Need For Postoperative Blood Transfusion Research Articles

Blood loss following medial unicondylar knee replacements without a tourniquet: is there a need to group and save?

<p class="abstract"><strong>Background:</strong> There are current trends towards not using a tourniquet in total knee replacement (TKR), but there is nothing published on what the effects of not using a tourniquet on unicondylar knee replacements (UKR) may be in terms of blood loss.</p><p class="abstract"><strong>Methods:</strong> A retrospective case series of 36 consecutive UKR from our institution were analysed. All procedures were carried out without a tourniquet and also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, administration of periarticular local anaesthetic and adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most patients (61.1%) experienced an estimated intra-operative blood loss of less than100 mls. There was a mean haemoglobin drop of 16.1 g/l (range 1–26, SD ±5.9), with a mean post operatively haemoglobin level of 125.1 g/l (range 107-142, SD ±8.7). No patients required a blood transfusion.</p><p class="abstract"><strong>Conclusions:</strong> A low level of blood loss is encountered when UKR is undertaken without a tourniquet and with our standard interventions to reduce bleeding. The level of post-operative haemoglobin and absence of requirement for blood transfusion suggests that this operation can be undertaken without the need for a group and save. It is our hope that surgeons will be encouraged to perform this procedure without a tourniquet and benefit from the cost-saving opportunity of not performing a group and save.</p>

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

<p class="abstract"><strong>Background:</strong> Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery.</p><p class="abstract"><strong>Methods:</strong> A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.<strong></strong></p><p class="abstract"><strong>Results:</strong> Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.</p>

Use of Tranexamic Acid to Reduce Postoperative Blood Transfusion in Total Hip Replacement Surgery: A Prospective Study

Background: Total hip replacement surgery is one of the most advanced and technically demanding surgeries in orthopaedics in which blood loss is inevitable. Most of the patients are elderly with multiple co morbidities and the estimated one-year mortality is about 25%. Objective of the study was to assess the need of post-operative blood transfusion in total hip replacement surgery in patients given tranexamic acid versus control. Methods: It was a randomized controlled trial. Sixty patients of both sexes undergoing total hip replacement surgery included in study on the basis of inclusion and exclusion. Equal patients 30-30 (50%) divided in two groups Tranexamic Acid group and Control Group based on a computer-generated random number table. The Tranexamic Acid group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and two hours later intravenously, whereas Control group received two doses of 10mg/kg body weight of normal saline at similar intervals. Numbers of blood transfusions required postoperatively were noted based on the postoperative haemoglobin readings. Results: Mean post-op haemoglobin for the Tranexamic acid group was 10.1±2.6 g/dl and for the Control group it was 9.1±2.4 g/dl. Seven patients (23%) in intervention group required blood transfusion compared to 13 (43%) in control group. Conclusions: Our study revealed that Perioperative Tranexamic acid is a safe and useful method of reducing intra op bleeding and need of post-operative blood transfusion postoperatively in THR patients.

Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction

Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. A standardized ERAS pathway was developed through multidisciplinary collaboration. It addressed all phases of surgical care for patients undergoing free-flap breast reconstruction utilizing an abdominal donor site. In this retrospective cohort study, clinical variables associated with hospitalization costs for patients who underwent free-flap breast reconstruction with the ERAS pathway were compared with those of historical controls, termed traditional recovery after surgery (TRAS). All patients included in the study underwent surgery between September 2010 and September 2014. Predicted costs of the study groups were compared using generalized linear modeling. A total of 200 patients were analyzed: 82 in the ERAS cohort and 118 in the TRAS cohort. Clinical variables that were identified to potentially affect costs were found to have a statistically significant difference between groups and included unilateral versus bilateral procedures (p = 0.04) and the need for postoperative blood transfusion (p = 0.03). The cost regression analysis on the two cohorts was adjusted for these significant variables. Adjusted mean costs of patients with ERAS were found to be $4,576 lesser than those of the TRAS control group ($38,688 versus $43,264). Implementation of the ERAS pathway was associated with significantly decreased costs when compared to historical controls. There has been a healthcare focus toward prudent resource allocation, which dictates the need for plastic surgeons to recognize economic evaluation of clinical practice. The ERAS pathway can increase healthcare accountability by improving quality of care while simultaneously decreasing the costs associated with autologous breast reconstruction.

The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study

IntroductionTogether with evidence of higher bleeding tendencies, the vulnerability of the South-Asian population to anemia secondary to a higher prevalence of hemoglobinopathies and micronutrient deficiencies merits further exploration of the effects of tranexamic acid on this population. Additionally, limited access to self-care facilities and certain sociocultural beliefs and practices may not be conducive to a speedy recovery from surgical complications. The aim of this study is to investigate the effects of intraoperative administration of tranexamic acid during total knee arthroplasty when considering the South-Asian population. MethodologyMedical record files of 355 patients who underwent total knee arthroplasty (2007–2015) were reviewed to collect data regarding patient characteristics, surgical variables and post-operative complications. Unilateral and Bilateral total knee arthroplasty were studied separately. Analysis was done using t-test, Mann-Whitney U test, chi-square and Fisher's exact square where appropriate. The threshold for significance was p < 0.05. ResultsThe study showed that for unilateral surgery, tranexamic acid caused a significant reduction in estimated blood loss (p-value=0.011), total operative time, calculated blood loss, and hemoglobin change (p-value<0.001) whereas in bilateral surgery, tranexamic acid only caused a significant reduction in calculated blood loss (p-value < 0.001) and hemoglobin change (p-value=0.001). Interestingly, in those who received tranexamic acid vs. those who did not, there was a significant increase in length of hospital stay (p<0.001) and special care unit admissions (p-value=0.033) in unilateral and bilateral surgery respectively. ConclusionsAlthough tranexamic acid effectively reduces intraoperative blood loss, it does not have an effect on the need for post-operative blood transfusions. The increased length of stay and special care unit admissions associated with tranexamic acid use should be explored further to reveal the complete safety profile of tranexamic acid administration in the South-Asian population during total knee arthroplasty.

The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA

ObjectiveTo investigate the effect of tranexamic acid (TXA) on hidden bleeding in older intertrochanteric fracture patients treated with intramedullary nails. MethodBetween January 2016 and January 2017, 100 cases of intertrochanteric fractures eligible for the study were treated with proximal femoral nail antirotation (PFNA) in our hospital. All patients were divided into two groups of 50 patients each: the TXA group and a blank control group. In the TXA group, all patients received TXA at a dose of 10 mg/kg−1 intravenously, 10 min preoperatively and 5 h postoperatively. The control group did not receive TXA. We recorded the volume of intraoperative blood loss and postoperative drainage, and the need for postoperative blood transfusion and transfusion volume for all patients. Blood routine examination was performed on the day of surgery and 2 days postoperatively. We calculated the total blood loss and hidden blood loss in the two groups separately according to the Gross equation. All patients underwent deep vein ultrasound of the lower limbs preoperatively and 1 week postoperatively to detect thrombosis. ResultsCompared with controls, patients in the TXA group had lower: overt bleeding (50.59 ml; p = .012), total blood loss (181.58 ml; p = .005), hidden blood loss (130.64 ml; p = .037), volume of blood transfusion (110.0 ml; p = .019), and 20% lower transfusion rate compared with the control group. Patients receiving short-nail fixation had significantly lower hidden blood loss compared with patients receiving long-nail fixation (p < .05). However, we found no statistically significant difference in the incidence of deep vein thrombosis in the lower limbs between the two groups (p = .938). ConclusionTXA significantly reduced hidden blood loss in older intertrochanteric fracture patients treated with intramedullary nails without an increased risk of thrombosis in lower limb deep veins.

P133 AN ANALYSIS OF SURGICAL OUTCOMES IN IBD PATIENTS TREATED WITH AND WITHOUT BIOLOGIC THERAPY

Treatment options for inflammatory bowel disease (IBD) have expended tremendously in the past two decades. Biologics have now been increasingly used early in the course of therapy with the goal of inducing remission and thus delaying or avoiding the need for surgery. In spite of these advances, approximately 1/3rd of the patients with ulcerative colitis (UC) and 70% of those with Crohn’s disease (CD) undergo surgery over their lifetime. Comparative data of different biologics regarding surgical outcomes are relatively sparse outside of the clinical trials. Fifty-one patients (34 CD, 17 UC) undergoing IBD-related surgery from 4/2015-4/2017 were retrospectively studied. 48 patients were classified into “No biologic”, “Anti-TNF” (patients on infliximab/adalimumab/certolizumab) and “Vedolizumab” groups based on their biologic therapy at the time of surgery. Pertinent data were obtained, including the history of biologic use. Surgical outcomes were measured as 30-day readmission rate, complications and need for post-operative blood transfusion. T-test and Chi-square test were used for analysis. In the “No biologics” group, 9/12 were biologic-naïve and 3 had been exposed to one biologic in the past. In the anti-TNF group, 4/20 had been exposed to single biologic and 3/20 had been exposed to 2 biologics in the past. In the vedolizumab group, 12/16 patients had been exposed to 2 or more biologics before vedolizumab. Comparing these three groups of patients, no statistically significant difference was noted across these groups with regards to surgical complication rate. No significant differences in surgical outcomes were noted in patients preoperatively not on biologics, those who were on anti-TNFs and on vedolizumab, an anti-integrin biologic. The patients on vedolizumab were exposed to more number of biologics in the past, likely indicating a more complex disease.

Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study.

Background:During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.Patients and Methods:A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.Results:Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.Conclusion:The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: A meta-analysis.

This meta-analysis evaluated the effectiveness of hybrid coronary revascularization (HCR) compared to coronary artery bypass grafting (CABG) for the treatment of multivessel coronary artery disease (MVCAD). HCR involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional CABG. Databases were searched through June 30, 2016, and studies comparing HCR with CABG for treatment of MVCAD were selected. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome of interest was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of all cause mortality, myocardial infarction, and stroke. The analysis included 2,245 patients from 8 studies (1 randomized controlled trial and 7 observational studies). The risk of MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR, 0.53; 95% CI, 0.24-1.16). Compared to CABG group, patients in HCR group had similar risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88), myocardial infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95% CI, 0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI, 0.58-2.83). The need for postoperative blood transfusions (OR, 0.29; 95% CI, 0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95% CI -1.52 to -0.88 days) was significantly lower in the HCR group. HCR appears to be safe, and has similar outcomes when compared with conventional CABG. HCR can be a suitable alternative to conventional CABG in select patients with MVCAD. © 2017 Wiley Periodicals, Inc.

Comparison of results of primary total hip replacement in diabetic and nondiabetic patients

Objective The aim of this study was to compare the results of total hip arthroplasty in diabetic and nondiabetic patients. Background Total hip arthroplasty is considered one of the most successful and effective surgical procedures performed in the world. The increase in the numbers of patients undergoing hip arthroplasty coincides with the incidence of increased prevalence of diabetes over the last two decades. The diabetic population undergoing arthroplasty is very poorly reported in comparison with the nondiabetic population due to the adverse outcomes of diabetes. Materials and methods All 40 patients received cemented primary total hip replacement for the treatment of osteoarthritis and were divided into two groups: a diabetic group, which included 20 patients, and the nondiabetic group, which included 20 patients. The functional outcome was evaluated according to the modified Harris Hip Score in all patients, and complications (e.g., superficial wound problems, deep infection, periprosthetic fracture, loosening, and osteolysis) were recorded in both groups. Results Patients with diabetes mellitus required longer hospital stay and increased overall cost. Moreover, the need for postoperative blood transfusion was higher in the diabetic group. The diabetic group showed a higher number of complications in comparison with the nondiabetic group, although it was statistically nonsignificant. The study showed the negative impact of body weight on the functional outcome in both groups. Conclusion Diabetic patients undergoing arthroplasty are the high-risk group and they required close monitoring of blood glucose level during the perioperative period, as diabetic patients had a higher rate of postoperative complications and required longer hospital stay and had increased total cost in comparison with the nondiabetic group.

Morbidity and mortality and predictors of outcome following hepatectomy at a Saudi tertiary care center.

BACKGROUNDHepatic resection is a major surgical procedure. Data on outcomes of hepatectomy in Saudi Arabia are scarce.OBJECTIVETo measure morbidity and mortality and assess predictors of outcome after hepatectomy.DESIGNDescriptive study.SETTINGTertiary care center in Saudi Arabia with well-established hepatobiliary surgery unit.PATIENTS AND METHODSAll patients undergoing liver resection in our institute during 2006–2014. Data were analyzed by Kaplan-Meier survival analysis.MAIN OUTCOMES MEASURE(S)Postoperative morbidity and 90-day mortality. Secondary outcomes were risk factors associated with increased morbidity and mortality.RESULTSData on 77 resections were collected; 56 patients (72.7%) had a malignant etiology, mainly colorectal liver metastases and hepatocellular carcinoma (45.5% and 14.3% respectively). Complications developed following 30 resections (39.0%), with the majority being Clavien grades I–III. In the univariate analysis, predicting factors were the total bilirubin level preoperatively, operative time, extent of resection (i.e., major resection), use of epidural anesthesia, and postoperative liver dysfunction. In the multivariate analysis, the Schindl liver dysfunction score showed the strongest correlation with the development of complications (P=.006). The 90-day postoperative mortality was 5.2% (4/77 patients); 3 patients fulfilled the 50:50 liver dysfunction criteria. Significant predictors were concurrent intra-abdominal surgery, postoperative liver dysfunction, and multiple complications.CONCLUSIONFactors that predicted development of complications were elevated total bilirubin level preoperatively, operative time, extent of the resection, use of epidural anesthesia and a postoperative need for blood transfusion. Liver resection is a safe and feasible option at our center.LIMITATIONSThe small number of indications for resection and consequent reduction in variety of risk factors limited ability to make inferences. Additionally, only a handful of cases were performed laparoscopically.

Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large myomas

To assess the usefulness of 3-month therapy with UPA prior to laparoscopic myomectomy (LM) of large uterine myomas. Retrospective analysis of a prospectively collected database. The study included premenopausal women who underwent LM because of myomas with the following characteristics: main myoma FIGO type 3, 4 or 5 with diameter ≥ 10 cm; presence of ≤ 3 myomas; main diameters of the other myomas (FIGO type 3, 4, 5 or 6) ≤ 5 cm and ≤ 3 cm. Patients underwent either direct surgery (group S) or received 3-month preoperative therapy with UPA (5 mg/day orally, Esmya; Gedeon Richter; group UPA). Patients who underwent surgery prior to UPA approval and those who refused preoperative treatment with UPA were included in group S. The pictorial blood-loss assessment chart (PBAC) was used to estimate uterine bleeding. 34 women were included in group UPA and 43 patients in group S. The two groups were similar in demographic characteristics, pretreatment menstrual blood loss and characteristics of the myomas. Prior to treatment with UPA, the two study groups had similar main diameter of the largest myoma, volume of the largest myoma and total myoma volume. In the UPA group, all patients completed the 3-month hormonal treatment. At the end of the 3-month treatment, 70.6% of the patients were amenorrheic; 20.6% of the patients had controlled uterine bleeding (PBAC 28-days score < 75) and 12.5% of the patients had PBAC 28-days score < 100. The 3-month UPA treatment caused a mean (± SD) 31.8% (± 10.9%; 95% C.I., 28.1%-35.5%) decrease in the volume of the largest myoma, a 13.5% (± 5.8%; 95% C.I., 11.6%-15.5%) decrease in the main diameter of the largest myoma, a 31.8% (± 10.7%; 95% C.I., 28.2%-35.4%) decrease in the total myoma volume. Hemoglobin levels significantly increased after UPA treatment (p<0.001). Because of the preoperative treatment with UPA, at surgery, patients included in group UPA had lower diameter of the largest myoma (p<0.001), lower volume of the largest myoma (p=0.020), lower total myoma volume (p=0.015) and higher hemoglobin levels (p<0.001) than patients included in group S. No patient required conversion to laparotomy. The operative time was shorter in group UPA than in group S (p<0.001); the suturing time was similar in the two study groups (p=0.076) . Both the intraoperative blood loss (p=0.012) and the hemoglobin drop (p=0.034) were lower in group UPA than in group S. Six patients in group S and no patient in group UPA required postoperative blood transfusion (p=0.031). The incidence of complications was similar in the two study groups (p=0.726). This study shows that a 3-month preoperative treatment with UPA prior to laparoscopic excision of large uterine myomas decreases the intraoperative blood loss, the hemoglobin drop, the need of postoperative blood transfusion and the length of surgery.

Clinical Factors Influencing Bowel Anastomotic Leak

Background and objectives: Anastomotic leakage is one of the most feared complications of gastrointestinal surgery. It causes considerable morbidity and mortality to the patient as well as trying the patience of the surgical team: it doubles the length of the hospital stay and increases the mortality as much as 8 to 10 fold. The objectives of this study were:1. To study the demographic profile of patients who have anastomotic leak postoperatively.2. To determine whether the risk factors of: hypoalbuminaemia; preoperative anaemia; emergent setting of surgery; intraoperative hypotension; body mass index; duration of surgery; post operative blood transfusions and dyselectrolytaemia contribute significantly to anastomotic leaks after resection anastomosis of bowel.Methodology: This study was conducted on 87 patients who underwent resection-anastomosis in Victoria Hospital, either in Emergency or Elective OT between 1st December 2013 and 31st May 2015. Cases with comorbidities of uncontrolled DM, HIV/AIDS and carcinoma were excluded in this study.Results: Serum albumin (p-value-0.01), BMI (0.05), serum potassium (0.05) and need for post operative blood transfusion (0.04) were strongly associated with bowel AL.Conclusion: In the presence of: Serum albumin pre-operative value of 3.2g/dl or lower; Serum potassium pre-operative value of 3.8 mmol/L or lower, and Need for post-operative blood transfusion, it is important that the operating surgeon make a decision to prevent AL by either creating a diversionary stoma proximal to the site of anastomosis (for emergency patients) or pre-optimize the patient with nutritional support (for elective patients).

Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty

BackgroundUse of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. MethodsRetrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network. ResultsIn our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery. ConclusionIntraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery.

Safety of Live Liver Donation by Individuals With G6PD Deficiency

G6PD deficiency (G6PDd) is the commonest genetic enzyme defect in the world. However, baring a single case report, there is no published literature regarding the safety of donor hepatectomy in G6PDd individuals. Potential donors with World Health Organization class III or class IV G6PDd without evidence of hemolysis were evaluated for donation, if there was no other suitable donor. Postoperatively, donors were closely monitored for hemolysis and medications, which can induce hemolysis, were avoided. Outcomes of our first 14 G6PDd donors are presented. Postoperative course of these donors was also compared with a matched cohort of 30 non-G6PDd donors. There were 9 left lateral segment, 2 left lobe, and 3 right lobe donors. Two G6PDd donors had biochemical evidence of postoperative hemolysis not needing any specific treatment. Postoperative liver function tests, intensive care unit stay, hospital stay, and morbidity (greater than Clavien II) were similar in the G6PDd and non-G6PDd donor cohorts. Donors in the G6PDd group had lower trough hemoglobin in postoperative period (P = 0.006), greater drop in postoperative hemoglobin (P = 0.007), and a higher need for postoperative blood transfusion (4/14 vs 2/30, P = 0.071). This is the first case series reporting the safety of liver resection in G6PDd individuals. Hepatectomy in G6PD-deficient donors is associated with a greater drop in postoperative hemoglobin and a marginally increased need for postoperative transfusion. Use of these donors can be considered with caution, and it should not be an absolute contraindication for live liver donation.

Administration of tranexamic acid in primary total joint arthroplasty

One of the concerning problems with total joint arthroplasties is a need for postoperative blood transfusion. Currently, evidence is gathered that allogenic blood transfusion has more disadvantages than previously thought. It is an independent risk factor that boosts infection rate, it increases total cost of joint arthroplasty and amplifies the risk of fluid overload as well as increases length of hospital stay. In the search for factors that may contribute to influencing the need for blood transfusion, tranexamic acid has been tested. Currently, it has a well-documented effect on reduction of intra- and postoperative blood loss and transfusion requirements in patients undergoing total knee arthroplasty. In this brief review, we will discuss documented use of tranexamic acid in total joint arthroplasties, focusing on the hip joint.

AB101. Diversity and choice in the surgical techniques for benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) is still one of the most diseases that urologists need to deal with every day. Although conservative and medical therapy for BPH is now well established in terms of alpha-blocker and 5-alpha reductase inhibitor treatment, surgical intervention is still finally irreplaceable for many cases. Open prostectomy has more than 200 years of history since Doctor Guthrie first used the perineum incision to enucleate the hyperplastic prostate adenoma in the year of 1834. From then on, surgical techniques have been evolved and improved constantly and Guthrie’s perineum approach was superseded by Freyer’s suprapubic transvesical approach, Millin’s retropubic transcapsular prostectomy, and more recently laparoscopic and robotic-assisted approach. When it comes to surgical treatment options available for BPH, transurethral surgery of prostate (TUSP) have to be mentioned. Monopolar transurethral resection of the prostate (TURP) have been called for many years as the golden standard treatment for the surgical management of BPH. However, TURP rates have declined over the past two decades due to the significant benefits of medical therapy and, to a lesser extent, the proliferation of other transurethral surgical techniques. Transurethral vaporization and vaporesection of the prostate are reported to have the similar results compared to TURP. With the development of the monopolar to bipolar technique and many electrode designs available, TUSP is becoming more and more safety. In recent years, transurethral plasmakinetic resection of the prostate (TUPKRP/PKRP) is the more and more popular technique of TUSP and considered as the new golden standard procedure for surgical treatment of BPH. In the past 5 years, transurethral laser techniques have been used more and more in the surgical management of BPH. There are several types of lasers used for BPH surgery by either coagulating, vaporizing or enucleating the prostate. Laser techniques for treating BPH appears to have equivalent results to TURP and have superiority to TURP in anticoagulated patients where risks of bleeding and the need for post-operative blood transfusion remain low. Transurethral laser treatment of BPH seems to have a tendency to replace the TURP. In fact, surgical treatment options are far more than the above mentioned, for example, UroLift system can illustrate this point as the latest technique and new technology will appear constantly and apply to clinic. However, so many surgical options exist for BPH and indications are well defined, questions remain in this area. How much prostate volume reduction is necessary to relieve BOO or LUTS, how is bladder underactivity and its associated with LUTS after BPH surgery and which procedure is the best choice for each BPH patient. And more, cost effectiveness of any options should be considered, especially in developing country. It is clear that appropriate counseling is necessary in all patients who undergo BPH surgery.

A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial

To evaluate the effect of vaginal misoprostol on intraoperative bleeding during myomectomy. In this randomized clinical trial, 80 women with myomas were randomly assigned to receive 200 µg misoprostol or placebo (vitamin B6) 3 h before surgery. Blood loss during surgery, postoperative need for blood transfusion, and the hemoglobin level before surgery, and 6 and 12 h after surgery were assessed in two groups. Mean age and the mean preoperative and postoperative Hb levels were not significantly different between the two groups. Mean duration of surgery and mean estimated blood loss were significantly higher in control group. Nine (22.5 %) patients in control group needed blood transfusion while there was no need blood transfusion in misoprostol group (p = 0.001). A single dose of vaginal misoprostol is effective in reducing hemorrhage during myomectomy.

Does a single loading dose of tranexamic acid reduce perioperative blood loss and transfusion requirements after total knee replacement surgery? A randomized, controlled trial.

Background:Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR.Materials and Methods:70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6th and 24th h postoperative period.Results:In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001).Conclusion:Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.

Minimizing intraoperative blood loss: Contemporary strategies

Postoperative blood loss continues to be a common complication following total hip and knee arthroplasty. There are inherent risks to blood transfusion, including increased infection risk, volume overload, and transfusion-related reactions. Recently, antifibrinolytic medications including tranexamic acid have been utilized to decrease perioperative blood loss and decrease the need for postoperative blood transfusions. Recent research has specifically addressed both the efficacy and the safety concerns of these newer treatment modalities and found great results.