfor both) or LOS (median=6 d for both). Hematocrit levels were slightly higher in TXA subjects intraoperatively (P=0.047), at the end of surgery (P=0.04), and for the overall lowest perioperative level (P=0.04). The overall percent loss of estimated blood volume was less for those who were given TXA compared with those who were not (P=0.001). The use of TXA during hip reconstruction surgery in NMCCC children significantly reduced the percent loss of estimated blood volume and postoperative transfusion rate. Further prospective multicenter studies are needed to verify the positive effects and safety of TXA in the setting of hip reconstruction surgery in NMCCC children. Level III-retrospective comparative study.

The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures.

The aim of this study was to determine if the use of tranexamic acid (TXA) in long-segment spinal fusion surgery can help reduce perioperative blood loss, transfusion requirements, and morbidity. In this retrospective single-center study, the authors included 119 consecutive patients who underwent thoracolumbar fusion spanning at least 4 spinal levels from October 2016 to February 2019. Blood loss, transfusion requirements, perioperative morbidity, and adverse thrombotic events were compared between a cohort receiving intravenous TXA and a control group that did not. There was no significant difference in any measure of intraoperative blood loss (1514.3 vs 1209.1 mL, p = 0.29) or transfusion requirement volume between the TXA and control groups despite a higher number of pelvic fusion procedures in the TXA group (85.9% vs 62.5%, p = 0.003). Postoperative transfusion volume was significantly lower in TXA patients (954 vs 572 mL, p = 0.01). There was no difference in the incidence of thrombotic complications between the groups. TXA appears to provide a protective effect against blood loss in long-segment spine fusion surgery specifically when pelvic dissection and fixation is performed. TXA also seems to decrease postoperative transfusion requirements without increasing the risk of adverse thrombotic events.

Defining high volume center for minimally invasive distal pancreatectomy

Presenter: Roheena Panni MD, MPHS | Washington University, St. Louis Background: Minimally Invasive Distal Pancreatectomy (MIDP) is associated with reduced intra-operative blood loss, transfusion requirement, and shorter length of stay compared to open distal pancreatectomy (ODP). However, its advantages over OPD and oncologic adequacy are unclear, due to the small number of centers performing MIDP and strict patient selection criteria. Several studies have outlined the relationship between hospital volume and postoperative mortality for patients undergoing pancreatic surgery, but the exact effect of centralization of care for MIDP still needs to be determined. The purpose of this study is to evaluate the association between hospital procedure volume and mortality for patients undergoing MIDP using a large database to determine an evidence-based threshold of hospital volume associated with improvement in mortality. Methods: Patients who underwent MIDP were identified using the National Cancer Database from 2010 to 2015. The relationship between hospital volume and 90-day mortality was assessed using a logistic regression model. Logistic regression analysis and restricted cubic spline regression analysis was performed to determine the linear and non-linear association between mean hospital volume and mean 90-day mortality. Results: 2,837 patients underwent distal pancreatectomy at 487 different hospitals. 30- and 90-day mortality of the study population were 1.27% (n=36) and 2.54% (n=72), respectively. Baseline characteristics and mean annual mortality of individual hospitals were determined (fig1). A logistic regression analysis was performed, which demonstrated that institutional volume is significantly associated with decreased overall 90-day mortality. The maximum improvement in 90-day mortality is seen if the annual hospital volume was greater than 7 (p<0.0001). We further explored the non-linear association between institutional volume and 90-day mortality, which demonstrated continued improvement in 90-day mortality with an increase in average hospital volume. Conclusion: Our data suggest that the centralization of MIDP is associated with lower postoperative mortality. Based on the results, we recommend defining a high volume center as hospitals performing eight or more MIDP cases per year. The true impact of this finding on overall survival should be assessed in future studies using large databases with long-term follow-up information.

Systematic Review and Meta-analysis of Minimally Invasive Pancreatectomies for Solid Pseudopapillary Neoplasms of the Pancreas.

We report the first systematic review and meta-analysis on minimally invasive pancreatectomy (MIP) for solid pseudopapillary neoplasms (SPPN) of the pancreas. A systematic review of all studies reporting patient characteristics and outcomes of MIP for SPPN was conducted. We reviewed 27 studies comprising 149 patients with SPPN managed via MIP. Five were comparative retrospective cohort studies, comprising 46 and 60 patients in the minimally-invasive and open groups, respectively. Tumor size was smaller in the minimally-invasive group (mean difference, -2.20; 95% confidence interval (CI), -3.09 to -1.32; P < 0.001). The MI group had lower intraoperative blood loss (mean difference, -180.19; 95% CI, -344.28 to -16.09; P = 0.03) and transfusion requirement (relative risk, 0.24; 95% CI, 0.06-0.94; P = 0.04), and a shorter time to diet (mean difference, -2.99; 95% CI, -3.96 to -2.03; P < 0.001) and length of stay (mean difference, -3.61; 95% CI, -6.98 to -0.24; P = 0.04). There was no significant difference in operating time, margin positivity, postoperative morbidity, and postoperative pancreatic fistula rates. Minimally invasive pancreatectomy for SPPN is associated with decreased intraoperative blood loss and transfusion requirements and a shorter postoperative time to diet and hospital stay.

Epsilon-aminocaproic acid versus tranexamic acid in total knee arthroplasty: a meta-analysis study

IntroductionTotal knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [1]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery.Materials and methodsMEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics.ResultsThree studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) −0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI −0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI −0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI −0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI −0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61).ConclusionsThis study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA surgery.Level of evidence3.

Is Intraoperative Blood Cell Salvage Effective in Hip Surgery?

Objective The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury. Methods Prospective cohort of 38 patients from a school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0. Results There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group ( p < 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found. Conclusion This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.

Intensive Care Unit Readmission After Left Ventricular Assist Device Implantation: Causes, Associated Factors, and Association With Patient Mortality.

Previous studies on readmissions after left ventricular assist device (LVAD) implantation have focused on hospital readmissions after dismissal from the index hospitalization. Because few data exist, the purpose of this study was to examine intensive care unit (ICU) readmissions in patients during their initial hospitalization for LVAD implantation to determine reasons for, factors associated with, and incidence of mortality after ICU readmission. A retrospective analysis was performed from February 2007 to March 2015 of patients at our institution receiving first-time LVAD implantation. After LVAD implantation, patients dismissed from the ICU who then required ICU readmission before hospital dismissal were compared to those not requiring ICU readmission before hospital dismissal with respect to preoperative, intraoperative, and postoperative factors. Among 287 LVAD patients, 266 survived their initial ICU admission, of which 49 (18.4%) required ICU readmission. The most common reasons for readmission were bleeding and respiratory failure. Factors found to be univariably associated with ICU readmission were preoperative hemoglobin, preoperative aspartate aminotransferase, preoperative atrial fibrillation, preoperative dialysis, longer cardiopulmonary bypass times, and higher intraoperative allogeneic blood transfusion requirements. Multivariable analysis revealed ICU readmission to be independently associated with preoperative dialysis (odds ratio, 12.86; 95% confidence interval, 3.16-52.28; P < .001). Overall mortality at 1 year was 22.6%. Survival after hospital dismissal was worse for patients who required ICU readmission during the index hospitalization (adjusted hazard ratio, 2.35; 95% confidence interval, 1.15-4.81; P = .019). ICU readmission after LVAD implantation occurred relatively frequently and was significantly associated with 1-year mortality after hospital dismissal. These data can perhaps be used to identify subsets of LVAD patients at risk for ICU readmission and may lead to implementation of practice changes to mitigate ICU readmissions. Future larger and prospective studies are warranted.

Abstract No. 553 Preoperative embolization of bone cancers: tumor types, location, estimated blood loss, and blood transfusion requirements

Osseous metastases of certain primary cancers are hypervascular, such as renal cell carcinoma (RCC), and lead to concern for life-threatening high intra-operative blood loss and high intra-operative blood transfusion requirements. Some primary bone cancers can also appear hypervascular and in certain locations hemorrhage can lead to significant complications, such as the spine. Preoperative embolization of hypervascular osseous tumors is thought to decrease intra-operative bleeding. To evaluate intra-operative blood loss and blood transfusions after preoperative embolization, we reviewed our experience with preoperative embolization of osseous cancers. We reviewed imaging and medical charts for preoperative embolization by interventional radiology at a large academic institution for the past 4 years. Patient demographics, tumor type, tumor location, embolic agent(s) used, date of procedure and surgery, estimated blood loss (EBL), blood products administered and complications were reviewed. Thirteen bony tumors had preoperative embolization followed by surgical resection. The majority of the cancers, 62%, were renal cell carcinoma, followed by non-squamous cell lung cancer, 15%. The majority of cases involved the lower extremity, 62%, followed by the upper extremity, 23%, followed by the spine, 15%. The mean EBL for spine cases was 2850 mL versus 619 mL for non-spine cases, which was significantly different (p < 0.05). The EBL for lower extremity cases was 726 mL and for upper extremity cases was 333 mL. The mean EBL for RCC cases was higher than non-RCC cases (1051 mL versus 763 mL) but not significantly different (p = 0.8). The average packed red blood cells transfused was also highest for spine cases, 3 units versus 1.1 for extremity cases but this was not significantly different. The mean number of blood transfusions was also not significantly different depending on tumor type. There were no reported complications. No complications were reported with any of the preoperative embolizations or subsequent surgeries. EBL was significantly higher for spine cases. The mean EBL for RCC cases was higher than non-RCC cases but not significantly different.

Calculated Blood Loss and Transfusion Requirements in Primary Open Repair of Craniosynostosis.

Background:Open surgical correction is effective in the treatment of craniosynostosis but may result in significant blood loss and transfusions. This study seeks to compare surgeon estimated blood loss with calculated blood loss and provide contemporary data that objectively quantify blood loss and transfusion rate associated with open repair of craniosynostosis.Methods:A retrospective review of patients undergoing primary open repair of craniosynostosis between May 2011 and November 2016 was performed. The medical records of 43 patients were reviewed to obtain the operative age, weight, affected suture, pre- and postoperative hematocrit, blood transfusion volume, estimated blood loss, and syndromic status. Estimated blood volume (EBV) and red cell mass were calculated for analysis.Results:The median age and weight at the time of surgery were 9 months and 8.6 kg, respectively. Mean surgeon estimated blood loss was 207.4 mL (28.1% of EBV). Mean calculated blood loss was 318 mL (44.3% of EBV). The mean transfusion volume was 188 mL (26.5% of EBV). The mean transfusion as a percent of estimated red cell mass was 59.1%. Fourteen percent of patients did not require any transfusion.Conclusions:We report intraoperative blood losses and transfusion requirements that are lower than those of many previous studies of open repair of craniosynostosis. Additionally, we found that calculated blood loss estimates may be more reliable than surgeon-derived estimated blood loss. We hope that these updated, objective data will be useful in comparisons of open repair to minimally invasive surgery or to new blood loss reducing procedures.

Tranexamic Acid Utilization in Craniosynostosis Surgery.

To analyze the impact of Tranexamic acid (TXA) on perioperative hemodynamics in craniosynostosis surgery. Data of thirty-six children (operated between 2014-2017) were categorized into two groups depending on TXA delivery. Patient demographics, preoperative, intraoperative, postoperative data on hemostasis and metabolic outcomes were recorded. Blood loss from the drains, estimated blood loss (EBV loss), volume of blood transfusions, hemodynamic alerations and complications were extracted. Postoperative outcome involved variables at admission, 2 < sup > nd < /sup > , 6 < sup > th < /sup > , 12 < sup > th < /sup > , 24 < sup > th < /sup > hours. A multiple logistic regression analysis was also performed. Demographics presented mean age of 8.14 ± 3.53 months, male/female ratio:1.76/1, procedure length 3.98 ± 0.78 hours. Intraoperative analysis indicated TXA deliveries manifested fewer blood transfusion volumes (p=0.002) due to lower EBV loss (4.02 ± 1.19 ml/kg vs. 5.97 ± 1.61 ml/kg, p < 0.001) with better metabolic outcome. Postoperative outcomes presented all children manifested hematocrit decline after surgey. TXA did not influence postoperative hemodynamic alterations (p=0.090, p=0.112), despite reduced blood loss from the drains and transfusion necessity (p=0.015, p=0.0175). Intraoperative transfusion volumes and EBV loss were associated with postoperative hemodynamics (OR: 3.033, 95% CI: 1.286-7.154; p=0.011; OR: 0.280, 95% CI: 0.081-0.972; p=0.045, respectively). ROC analysis indicated 10.13 ml/kg of intraoperative blood transfusion requirement as the cut off value for hemodynamic instability with 91% sensitivity and 80% specificity. One unit increase in intraoperative transfused blood volume increased the odds of developing hemodynamic alterations by 3.033 times. Intraoperative TXA is crucial for successful surgical management; however postoperative period carries out paramount importance due to excessive bleeding after surgery. In case of severe intraoperative transfusion necessity, postoperative TXA utilization might be considered to minimize potential risks by balancing the pros and cons of the drug.

Clinical Efficacy of Intra-Operative Cell Salvage System in Major Spinal Deformity Surgery

ObjectiveThe purpose of this study was to determine the efficacy of intra-operative cell salvage system (ICS) to decrease the need for allogeneic transfusions in patients undergoing major spinal deformity surgeries. MethodsA total of 113 consecutive patients undergoing long level posterior spinal segmental instrumented fusion (≥5 levels) for spinal deformity correction were enrolled. Data including the osteotomy status, the number of fused segments, estimated blood loss, intra-operative transfusion amount by ICS (Cell Saver®, Haemonetics©, Baltimore, MA, USA) or allogeneic blood, postoperative transfusion amount, and operative time were collected and analyzed. ResultsThe number of patients was 81 in ICS group and 32 in non-ICS group. There were no significant differences in demographic data and comorbidities between the groups. Autotransfusion by ICS system was performed in 53 patients out of 81 in the ICS group (65.4%) and the amount of transfused blood by ICS was 226.7 mL in ICS group. The mean intra-operative allogeneic blood transfusion requirement was significantly lower in the ICS group than non-ICS group (2.0 vs. 2.9 units, p=0.033). The regression coefficient of ICS use was -1.036. ConclusionICS use could decrease the need for intra-operative allogeneic blood transfusion. Specifically, the use of ICS may reduce about one unit amount of allogeneic transfusion in major spinal deformity surgery.

Propofol Versus Remifentanil: Which One Is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial

Propofol and remifentanil are 2 useful drugs used in induced hypotensive anesthesia. The purpose of this study was to compare the effects of these drugs on intraoperative blood loss, transfusion requirements, and hemodynamic status during standardized orthognathic surgical procedures. In this double-blind randomized clinical trial, 50 consecutive healthy patients with Class III skeletal deformity were candidates for bimaxillary orthognathic surgery at Qaem Hospital, Mashhad University of Medical Sciences (Mashhad, Iran), from November 2016 until December 2017. These patients were randomly assigned to 2 equal-number groups to receive hypotensive anesthesia with propofol or remifentanil. Neither the surgeon nor the patients were aware of the study groups, whereas both the student and anesthesiologist were not blinded. Age and gender were recorded, and mean blood loss, mean arterial pressure, and mean heart rate, as well as duration of surgery and duration of general anesthesia, were monitored intraoperatively.The hypotensive anesthetic drugs were the primary predictor variables and the mean blood loss volume was the main outcome in this research. The independent t test and χ2 test were performed for data analysis using SPSS software (version 16; SPSS, Chicago, IL). In this study, 25 patients with a mean age of 22.25±3.31years were investigated in each group. The mean blood loss volume was 578.26±95.14mL and 366.67±64.92mL in the propofol and remifentanil groups, respectively. The independent-samples t test showed that mean blood loss was significantly lower in the remifentanil group than in the propofol group (P=.001). Furthermore, the mean arterial blood pressure was significantly lower in the remifentanil group than in the propofol group (85±20mm Hg vs 95±15mm Hg, P<.001). Hypotensive anesthesia with remifentanil, in comparison with propofol, significantly reduces mean blood loss during orthognathic surgery, which decreases the transfusion requirements and disadvantages of transfusion and blood loss.

Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study.

Postoperative ileus (POI) is associated with an elevated risk of other complications and increases the economic impact on healthcare services. The aim of this study was to identify pre-, intra- and postoperative risk factors associated with the development of POI following elective laparoscopic right colectomy. Between 2004 and 2016, 637 laparoscopic right colectomies were performed. Data were analysed retrospectively thanks to the CLIHMET database. Potential contributing factors were analysed by logistic regression. Patients with POI (n = 113, 17.7%) were compared to those without postoperative ileus (WPOI) (n = 524, 82.3%). In the POI group, there were more men (62 vs 49%; p = 0.012), more use of epidural anaesthesia (19 vs 9%; p = 0.004), more intraoperative blood transfusion requirements (7 vs 3%; p = 0.018) and greater perioperative intravenous fluid administration (2000 vs 1750mL; p < 0.001). POIs were more frequent when extracorporeal vascular section (20 vs 12%; p = 0.049) and transversal incision for extraction site (34 vs 23%; p = 0.044) were performed. Overall surgical complications in the POI group were significantly greater than in the control group WPOI (31.9 vs 12.0%; p < 0.0001). Multivariate analysis found the following independent POI risk factors: male gender (HR = 2.316, 1.102-4.866), epidural anaesthesia (HR = 2.958, 1.250-6.988) and postoperative blood transfusion requirement (HR = 6.994, 1.550-31.560). This study is one of the first to explore the CLIHMET database and the first to use it for investigating risk factors for POI development. Modifiable risk factors such as epidural anaesthesia and intraoperative blood transfusion should be used with caution in order to decrease POI rates.

Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

Background: Pain control after breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) often requires intravenous narcotic analgesia and inpatient hospitalization. Intrathecal morphine (ITM) administration analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief with less systemic side effects. Questions/purposes: The aim of this retrospective study was to evaluate the effect of intrathecal morphine on postoperative morbidity of breast reconstruction by Deep Inferior Epigastric Perforator flap and compare it with intravenous narcotic analgesia. Methods: 269 patients underwent immediate or delayed DIEP reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving ITM analgesia (300 μ) were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri- and postoperative complications across the two groups were assessed. Results: The two groups were comparable in terms of demographic characteristics and factors of morbidity. Intraoperative variables were not statistically different between the groups except for intraoperative blood loss (P = 0.0001), transfusion (P = 0.0001) and Intraoperative liquid requirement (p = 0.0001). Intra and postoperative blood pressure were lower in ITM group (p < 0.05). Patients in ITM group showed lower postoperative analgesia requirement (P < 0,0001), less respiratory complications and less acute respiratory failure (P = 0,003 and P = 0,004, respectively). No statistically significant differences in the length of hospital stay (LOS) were noted Conclusion: We found that intrathecal morphine analgesia was associated with less blood loss and fluid administration, better postoperative pain control, and less respiratory complications with an acceptable security profile than intravenous narcotic analgesia. Clinical relevance: This study suggests that using intrathecal morphine may result in less blood loss and blood transfusion, better postoperative pain control, and less respiratory complications.