Intraoperative Transfusion Rate Research Articles

Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis.

Indocyanine green (ICG) fluorescence imaging technology is increasingly widely used in laparoscopic hepatectomy. However, previous studies have produced conflicting results regarding whether it is truly superior to traditional laparoscopic hepatectomy. This study investigated the clinical effect of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) using ICG imaging technology. A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42024532356). A computer search was conducted in databases including CNKI, Wanfang, PubMed, Embase, Cochrane Library, and Web of Science from January 1, 1990, to April 30, 2024. A total of 17 articles were included after screening, comprising 4 randomized controlled trials and 13 case-control studies, with 1620 patients in total. Among these, there were 743 cases in the fluorescence laparoscopy group and 877 cases in the non-fluorescence laparoscopy group. Hepatectomy guided by indocyanine green fluorescence navigation significantly reduced operation time (MD = -23.25, 95% CI: -36.35 to -10.15, P = 0.0005), intraoperative blood loss (MD = -51.04, 95% CI: -69.52 to -32.56, P < 0.00001), and intraoperative transfusion rate (OR = 0.43, 95% CI: 0.27 to 0.69, P = 0.0004), while increasing the R0 resection rate (OR = 2.93, 95% CI: 1.73 to 4.96, P < 0.0001) and decreasing the postoperative complication rate (OR = 0.59, 95% CI: 0.43 to 0.82, P = 0.002). However, there was no statistically significant difference in postoperative length of hospital stay (MD = -0.67, 95% CI: -1.51 to 0.18, P = 0.12). In the treatment of HCC, hepatectomy guided by indocyanine green fluorescence navigation demonstrates superior efficacy and safety, its application and promotion are warranted.

Robotic Versus Laparoscopic Adrenalectomy for Adrenal Tumors: An Up-to-Date Meta-Analysis on Perioperative Outcomes.

Background: Minimally invasive surgery (MIS) for adrenal glands is becoming increasingly developed worldwide and robotic surgery has advanced significantly. Although there are still concerns about the generalization of outcomes and the cost burden, the robotic platform shows several advantages in overcoming some laparoscopic shortcomings. Materials and Methods: A systematic review and meta-analysis were conducted using the PubMed, MEDLINE and Cochrane library databases of published articles comparing RA and LA up to January 2024. The evaluated endpoints were technical and post-operative outcomes. Dichotomous data were calculated using the odds ratio (OR), while continuous data were analyzed usingmean difference (MD) with a 95% confidence interval (95% CI). A random-effects model (REM) was applied. Results: By the inclusion of 28 studies, the meta-analysis revealed no statistically significant difference in the rates of intraoperative RBC transfusion, 30-day mortality, intraoperative and overall postoperative complications, re-admission, R1 resection margin and operating time in the RA group compared with the LA. However, the overall cost of hospitalization was significantly higher in the RA group than in the LA group, [MD USD 4101.32, (95% CI 3894.85, 4307.79) p < 0.00001]. With respect to the mean intraoperative blood loss, conversion to open surgery rate, time to first flatus and length of hospital stay, the RA group showed slightly statistically significant lower rates than the laparoscopic approach. Conclusions: To our knowledge, this is the largest and most recent meta-analysis that makes these comparisons. RA can be considered safe, feasible and comparable to LA in terms of the intraoperative and post-operative outcomes. In the near future, RA could represent a promising complementary approachto LA for benign and small malignant adrenal masses, particularly in high-volume referral centers specializing in robotic surgery. However, further studies are needed to confirm these findings.

Adolescent vs. Young Adult Idiopathic Scoliosis patients: how different are their two year postoperative radiographic and clinical outcomes?

To compare the long-term outcomes among AIS (10-18 years) and young AdIS (YAdIS) (19-40 years) patients with minimum 2 year follow up. A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, operative data, patient reported outcome measures (PROMs), including the ODI and SRS-22r, and long-term complications were collected. A 1:1 propensity score matched (PSM) analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels (TIL), and main coronal cobb angle. 95 patients (60 AIS, 35 YAdIS) were identified. Following PSM, 27 matched pairs were identified. AIS patients had greater LL (-55.6 ± 14.0 vs. -61.8 ± 11.7, p = 0.0486) at preop, less OR time (4.7 ± 1.2h vs. 5.2 ± 1.5h, p = 0.0468), intraoperative transfusion rates (70.4% vs. 96.3%, p = 0.0082), and postop Hb (9.0 ± 1.9 vs. 10.1 ± 1.4, p = 0.0280) and Hct (26.4 ± 5.4 vs. 29.7 ± 3.7, p = 0.0453). YAdIS patients had greater T2-T12 TK (42.7 ± 13.6 vs. 36.3 ± 11.0, p = 0.0412), T2-T5 TK (19.4 ± 9.4 vs. 13.3 ± 8.7, p = 0.0187), and TPA (12.4 ± 7.9 vs. 7.4 ± 8.9, p = 0.0200). There were no significant differences in baseline and 2year follow up PROMs and in the rates of 2 year complications, including proximal/distal junctional kyphosis (PJK/DJK), pseudarthrosis, rod fracture, curve progression, and revision (p > 0.05). Despite differences in operative characteristics, idiopathic scoliosis (IS) patients who underwent corrective surgery at a younger age had comparable PROMs and 2 year outcomes to older patients. Corrective fusion surgery is safe and effective in both adolescents and young adults and may avoid the higher complication rates seen in older adults.

Impact of zero-positive end-expiratory pressure on blood transfusion rates in off-pump coronary artery bypass surgery: a retrospective cohort study

BackgroundBleeding are common in cardiac surgery, with significant impacts on transfusion-related complications and patient prognosis. This study aimed to determine the differences in perioperative blood loss, transfusion rates, and the incidence of postoperative pulmonary complications (PPCs) with and without the use of positive end-expiratory pressure (PEEP) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).MethodsThis single-center, retrospective study included 106 adult patients undergoing coronary artery bypass surgery without cardiopulmonary bypass from January 2018 to March 2022. The patients were divided into two groups based on intraoperative ventilator settings: the zero-PEEP (ZEEP) group and the PEEP group. The primary outcome was the perioperative transfusion rate from the intraoperative period to postoperative 7 day. The incidence of PPCs was recorded for 1 week post-operatively. Logistic regression analysis was performed for statistical analysis.ResultsThe average PEEP in the PEEP group was 4.92 ± 0.42 cmH2O. Multiple regression analysis indicated that lower mean airway pressure during surgery tend to associate with intraoperative lower blood loss. The intraoperative transfusion rates in the ZEEP group were significantly lower than those in the PEEP group (ZEEP:14%, PEEP 38.4%, P = 0.02). Logistic regression analysis revealed that ZEEP (adjusted odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04–0.78) and Society of Thoracic Surgeons(STS) scores (adjusted OR 2.31, 95% CI 1.53–3.49) were significantly associated with a reduced requirement for perioperative transfusions. No significant difference was observed between the two groups in terms of PPCs (p = 0.824). Atelectasis was the most common complication in both groups (ZEEP: 35.7%, PEEP: 40%, P = 0.832).ConclusionsZEEP and STS scores were associated with significantly reduced requirement for perioperative transfusion rates during elective OPCAB surgery. However, ZEEP did not significantly affect the incidence of PPCs.

Efficacy and Safety of Combined Intravenous and Topical Use of Tranexamic Acid During Separation Surgery for Thoracolumbar Spine Metastasis: A Retrospective Study

The purpose of this study was to determine the efficacy and safety of combined intravenous and topical use of tranexamic acid (TXA) in patients undergoing separation surgery for thoracolumbar spinal metastases by evaluating perioperative blood loss and complications. A total of 54 patients with thoracolumbar spinal metastases who received separation surgery in our hospital from 2021 to 2024 were retrospectively analyzed and divided into 3 groups according to the use of TXA. Combined use of TXA group (group A) included 20 patients, intravenous TXA group (group B) contained 18 patients, and 16 cases received no TXA . The evaluation indexes included perioperative blood loss, hematologic parameters, surgical time, drain days, perioperative transfusions, and the presence of complications. During separation surgery for thoracolumbar spine metastasis, TXA decreased the perioperative blood loss significantly (P<0.001). Compared with TXA infusion alone, combined usage of TXA reduced postoperative blood loss significantly (P<0.001). Number of drain days was 4.00 ± 1.55, 5.50 ± 1.56 and 8.50 ± 2.81, respectively, which showed an obvious decline in groups A and B (P<0.001). TXA showed conspicuous effect on intraoperative transfusion rate. No complications happened except for 1 patient who experienced respiratory aspiration in group B. The application of TXA in separation surgery of spinal metastases can obviously reduce drain days, perioperative blood loss, an dintraoperative transfusion rate. The combination of intravenous infusion and topical use of TXA is more effective than intravenous use alone, which showed a strong synergistic effect; additionally, it does not increase the risk of venous thromboembolism and wound infection.

Robotic Versus Thoracoscopic Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis of Matched Studies.

Mitral regurgitation is the most prevalent form of valvular heart disease, impacting over 24 million people globally. Robotic and thoracoscopic minimally invasive mitral valve repair (MIMR) techniques have emerged as viable alternatives to traditional open-heart surgery. However, the comparative effectiveness and safety of these 2 approaches remain underexplored. This systematic review and meta-analysis, conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, aimed to compare robotic and thoracoscopic MIMR outcomes. A literature search was performed across PubMed, Scopus, and Embase databases to identify studies comparing these 2 surgical techniques. Eligible studies included randomized controlled trials and cohort studies. Six propensity score-matched studies and 1 retrospective cohort study, involving 11,823 patients, were included, with 5851 undergoing robotic mitral valve repair and 5972 receiving thoracoscopic MIMR. No significant differences were found in perioperative mortality [risk ratio (RR): 0.97, 95% confidence interval (CI): 0.65-1.45] or pump/clamp times. Robotic surgery was associated with longer operative times (mean difference: 33.01 minutes) and higher intraoperative transfusion rates (RR: 1.53, 95% CI: 1.07-2.18), but a lower risk of atrial fibrillation (RR: 0.89, 95% CI: 0.83-0.95). In conclusion, robotic and thoracoscopic MIMR show comparable mortality and overall safety profiles. However, robotic surgery may require longer operative times and increased transfusion needs, while reducing the risk of atrial fibrillation. Further high-quality, randomized studies are warranted to validate these findings.

Tranexamic acid reduces perioperative blood transfusions following open radical cystectomy – a propensity-score matched analysis

PurposeRadical cystectomy is associated with bleeding and high transfusion rates, presenting challenges in patient management. This study investigated the prophylactic use of tranexamic acid during radical cystectomy.MethodsAll consecutive patients treated with radical cystectomy at a tertiary care university center were included from a prospectively maintained database. After an institutional change in the cystectomy protocol patients received 1 g of intravenous bolus of tranexamic acid as prophylaxis. To prevent bias, propensity score matching was applied, accounting for differences in preoperative hemoglobin, neoadjuvant chemotherapy, tumor stage, and surgeon experience. Key outcomes included transfusion rates, complications, and occurrence of venous thromboembolism.ResultsIn total, 420 patients were included in the analysis, of whom 35 received tranexamic acid. After propensity score matching, 32 patients and 32 controls were matched with regard to clinicopathologic characteristics. Tranexamic acid significantly reduced the number of patients who received transfusions compared to controls (19% [95%-Confidence interval = 8.3; 37.1] vs. 47% [29.8; 64.8]; p = 0.033). Intraoperative and postoperative transfusion rates were lower with tranexamic acid, though not statistically significant (6% [1.5; 23.2] vs. 19% [8.3; 37.1], and 16% [6.3; 33.7] vs. 38% [21.9; 56.1]; p = 0.257 and p = 0.089, respectively). The occurrence of venous thromboembolism did not differ significantly between the groups (9% [2.9; 26.7] vs. 3% [0.4; 20.9]; p = 0.606).ConclusionProphylactic tranexamic administration, using a simplified preoperative dosing regimen of 1 g as a bolus, significantly lowered the rate of blood transfusion after cystectomy. This exploratory study indicates the potential of tranexamic acid in enhancing outcomes of open radical cystectomy.

Role of Neoadjuvant Chemotherapy in High-Grade Neuroendocrine Carcinoma of the Uterine Cervix

Background: This study aimed to assess the feasibility and efficacy of neoadjuvant chemotherapy (NACT) in treating patients with high-grade neuroendocrine carcinoma of the uterine cervix (HGNEC). Methods: We performed a retrospective case-control study at Asan Medical Center, Seoul, Republic of Korea, from January 1993 to December 2017, involving 60 patients with surgically treated HGNEC. Thirteen patients (21.7%) received NACT before undergoing surgery. Regarding the comparison between the group that underwent NACT and the group that did not, we used a propensity score-matched analysis, matching 22 patients in the primary radical surgery group with 11 patients in the neoadjuvant chemotherapy followed by radical hysterectomy group. Results: In the entire cohort, primary open surgery was more common in the primary surgery group compared to the NACT group (p = 0.004). After propensity score matching (PSM), the median tumor size was 3.5 cm in the primary surgery group and 2.4 cm in the NACT group (p = 0.078). After matching, there was no significant difference in the recurrence rate between the two groups (63.6% in the primary surgery group vs. 63.6% in the neoadjuvant chemotherapy group, p = 0.782). After PSM, the primary surgery group exhibited a lower intraoperative transfusion rate (10%) than the NACT group (45.5%, p = 0.052). Conclusions: While NACT was feasible in patients with HGNEC, it did not significantly improve the survival rate over primary radical surgery.

Blood Transfusion in the Age of Tranexamic Acid: Who Needs a Type and Screen Before Total Hip Arthroplasty?

BackgroundModern surgical protocols, particularly the use of tranexamic acid (TXA), have reduced, but not eliminated, blood transfusions surrounding total hip arthroplasty (THA). Identifying patients at risk for transfusion remains important for risk reduction and to determine type and screen testing. MethodsWe reviewed 6,405 patients who underwent primary, unilateral THA between January 2014 and January 2023 at a single academic institution, received TXA, and had preoperative hemoglobin (Hgb) values. We compared demographics, baseline Hgb levels, and surgical details between patients who were and were not transfused. Data were analyzed utilizing multivariate regression and receiver operating characteristic curve analysis. ResultsThe overall perioperative and intraoperative transfusion rates were 3.4 and 1.0%, respectively. Patients who were older, women, and American Society of Anesthesiologists class >II demonstrated an increased risk of transfusion. Risk of transfusion demonstrated an inverse correlation with preoperative Hgb levels, a bimodal association with body mass index, and a direct correlation with age, surgical time, and estimated blood loss on multivariate analysis. The receiver operating characteristic analysis demonstrated a preoperative Hgb cutoff of 12 g/dL for predicting any transfusion. Above the threshold of 12 g/dL, total and intraoperative transfusions were rare, with rates of 1.7 and 0.3%, respectively. Total and intraoperative transfusion rates with Hgb between 11 and 12 g/dL were 14.3 and 4.6%, respectively. Below 11 g/dL, total and intraoperative transfusion rates were 27.5 and 10.1%, respectively. ConclusionsIn the age of TXA, blood transfusion is rare in THA when preoperative Hgb is >12 g/dL, challenging the need for universal type and screening. Conversely, patients who have Hgb < 11.0 g/dL, remain at substantial risk for transfusion. Between Hgb 11 and 12 g/dL, patient age, sex, body mass index, American Society of Anesthesiologists classification, anticipated estimated blood loss, and surgical time may help predict transfusion risk and the need for a perioperative type and screen. Level of EvidenceIII.

Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience.

Background: Coronary artery disease is a major cause of death globally. Minimally invasive direct coronary artery bypass (MIDCAB), using a small left anterior thoracotomy, aims to provide a less invasive alternative to traditional procedures, potentially improving patient outcomes with reduced recovery times. Methods: This retrospective, non-randomized study analyzed 310 patients who underwent MIDCAB between July 1999 and April 2022. Data were collected on demographics, clinical characteristics, operative and postoperative outcomes, and follow-up mortality and morbidity. Statistical analysis was conducted using IBM SPSS, with survival curves generated via the Kaplan-Meier method. Results: The cohort had a mean age of 63.3 ± 10.9 years, with 30.6% females. The majority of surgeries were elective (76.1%), with an average operating time of 129.7 ± 35.3 min. The median rate of intraoperative blood transfusions was 0.0 (CI 0.0-2.0) Units. The mean in-hospital stay was 8.7 ± 5.5 days, and the median ICU stay was just one day. Early postoperative complications were minimal, with a 0.64% in-hospital mortality rate. The 6-month and 1-year mortalities were 0.97%, with a 10-year survival rate of 94.3%. There were two cases of perioperative myocardial infarction and no instances of stroke or new onset dialysis. Conclusions: The MIDCAB approach demonstrates significant benefits in terms of patient recovery and long-term outcomes, offering a viable and effective alternative for patients suitable for less invasive procedures. Our results suggest that MIDCAB is a safe option with favorable survival rates, justifying its consideration in high-volume centers focused on minimally invasive techniques.

Short‑ and long‑term outcomes after laparoscopic and open pancreatoduodenectomy for elderly patients: a propensity score‑matched study

BackgroundThe feasibility and safety of laparoscopic pancreatoduodenectomy (LPD) in elderly patients is still controversial. This study aimed to compare the clinical outcomes of LPD and open pancreatoduodenectomy (OPD) in elderly patients.MethodsClinical and follow-up data of elderly patients (≥ 65 years) who underwent LPD or OPD between 2015 and 2022 were retrospectively analyzed. A 1:1 propensity score-matching (PSM) analysis was performed to minimize differences between groups. Univariate and multivariate logistic regression analysis were used to select independent prognostic factors for 90-day mortality.ResultsOf the 410 elderly patients, 236 underwent LPD and 174 OPD. After PSM, the LPD group had a less estimated blood loss (EBL) (100 vs. 200 mL, P < 0.001), lower rates of intraoperative transfusion (10.4% vs. 19.0%, P = 0.029), more lymph node harvest (11.0 vs. 10.0, P = 0.014) and shorter postoperative length of stay (LOS) (13.0 vs. 16.0 days, P = 0.013). There were no significant differences in serious complications, reoperation, 90-day readmission and mortality rates (all P > 0.05). Multivariate logistic regression analysis showed that post-pancreatectomy hemorrhage (PPH) was an independent risk factor for 90-day mortality. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) who underwent LPD or OPD had similar overall survival (OS) (22.5 vs.20.4 months, P = 0.672) after PSM.ConclusionsIt is safe and feasible for elderly patients to undergo LPD with less EBL and a shorter postoperative LOS. There was no statistically significant difference in long-term survival outcomes between elderly PDAC patients who underwent LPD or OPD.

Effect of geography on the use of ultrafiltration during cardiac surgery with cardiopulmonary bypass.

Ultrafiltration (UF) is a common practice during cardiopulmonary bypass (CPB) where it is used as a blood management strategy to reduce red blood cell (RBC) transfusion, minimize adverse effects of hemodilution, and reduce proinflammatory mediators. However, its clinical utilization has been shown to vary throughout the continents. The purpose of this investigation was to assess the distribution of UF use across the United States. Data on UF use during cardiac surgery was obtained from a national (United States) perfusion database for adult cardiac procedures performed from January 2016 through December 2018. Four geographical regions were established: Northeast (NE), South (SO), Midwest (MW) and West (WE). The primary endpoint was the use of UF with secondary endpoints UF volume, CPB and anesthesia asanguineous volumes, intraoperative allogeneic RBC transfusion, nadir hematocrit and urine output (UO). 92,859 adult cardiac cases from 191 hospitals were reviewed. The NE and the WE had similar usages of UF (59.9% and 59.7% respectively), which were higher than the MW and the SO (38.6% and 34.9%, p < .001). When UF was utilized, the median [IQR] volume removed was highest in the NE (1900 [1200-2800]mL), and similar in all other regions (WE 1500 [850-2400mL, MW 1500 [900-2300]mL and SO 1500 [950-2200]mL, p < .001. Median total UO was lowest in the NE 400 [210,650]mL vs all other regions (p < .001), and remained so when indexed by patient weight and operative time (NE-0.8 [0.5, 1.3]mL/kg/hour, MW-1.1 [0.7, 1.8] mL/kg/hour, SO-1.3 [0.8, 2.0]mL/kg/hour, WE-1.1 [0.7, 1.3]mL/kg/hour, p < .001. Intraoperative RBC transfusion rate was highest in the SO (21.3%) and WE (20.5%), while similar rates seen in the NE (16.2%) and MW (17.6%), p < .001. Across the United States there is geographic variation on the use of UF. Further research is warranted to investigate why these practice variations exist and to better understand and determine their reasons for use.

The Efficacy of Tranexamic Acid in Reducing Perioperative Drainage in Cardiac Surgery with Cardiopulmonary Bypass.

Although cardiopulmonary bypass procedures remain a critical treatment option for heart disease, they come with risks, including hemorrhage. Tranexamic acid is known to reduce morbidity and mortality in surgical hemorrhage. This study aimed to evaluate the efficacy of tranexamic acid, which is routinely used to treat hemorrhage, in decreasing the amount of intraoperative and postoperative drainage. A total of 80 patients who underwent cardiac surgery with cardiopulmonary bypass were included in this retrospective study. Forty patients who received tranexamic acid during the operation were assigned to Group 1, while 40 patients who did not receive tranexamic acid were assigned to Group 2. Patient data were collected from the hospital computer system and/or archive records after applying exclusion criteria, and the data were recorded. Statistical analyses were then performed to compare the data. Age, sex, height, weight, body surface area, flow, and ejection fraction percentages, preoperative hematological parameters, and intraoperative variables (except tranexamic acid) were similar between the groups (P>0.05). However, there were statistically significant differences between the groups in terms of intraoperative (through the heart-lung machine) and postoperative red blood cell transfusion rates, intraoperative and postoperative bleeding drainage amounts, as well as postoperative hematocrit, hemoglobin, platelet, and red blood cell levels (P<0.05). We concluded that intraoperative and postoperative use of tranexamic acid in patients who underwent coronary artery bypass grafting with cardiopulmonary bypass has positive effects on hematological parameters, reducing blood product use, and bleeding drainage amount.

Tranexamic acid reduces intraoperative red blood cell transfusion rates in craniosynostosis surgery: a 6-year retrospective analysis

Surgery for craniosynostosis in children is associated with substantial intraoperative bleeding and the need for blood transfusions. Recent studies have supported the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements. The records of 72 patients under 18 months of age who had undergone 113 surgeries for non-syndromic craniosynostosis in a single institution for 6 years were retrospectively analyzed. The transfusion requirements in infants with and without TXA administration were compared. The concept of patient blood management before and after TXA implementation in practice was also examined. The rate of intraoperative packed red blood cells (PRBC) transfusion was significantly lower in the TXA than in the non-TXA group (26.7% vs. 83%, p < 0.001). The volume of intraoperatively transfused PRBC was also lower in the TXA group compared to the non-TXA group (mean 68.25 mL vs. 101.91 mL, p < 0.001), as was the weight-adjusted volume (mean 11.2 mL/kg vs. 15 mL/kg, p = 0.002). There were no significant differences in the rate and volumes of postoperative PRBC transfusion between groups. The volume of intraoperatively transfused PRBC was dependent on TXA administration, but not on the affected suture and type of intervention. We found that while in the pre-TXA period all patients were transfused intraoperatively, the frequency of intraoperative transfusions in the post-TXA period was reduced by 40.9% even in the patients who had not received TXA. TXA seems to effectively reduce the intraoperative transfusion requirements in children undergoing craniosynostosis surgery. The optimal blood management in this patient population remains to be further evaluated.

Efficacy of hepatectomy for hepatolithiasis using 3D visualization combined with ICG fluorescence imaging: A retrospective cohort study.

Hepatolithiasis is a complex condition that poses challenges and difficulties in surgical treatment. Three-dimensional visualization technology combined with fluorescence imaging (3DVT-FI) enables accurate preoperative assessment and real-time intraoperative navigation. However, the perioperative outcomes of 3DVT-FI in hepatolithiasis have not been reported. We aim to evaluate the efficacy of 3DVT-FI in the treatment of hepatolithiasis. A retrospective analysis was performed on 128 patients who underwent hepatectomy for hepatolithiasis at the Department of Hepatobiliary Surgery, Zhujiang Hospital, between January 2017 and December 2022. Among them, 50 patients underwent hepatectomy using 3DVT-FI (3DVT-FI group), while 78 patients underwent conventional hepatectomy without 3DVT-FI (CH group). The operative data, postoperative liver function indices, complication rates and stone residue were compared between the two groups. There were no significant differences in preoperative baseline data between the two groups (p>0.05). Compared with the CH group, the 3DVT-FI group exhibited lower intraoperative blood loss (140.00±112.12 vs. 225.99±186.50mL, p=0.001), and a lower intraoperative transfusion rate (8.0% vs. 23.1%, p=0.027). The overall incidence of postoperative complications did not differ significantly (22.0% vs. 35.9%, p=0.096). The 3DVT-FI group was associated with a lower immediate residual stone rate (16.0% vs. 34.6%, p=0.021). There were no perioperative deaths in the 3DVT-FI group, while one perioperative death occurred in the CH group. The 3DVT-FI may offer significant benefits in terms of surgical safety, reduced intraoperative bleeding and decreased stone residue during hepatectomy for hepatolithiasis.

Impact of anticoagulation intensity on blood transfusion for venoarterial extracorporeal membrane oxygenation during lung transplantation

Venoarterial ECMO is increasingly used for mechanical circulatory support during lung transplant. Optimal intensity of intraoperative anticoagulation would be expected to mitigate thromboembolism without increasing bleeding and blood product transfusions. Yet, the optimal intensity of intraoperative anticoagulation is unknown. We performed a retrospective cohort study of 163 patients who received a bilateral lung transplant at a single center. We categorized intensity of anticoagulation into four groups (very low to high) based on the bolus dose of unfractionated heparin given during lung transplant and compared the rates of intraoperative blood transfusions and the occurrence of thromboembolism between groups. When compared to the very low intensity group, each higher intensity group was associated with higher red blood cell, fresh frozen plasma, and platelet transfusions. The occurrence of thromboembolism was similar across groups. These preliminary data suggest that lower intensity anticoagulation may reduce the rate of intraoperative blood transfusions although further study is needed.

The Adherence to an Intraoperative Blood Product Transfusion Algorithm Is Associated With Reduced Blood Product Transfusions in Cardiac Surgical Patients Undergoing Coronary Artery Bypass Grafts and Aortic and/or Valve Replacement Surgery: A Single-Center, Observational Study

Objective(s)To demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce blood product administration in adult cardiac surgical patients. DesignProspective observational. SettingQuaternary academic teaching hospital. ParticipantsCardiac surgical patients. InterventionsViscoelastic-based intraoperative transfusion algorithm. Measurements and Main ResultsWe compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historical controls after implementing a viscoelastic-based algorithm. We found a 43.9% reduction in RBC units transfused (1.98 units ±2.24 vs 0.55 ±1.36; p=0.008). We found a reduction in transfusion of 23.8% for FFP (0.84 units ±1.4 vs 0.64 ±1.38; p=ns), 33.4% for platelets (0.90 units ±1.39 vs 0.60 ±131; p=ns), and 15.8% for cryoprecipitate (0.19 units ±0.54 vs 0.16 ±0.50; p=ns). There was no statistically significant difference in time to extubation (8.0 hours [4.0, 21.0] vs 8.0 [4.0, 22.3], reoperation for bleeding (15 (12.3%) vs 10 (10.6%), ICU LOS (51.0 hours [28.0, 100.5] vs. 53.5 [33.3, 99.0]) or hospital length of stay (9.0 days [6.0, 15.0] vs. 10.0 [7.0, 17.0]). Deviation from algorithm adherence was 32.7% (48/147). PRBC, FFP, platelets, cryoprecipitate and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with Historical Controls while times to extubation, ICU and hospital lengths of stay did not reach significance. ConclusionsFollowing implementation of a viscoelastic-based algorithm, patients received fewer PRBC, FFP, platelets, cryoprecipitate and cell saver. Algorithm Compliant patients received fewer transfusions; however, reductions in times to extubation, ICU and hospital lengths of stay were not statistically significant compared with historical controls.

Identify risk factors for perioperative outcomes in Intracorporeal Urinary Diversion and Extracorporeal Urinary Diversion with Robotic Cystectomy.

The increasing adoption of robotic-assisted cystectomy with intracorporeal urinary diversion (ICUD), despite its complexity, prompts a detailed comparison with extracorporeal urinary diversion (ECUD). Our study at a single institution investigates perioperative outcomes and identifies risk factors impacting the success of these surgical approaches. In this retrospective analysis, 174 patients who underwent robotic-assisted cystectomy at the University of Louisville from June 2016 to August 2021 were reviewed. The cohort was divided into two groups based on the urinary diversion method: 30 patients underwent ECUD and 144 underwent ICUD. Data on demographics, complication rates, length of hospital stay, and readmission rates were meticulously collected and analyzed. Operative times were comparable between the ICUD and ECUD groups. However, the ICUD group had a significantly lower intraoperative transfusion rate (0.5 vs. 1.0, p=0.02) and shorter hospital stay (7.8 vs. 12.3 days, p<0.001). Factors such as male sex, smoking history, diabetes mellitus, intravesical therapy, higher ASA, and ACCI scores were associated with increased Clavien-Dindo Grade 3 or higher complications. Age over 70 was the sole factor linked to a higher 90-day readmission rate, with no specific characteristics influencing the 30-day rate. Robotic cystectomy with ICUD results in shorter hospitalizations and lower intraoperative transfusion rates compared to ECUD, without differences in operative time, high-grade postoperative complications, or readmission rates. These findings can inform clinical decision-making, highlighting ICUD as a potentially more favorable option in appropriate settings.

Preoperative Anemia as a Negative Risk Factor for Coronary Artery Bypass Grafting Surgery: A Retrospective Study

OBJECTIVES The objective of this study is to check the effects of Anemia on mortality and morbidity in patients having ischemic heart disease and undergoing coronary artery bypass graft surgery (CABG). METHODOLOGY The study involved all the patients who underwent isolated coronary artery bypass graft surgery from July 2019 to December 2022. The clinical data of patients was retrospectively collected from the departmental data pool and was then analyzed using the chi-square test and t-test. A p-value of less than 0.05 was considered significant. RESULTSThe study included 2570 patients who underwent isolated CABG; 78.2% of patients were males with a mean age of 57.87±9.20. Hypertension was the most common comorbidity (68.9%), followed by dyslipidemia (53.7%) &amp; Diabetes mellitus (49.9%). The preoperative mean hematocrit was 30.05±17.85. Of these 2570 patients, 52.37% were anaemic with a mean age of 58.69±9.05. Anemic patients had a significantly higher rate of IABP insertion (P 0.02) and intra-operative blood product transfusion (P &lt;0.001). Anemic patients had a significantly higher incidence of in-hospital mortality (P 0.04) and a higher rate of postoperative blood product transfusion (P &lt;0.001). There is no significant difference in terms of prolonged ventilation, reintubation, or readmission to ICU; however, nonanemic patients have a significantly higher rate of re-opening for bleeding/ tamponade (P 0.01). CONCLUSION Preoperative anaemia increases the mortality and morbidity in ischemic heart disease patients undergoing coronary artery bypass grafting. To improve the outcomes in CABG surgery, preoperative anaemia should be thoroughly investigated and treated to improve the outcomes of surgery.

Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children: A systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology (IPSO).

Image-guided core-needle biopsy (IGCNB) is a widely used and valuable clinical tool for tissue diagnosis of pediatric neuroblastoma. However, open surgical biopsy remains common practice even if children undergo more invasive and painful procedures. This review aims to determine the diagnostic accuracy and safety of IGCNBs in pediatric patients with neuroblastoma. We conducted a systematic review of peer-reviewed original articles published between 1980 and 2023, by searching "pediatric oncology," "biopsy," "interventional radiology," and "neuroblastoma." Exclusion criteria were patients older than 18years, studies concerning non-neurogenic tumors, case reports, and language other than English. Both the systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 533 abstracts articles were analyzed. Of these, eight retrospective studies met inclusion criteria (490 infants, 270 surgical biopsies [SB], 220 image-guided biopsies). Tissue adequacy for primary diagnosis (SB: n=265, 98%; IGCNB: n=199, 90%; p=.1) and biological characterization (SB: n=186, 95%; IGCNB: n=109, 89%; p=.15) was similar with both biopsy techniques, while intraoperative transfusion rate (SB: n=51, 22%; IGCNB: n=12, 6%; p=.0002) and complications (%) (SB: n=58, 21%; IGCNB: n=14, 6%; p=.005) were higher with surgical biopsy. Length of stay was similar in both groups; however, no additional data about concurrent diagnostic or treatment procedures were available in the analyzed studies. IGCNB is a safe and effective strategic approach for diagnostic workup of NB and should be considered in preferance to SB wherever possible.