Blood Transfusion In Surgery Research Articles

A novel approach in the management of placenta accreta spectrum disorders: A single-center multidisciplinary surgical experience at Tu Du Hospital in Vietnam

ObjectivePlacenta accreta spectrum disorders (PASD) are the leading cause which results in highly maternal mortality during pregnancy. Although hysterectomy has been the gold standard for PASD, the recent study along with our experience has been demonstrated that the association between uterine myometrial resection and transverse B-Lynch suture in conservative management might be effective in the appropriate patients, thus we hereby attempted to determine this issue. Materials and methodsA retrospective observational study enrolled 65 patients at Tu Du Hospital in Vietnam between January 2017 and December 2018. This study included all pregnant women above 28 weeks of gestational age, who had undergone cesarean delivery due to PASD diagnosed preoperatively by ultrasound or upon laparotomy. Additionally, all patients who desired uterine preservation underwent modified one-step conservative uterine surgery (MOSCUS), avoiding peripartum hysterectomy. ResultsOverall, the rate of successful preservation was 93.8%. Other main outcomes such as average operative blood loss was 987 mL, mean blood transfusion was 831 ± 672 mL; mean operative time was 135 ± 31 min and average postoperative time was 5.79 days. Postoperative complications included six out of 65 cases due to intraoperative bleeding and postoperative infection, requiring hysterectomy in 4 patients. ConclusionMOSCUS was associated with less operative blood loss and blood transfusion amount. Its success rate of uterine preservation was approximately 94% in our study. Thus, this method can be acceptable in PASD management at our maternity health care center. Further studies might be necessary to evaluate the long-term effects of this method in PASD management.

Neuronavigation in falcine meningiomasare surgery: Initial results from a Vietnamese multi-center study.

Neuronavigation has been applied in neurocenters to help neurosurgeons plan the way to resect tumor totally and decline the neuro-injuries. This study aims to initially evaluate the result of microsurgery applying neuronavigation in treating falcine meningioma, which has not been reported comprehensively in Vietnam. This cross-sectional study enrolled 62 patients diagnosised with falcine meningioma and treated by applying neuronavigation in operation in Neurosurgery Department of Military Hospital 103 and Viet Duc University Hospital from July 2015 to March 2017. Patients were assessed complications as well as residual lesions. Evaluate surgical results when discharging from hospital according to Ojemann MD standard. Mean tumor volume was 67.37±66.61cm³ (range 6-370cm³). Unilateral access site was the most common with 85.48%. Mean surgery duration was 209.84±70.86min. There were 27 out of 62 patients (43.55%) need blood transfusion in surgery. Tumor volume had an impact on blood transfusion in operation with p=0.002. 82.26% of patients had total resection (Simpson I,II). There were 4.84% of patients having haemorrhage and 3 patients (4.84%) had wound infection after operation. Short-term outcome was evaluated according to Ojemann MD standard: good outcome was 67.74%, medium 17.74%, and poor outcome 14.52%. The application of neuronavigation and microsurgery enables surgeons to access falcine meningiomasare exactly, lessen the surgery duration, limit blood transfusion and complications after operation.

Single institutional study on tubeless percutaneous nephrolithotomy

Background: The occurrence of renal stone is increasing which affect 10% of population with recurrence being 70% in affected patients. Tubeless PCNL is the mainstay of treatment in the management of large and complex stones. This study was conducted to evaluate the efficacy, feasibility and safety of tubeless PCNL.Methods: This study was conducted in the department of general surgery, Jagjivan Ram Railway Hospital, Mumbai over a period of one year from March 2019-Febuarary 2020. During this period 50 patients underwent tubeless PCNL for renal stones.Results: Among 50 patients 56% were in the age group of 46-60 years. Most common presenting complaint being flank pain (94%). About 86% of patient had complete stone clearance following tubeless PCNL. Post operative blood transfusion required in 10% of patients. The mean hospital stay was 2.12 days. Most common post operative complication were fever.Conclusions: Tubeless PCNL is a very safe and effective treatment for renal stones.

Effect of early continuously intravenous tranexamic acid on perioperative blood loss in thoracolumbar burst fractures with neurological symptoms.

There is still a conflict between early surgical decompression and increased bleeding resulting from early surgery for thoracolumbar burst fractures (TBF) with neurological symptoms. The aim of this study is to investigate the effect of early continuously intravenous tranexamic acid (TXA) on perioperative blood loss in TBF with neurological symptoms who underwent early surgery. A retrospective comparative analysis was performed. The patients in study group were treated with intravenous TXA 15 mg/kg every 24 hours after admission besides intravenous TXA 15 mg/kg before skin incision and patients in control group were treated with intravenous TXA 15 mg/kg before skin incision only. Perioperative blood loss was compared between the 2 groups. The hemoglobin at admission, before surgery, 1 day and 3 days after surgery, the operation time, drainage time, blood transfusion and volume, incidence of complications and length of hospital stay were also compared. The operation time, preoperative, intraoperative, total, hidden amounts of blood loss in TXA group were significantly lower than those in control group (P < .001). The hemoglobin level in the TXA group was significantly higher than that in the control group before and 1 day after surgery (P < .05). The remove drainage time, hospitalization time, blood transfusion rate and volume in the TXA group were significantly lower than those in the control group (P < .001). There was no significant difference in the incidence of lower limb thrombosis between the 2 groups (P > .05). Early continuously intravenous TXA reduces the perioperative blood loss of patients with TBF who underwent early posterior fracture reduction, nerve decompression and pedicle screw fixation.

Tranexamic acid dosage for spinal surgery: a meta-analysis.

We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of different doses of intravenous tranexamic acid (TXA) in spinal surgery. We searched relevant academic articles from PubMed, Embase, the Cochrane Library, and CNKI. Two reviewers independently selected studies, assessed quality, extracted data, and evaluated the risk of bias. RevMan 5.4 was used for data analysis. Ten randomized controlled trials (RCTs) met the inclusion criteria and were identified, including 740 patients. According to the different dose regimens of intravenous TXA, the included studies' patients were divided into the high dose of intravenous TXA group and the low dose of intravenous TXA group. Compared with the low-dose group, the high-dose group can reduce the intraoperative blood loss (MD = - 100.87, 95% CI: [- 147.81, -53.92], P<0.0001). For the postoperative Hb and HCT, the high-dose group can separately maintain 4.54g/dL (MD = 4.54, 95% CI: [2.08, 6.99], P = 0.003) and 1.27% (MD = 1.27, 95% CI: [0.59, 1.94], P = 0.0002). There were no statistically significant differences in total blood loss, preoperative Hb and HCT, operative time, and blood transfusion rate between the high-dose group and the low-dose group. Based on the present meta-analysis, compared with the low-dose of intravenous TXA in spinal surgery, the high dose of intravenous TXA decreases the intraoperative blood loss and preserves higher postoperative Hb and HCT levels without increasing the operative time and blood transfusion rate.

Variations in Craniosynostosis Surgery Affect Perioperative Outcomes: An Analysis of Peds-NSQIP Data

While many single-institution studies have investigated the relationship between surgical technique and perioperative outcomes in craniosynostosis surgery, the Pediatric National Surgical Quality Improvement Program (Peds NSQIP) allows this on a nationwide scale. By analyzing the CPT codes associated with craniosynostosis surgery, insight can be gained not only into the prevalence of certain procedures, but into their effects on perioperative outcomes. Patients with craniosynostosis were selected from the Peds NSQIP database (2012-2018) based on the corresponding ICD-9 code. CPT codes associated with single suturectomy or craniectomy with and without the use of distractors/springs, and craniotomy with and without the use of bone grafts, were used to further identify patient groups. Outcome variables included operative time, hospital stay, and blood transfusions. Analysis showed that patients undergoing single suturectomies or extensive cranioplasties with distractor/spring placement had shorter operative times, shorter hospital stays, and decreased incidence of blood transfusions. The use of bone grafts was associated with significantly longer operative times and a higher incidence of blood transfusions, as well as higher volumes of blood transfused. Distractor/spring use can facilitate shorter operative times and decreased rates of blood transfusion. Bone grafting, while commonly used, is associated with increased rates of blood transfusion. Despite the statistical significance of these results, the nonspecific nature of the craniosynostosis-specific CPT codes severely limited the extent of analysis possible. Updating the CPT coding system would allow for greater utility of NSQIP in determining nationwide procedure-specific outcomes.

Enhanced Recovery After Surgery Protocol for Oblique Lumbar Interbody Fusion.

Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it has not been widely utilized in spinal surgery. The study reported the development and implementation of an ERAS pathway for patients with lumbar spondylolisthesis undergoing oblique lumbar interbody fusion (OLIF). Seventy-six patients underwent OLIF surgery from January 2018 to December 2019 were enrolled. Thirty-seven patients were included in pre-ERAS group and 39 patients were included in ERAS group. Major outcomes that were collected included demographics, comorbidities, blood loss, operative time, length of hospital stay (LOS), cost, time to walk, blood transfusion, complications, Visual analogue scale (VAS) scores, Oswestry Disability Index (ODI) and factors affecting LOS were also recorded. The ERAS pathway and compliance with pathway elements were also recorded. After ERAS implementation, the blood loss, LOS, the financial costs, and the time to walk were significantly lower in the ERAS group compared to the pre-ERAS group (all P < 0.05). There was no significant difference in operative time, complications, and blood transfusion between both groups. VAS and ODI between the two groups showed a significant difference during postoperative 3days and postoperative 1month (both P < 0.05). The preoperative time to walk was significant factors for hospital stay at the final follow-up. Institution of an ERAS protocol for OLIF surgery appears to accelerate functional recovery, reduce length of stay and financial costs.

Enhanced Recovery After Surgery in the Patients With Hepatocellular Carcinoma Undergoing Hemihepatectomy.

This study aims to compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing hemihepatectomy. From January 2017 to June 2019, 54 and 56 patients were enrolled into the control and ERAS group, retrospectively. All the indicators related to operation, liver functions, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) analysis identified 72 patients for further analysis. The clinicopathological characteristics were well-matched after PSM, and there were no significant differences in the operative duration, blood loss, blood transfusion, hospital costs, and most postoperative indicators in these 2 groups. In the ERAS group, D-dimer and fibrin degradation product values were significantly reduced (3.57 (2.874.60)μg/ml vs 4.81 (3.948.29)μg/ml and 11.90 (10.0418.02)μg/ml vs 15.80 (11.5529.24)μg/ml; P = .002 and P = .023, respectively). The days that semiliquid diet was allowed after surgery (2.00 (2.003.00)days vs 5.00 (4.006.00)days, P < .001), abdominal drainage tube indwelling duration (5.00 (4.005.00)days vs 5.00 (4.756.25)days, P = .004), and hospital stay after surgery (6.00 (6.007.00)days vs 8.00 (7.0010.00)days, P < .001) were also significantly shorter. The proportion of patients requiring analgesic treatment was significantly lower in the postoperative day 2 and day 4 (P < .001 and P = .025, respectively). The morbidity was significantly less (36.11% vs 69.44%, P = .005). ERAS programs are feasible and safe in HCC patients undergoing hemihepatectomy. Postoperative anticoagulant therapy may be one of the necessary steps.

Pancreaticoduodenectomy: Benchmarking the New HPB Surgery Fellowship Graduate in a Non University Setting

Intro: Pancreatectomy is a complex operation with a well-established learning curve of 60 procedures. Increasing number of fellowship trained graduates practice outside the university setting and it is difficult to evaluate outcomes during the established learning curve and beyond in an unbiased fashion. Externally validated benchmarking data was utilized to evaluate a new fellowship trained HPB Surgeon performance outside of the university setting. Methods: Review of a prospectively maintained database was performed to identify all patients that underwent pancreaticoduodenectomy performed by a single HPB surgeon immediately following fellowship graduation at a non-university health system and compared to externally validated benchmarks (Sánchez-Velázquez et al. 2019) over a 6 year period. Results: 120 consecutive pancreaticoduodenectomies performed by a single HPB surgeon immediately following fellowship graduation at a non-university health system were identified (10/13-6/19). On the learning curve: no patient met benchmark criteria, 2/22 clinically relevant intra- and postoperative outcome indicators did not meet established Benchmark cutoffs – Grade IV Clavien-Dindo complication (p=0.02) and all cause readmission rate (p=<0.001), and 7 indicators exceeded benchmark (Table 1a). After learning curve cohort has 3 benchmark patients. Comparison of the two cohorts demonstrated statistically significant improvement in operative duration (p=<0.001), blood transfusions (p=0.01) and hospital stay (p=0.02). There was also a decrease in Grade IV complications and increase in total lymph nodes resected (p=0.08) (Table 1b). Conclusions: Externally validated benchmarks should be utilized to ensure appropriate outcomes, fair evaluation of new HPB surgeons and frame of reference to a health system unused to high volume complex pancreaticoduodenectomy.

Analysis of injury and pain scores during fusion surgery for multisegmental lumbar spinal stenosis in elderly patients

Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.

Intraoperative halo-femoral traction during posterior spinal arthrodesis for adolescent idiopathic scoliosis curves between 70° and 100°: a randomized controlled trial.

Surgical management of scoliosis curves between 70° and 100° remains controversial. The authors designed this randomized controlled trial to validate the efficacy of intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), Cobb angles between 70° and 100°, and flexibility < 35%. The authors prospectively recruited and randomized 29 patients with severe AIS scheduled for posterior surgery into a traction group or control (nontraction) group. The primary outcome measures were operative time, blood loss, and length of hospital stay. Secondary outcomes included degree of spine deformity correction, traction-related complications, and health-related quality of life. In the traction group, the average preoperative Cobb angle was 83.2°, with an average 20.6% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.3° at the final follow-up. In the control group, the average preoperative major curve was 80.3° with 22.8% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.1° at the final follow-up. The operative duration was 325.7 minutes for the traction group and 385.4 minutes for the control group (p = 0.018). Compared with the control group, the traction group had a 29.5% reduction in intraoperative blood loss and a significantly lower rate of blood transfusion (13.3% vs 50.0%, p = 0.033). There were no neurological complications in either group. One patient in the traction group had a superficial infection at the traction site. Use of IOHFT contributed to significant reductions in operative time and blood transfusion requirements, with no added morbidity. It is an effective and safe method to assist correction of AIS curves between 70° and 100° and flexibility < 35%.

The Japanese Difficulty Scoring System Correlates with Postoperative Outcome Assessed by the Comprehensive Complication Index in Patients Undergoing Minimally Invasive Liver Resection

Introduction: The Japanese difficulty score (JDS) was developed to standardize the difficulty grading of laparoscopic hepatectomy. The JDS has not consistently correlated well with postoperative outcomes such as Clavien-Dindo complications. This study aims to determine if the JDS correlates with complications as classified by the more inclusive comprehensive complication index (CCI). Methods: A single institutional database was retrospectively queried for all purely minimally-invasive (MIS) hepatectomies performed between January 2008 and December 2019Patient charts were reviewed and data was collected. Patients were grouped into “Low” (<4), “Intermediate” (4-6), and “High” (7+) difficulty based on JDS. Complications were graded using CCI. Statistical comparisons were made using ANOVA or χ2 test, as appropriate. IRB approval was obtained. Results: 413 pure MIS resections were performed. There were 75 (18.2%) Low, 207 (50.1%) Intermediate, and 131 (31.7%) High difficulty MIS hepatectomies. There were no demographic differences. High difficulty was associated with longer operative time (p<0.001), higher mean EBL (p<0.001), and were more likely to require blood transfusion (p<0.001). Mean length of stay (LOS) was longer for more difficult resections (p<0.001). There was no difference between groups in Clavien-Dindo complications or 30-day readmissions. The CCI was significantly higher (Low 7.0, Intermediate 9.5, High 15.8; p=0.006) for more difficult resections. Post-hepatectomy liver failure (PHLF) occurred more frequently with higher JDS (p=0.0023). Conclusions: MIS liver resections with higher JDS were associated with increased operative times, EBL, blood transfusions, LOS, PHLF and overall complications as indicated by the CCI, despite no difference between groups in Clavien-Dindo complications.

Trans tibial amputation with or without a tourniquet in patients with diabetic foot infection and peripheral vascular disease: Comparison of postoperative outcomes.

Background: Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this procedure is controversial and scarcely reported. Objective: this study aimed to compare the outcomes of TTAs with or without a tourniquet in a single tertiary medical center. Methods: We retrospectively identified all patients who had undergone TTA in our institution (1/2019-1/2020) and included only those who underwent the procedure due to complications of DFI or PVD (n = 69). The retrieved data included demographics, comorbidities, ASA score, the use of a tourniquet, operation duration, pre- and postoperative hemoglobin levels, administration of blood transfusions, hospitalization length, surgical site infection and 60-days reoperation and mortality rates. Results: TTA with a tourniquet was superior to TTA without a tourniquet in reducing the average operation length by 11 min (p = 0.05), the median postoperative hospitalization by 6days (p = 0.04), and the use of blood transfusions (odds ratio [OR] = 0.176, 95% confidence interval [CI]: 0.031-0.996). Conclusions: Our findings demonstrated advantages in operative time, hospitalization length, and blood transfusion requirement for TTA with a tourniquet compared to TTA without a tourniquet.

Porous tantalum implant for treatment of early-stage osteonecrosis of the femoral head: a minimum 5-year follow-up study

BackgroundTo evaluate the survival rate of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head (ONFH), evaluate its clinical effect and imaging results.MethodsFrom January 2008 to December 2013, porous tantalum rod implantation for ONFH was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion were recorded.Results52 hips received complete follow-up, the average follow-up time was 85.7 months (60–132 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was 44.3 ± 32.8 months, and the average Harris hip score before THA was 57.1 ± 7.6. Cox proportional-hazards model revealed that Association Research Circulation Osseous (ARCO) stage (P = 0.017), bone marrow edema (P = 0.006) and age > 40 years (P = 0.043) were independent risk factors for conversion to THA.ConclusionARCO stage, age and bone marrow edema were risk factors for the failure of porous tantalum rod implantation to convert to THA.

Using Fracture Patterns and Planned Operative Modality to Identify Fractured Neck of Femur Patients at High Risk of Blood Transfusion.

BackgroundFractured neck of femurs is common, serious injuries usually requiring operative management. Red blood cell transfusions are often required to treat perioperative anaemia, but these are not without adverse effects.Aims and objectivesThe aim of this study is to identify subgroups of fractured neck of femur patients more likely to require red blood cell transfusions. We try to identify targeted strategies to reduce blood transfusion-associated adverse effects and thus improve outcomes.Design and methodsA retrospective cohort study of 324 patients. Patients were divided into cohorts based on radiological fracture patterns and operations performed. Data were collected from patient records, picture archiving and communication systems, the local transfusion laboratory, and the national hip fracture database. The primary outcome was blood transfusion rates in different fracture patterns in fractured necks of femur patients. The secondary outcome was blood transfusion rates in different operation types for fractured neck of femur patients. Chi-squared tests for independence were performed.Results14.9%, 34.7% and 33.3% of patients with intracapsular, intertrochanteric and subtrochanteric fractures, respectively, received blood transfusions. There was a significant relationship between fracture pattern and blood transfusion (X2 (2, N = 324) = 17.1687, p = 0.000187).47% of patients receiving long intramedullary nails, 45% of short intramedullary nails, 27% of open reduction internal fixations, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. There was a significant relationship between operative modality and blood transfusion (X2 (4, N = 302) = 22.0184, p = 0.000199).ConclusionIn patients who have sustained a fractured neck of the femur, the fracture pattern and operative modality are both independently associated with the rates of red blood cell transfusion. In these identified groups, we propose that increased vigilance and awareness regarding transfusion avoiding strategies are utilised with the goal of improving patient outcomes.

The effect of Cushing's syndrome on pregnancy complication rates: analysis of more than 9 million deliveries

Purpose The purpose of this study to evaluate the risk of Cushing’s syndrome (CS) and maternal and fetal complications using the American Nationwide Inpatient Sample database. Materials and methods This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004 to 2014. We compared pregnancies with CS versus non-CS regarding pregnancy, delivery, and neonatal outcomes using multivariate logistic regression. Results We identified 9,096,788 pregnancies during the study period. Cushing’s syndrome complicated 135 pregnancies at a rate of 1–2 cases per 100,000 births. Cushing’s syndrome subjects were more likely to be older, obese, have private insurance, chronic hypertension, and pre-gestational diabetes (p<.001). The maternal mortality rate was 0.7 and 0.007% in Cushing’s syndrome and control groups, respectively, although due to small numbers of cases, this should be interpreted with caution. Preeclampsia was higher in CS compared to controls after controlling for confounding variables, aOR 2.20. Operative vaginal delivery and blood transfusion rates were higher in CS patients than controls after controlling for confounding factors, aOR 6.49 and 3.09, respectively. The rates of preterm delivery (8.9 versus 7.2%) and gestational diabetes (8.1 versus 5.8%) were not statistically different between CS and control groups. Conclusion Cushing’s syndrome patients begin pregnancies often with maladies making them more at risk for complications including, preeclampsia, blood transfusion, and operative vaginal delivery. These patients might benefit from prevention methods for preeclampsia, and increased surveillance to decrease maternal morbidity and mortality. However, the nature of the database and its limitations, including the lack of information about CS activity and treatments received by patients, warrant careful interpretation of these results.

Comparison between robotic-assisted and laparoscopic left hemi-hepatectomy

ObjectiveTo compare the safety and short-term outcomes between robotic-assisted and laparoscopic left hemi-hepatectomies in a single academic medical center. MethodsA cohort of 52 patients, who underwent robotic-assisted or laparoscopic left hemi-hepatectomies between April 2015 and January 2020 in Department of Pancreatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University was recruited into the study. Their clinicopathological features and short-term outcomes were analyzed retrospectively. ResultsThere were 25 robotic-assisted and 27 laparoscopic cases, with a median age of 55 years (34–77 years). There was one conversion to open in laparoscopic group. There were no significant differences in clinicopathological features between two groups, except robotic group had higher body mass index (23.9 vs. 22.0 kg/m2, p = 0.047). Robotic-assisted and laparoscopic groups had similar operative time (300 vs. 310 min, p = 0.515), length of hospital stay (8 vs. 8 days, p = 0.981) and complication rates (4.0% vs. 14.8%, p = 0.395), but the former had less blood loss (100 vs. 200 ml, p < 0.001) and lower incidence of blood transfusion (0% vs. 22.2%, p = 0.023) in comparison with laparoscopic group. R0 resection was achieved for all patients with malignancies. There was no perioperative mortality in both groups. The cost of robotic group was higher than laparoscopic group (105,870 vs. 64,191 RMB yuan, p = 0.02). ConclusionThe robotic-assisted and laparoscopic approaches had similar safety and short-term outcomes in left hemi-hepatectomy, and the former can reduce operative blood loss and blood transfusion. However, the costs were higher in robotic group.

Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material &amp; Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were &lt;30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was &lt;150ml while in 4(12.5%) it was estimated to be &gt;150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

Risk factors for surgical site infection following spinal surgery in Saudi Arabia: A retrospective case-control study.

Surgical site infections (SSIs) are common complications after spinal surgery that result in increased morbidity, mortality, and healthcare costs. It was estimated that SSIs after spinal surgery resulted in a 4-fold increase in health care costs. The reported SSI rate following spinal surgery remains highly variable between approximately 0.5% and 18%. In this study, we aimed to estimate the SSI rate and identify possible risk factors for SSI after spinal surgery in our Saudi patient population.We conducted a single-center, retrospective case–control study in Saudi Arabia that included patients who developed SSIs, while the controls were all consecutive patients who underwent spinal surgery between January 2014 and December 2016. We extracted data on patient characteristics, anthropometric measurements, preoperative laboratory investigations, preoperative infection prevention measures, intraoperative measures, comorbidities, and postoperative care.We included 201 consecutive patients in our study; their median age was 56.9 years, and 51.2% were men. Only 4% (n = 8) of these patients developed SSIs postoperatively. Postoperative SSIs were significantly associated with longer postoperative hospital stays, hypertension, higher American Society of Anesthesia (ASA) scores, longer procedure durations, and the use of a greater number of blood transfusion units.This study revealed a low SSI rate following spinal surgery. We identified a history of hypertension, prolonged hospitalization, longer operative time, blood transfusion, and higher ASA score as risk factors for SSI in spine surgery in our population. As our findings are from a single institute, we believe that a national research collaboration among multiple disciplines should be performed to provide better estimates of SSI risk factors in our patient population.

Transfusion of Blood Products in the Postoperative of Cardiac Surgery

Background: The indiscriminate use of blood transfusion in surgery has been associated with increased risk of infection and increased length of hospital stay. Objective: To identify the average amount of bleeding and rates of transfusion of blood products in the postoperative period of patients undergoing cardiac surgery in a cardiology center. Methods: Medical records of patients who underwent myocardial revascularization surgery and/or heart valve replacement with use of cardiopulmonary bypass (CPB) were analyzed. Perioperative data such as CPB time, [...]