Perioperative Blood Transfusion Rate Research Articles

Routine preoperative blood group and save is unnecessary for adult emergency appendicectomies: A retrospective multicentre study.

Routine group and save (G&S) is commonly performed before appendicectomy despite limited evidence. This study aims to evaluate the necessity of preoperative G&S by determining perioperative blood transfusion rates. A multicentre retrospective observational study of adult patients who had emergency appendicectomy across four hospitals between August 2018 and November 2020. Data analysed included demographics, operative details, G&S, crossmatching and perioperative blood transfusion. 1105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26-52). 1012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) normal. 921 (83.3%) patients had preoperative G&S. 42 (3.8%) patients also had crossmatch. No patients required blood transfusion in 30 days post appendicectomy. The cost of G&S is estimated to be £40,164 in this cohort. The need for perioperative blood transfusion is rare in patients undergoing appendicectomy. It has a significant cost impact and can cause unnecessary delays. Our study suggests that a routine G&S policy is not necessary, and we suggest a more 'selective' G&S policy.

High Rate of Complications With Early Conversion Hip Arthroplasty Following Fracture Treatment.

Conversion total hip arthroplasty (THA) is associated with higher rates of complications compared with primary THA, with prior surgical fixation of fractures in the ipsilateral hip shown to further increase these rates. There is a scarcity of literature on the effect of timing of conversion THA on complication rates. In this study, we evaluated early (≤6 months of index surgery) and late (>6 months of index surgery) conversion to THA following prior fixation of the proximal femur or acetabulum. Ninety-one patients who underwent conversion THA following prior surgical fixation of either the proximal femur or acetabulum were identified. Index surgery, fracture characteristics, time, and cause of failure were obtained. Postoperative complications evaluated following the conversion THA included infection, revision surgery rates, dislocation, and revision rates. A total of 91 patients were included, of which 22 underwent early conversion to THA. In the early conversion group, 22.7% of patients had a complication versus 11.6% of patients in the late conversion group (P = 0.194). The most common complications were deep infection (18.2% vs. 5.8%), revision surgery (22.7% vs. 10.1%), and revision THA (18.2% vs. 5.8%). The early conversion group had a markedly higher rate of perioperative blood transfusion compared with the late cohort (P = 0.013). In this study, we found a high rate of complications associated with early THA conversion. Patients should be counseled on the high risk for complications following early conversion to THA following failed fracture fixation.

Clinical Efficacy and Safety of Misoprostol During Abdominal Myomectomy: An Updated Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials.

Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as "low" or had "some concerns" of bias in seven and eight RCTs, respectively; one RCT had an overall "high" risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = -180.2 mL, 95% CI [-224.04, -136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = -0.58 g/dl, 95% CI [-0.82, -0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI -3.34, -0.96], p < 0.001), mean operative time (MD = -12.95 min, 95% CI [-19.89, -6.01], p < 0.001), and mean hospital stay (MD = -0.14 days, 95% CI [-0.25, -0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion.

Preoperative low serum albumin increases the rate of perioperative blood transfusion in patients undergoing total joint arthroplasty: propensity score matching

BackgroundTo investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA).MethodsWe enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes.ResultsAn under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888–0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50–2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30–37.3 g/L, 25–30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37–1.99, P < 0.001), 5.4 (95% CI 3.08–9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively.ConclusionIn TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion.Trial registration28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.

P.231: Anticoagulant and antiplatelet use in renal transplantation: Is perioperative blood loss and transfusion rates a significant concern?

P.231: Anticoagulant and antiplatelet use in renal transplantation: Is perioperative blood loss and transfusion rates a significant concern?

Anemia Preintervention: A Predictive Analytics–Based Clinical Decision Support System

This article delves into the implementation and impact of a clinical decision support system (CDSS) within the context of cardiovascular surgery, with a primary focus on the management of anemia in patients undergoing elective heart surgery. This innovative system was introduced at Fuwai Hospital, recognized as China’s largest cardiovascular center, as a response to the formidable challenges posed by the imbalance between blood supply and demand in cardiovascular surgery. The CDSS was designed to address several critical aspects of perioperative management in cardiovascular surgery. It proactively identifies anemia, a prevalent and reversible condition that significantly elevates perioperative blood transfusion rates. Although anemia correction has traditionally been centered on the period between hospitalization and surgery, this system expands its scope to include anemia preintervention, ensuring timely diagnosis and treatment even before hospital admission. This shift aims to reduce preoperative waiting times and overall hospital stays. The authors underscore the importance of harnessing digital health care tools, specifically electronic medical record systems, as a means to overcome challenges such as information lag and fragmented health care data. The CDSS operates by amalgamating real-time clinical data with decision support mechanisms, using pop-up notifications to ensure timely interventions based on predefined hemoglobin thresholds, consistent with World Health Organization standards. The successful deployment of CDSS mandates robust technical infrastructure, comprehensive interdisciplinary collaboration, and astute resource management. Furthermore, comprehensive training programs are imperative to equip health care professionals with the requisite proficiency in using the system effectively, enabling its widespread accessibility to a diverse patient demographic. The CDSS has had a clinically and statistically notable impact on improving patient outcomes, reducing reliance on allogeneic transfusions, and conserving valuable medical resources. For example, in the first year of the innovation, the hospital reported a decrease in the red blood cell transfusion rate by approximately 20.41% (to 19.50% in 2023 from 24.5% in 2022), a reduction in the average per capita red blood cell transfusion volume during hospitalization by approximately 32.46% (to 0.77 units in 2023 from 1.14 units in 2022), a decline in the preoperative anemia rate by approximately 21.86% (to 14.3% in 2023 from 18.3% in 2022), and a shortening of the mean hospital length of stay by approximately 21.44% (to 11.75 days in 2023 from 14.97 days in 2022). However, the authors also acknowledge that challenges remain, including the need for broader integration of the system beyond hospital settings, resource constraints for smaller health care organizations, and fostering greater patient engagement.

Comparison of blood loss between intra-articular microporous polysaccharide hemospheres powder and tranexamic acid following primary total knee arthroplasty

Total knee arthroplasty (TKA) is associated with substantial blood loss and tranexamic acid (TXA) effectively reduces postoperative bleeding. Although it is known that there is no difference between intravenous or intra-articular (IA) injection, the general interest is directed towards topical hemostatic agents regarding thromboembolic events in high-risk patients. This study aimed to compare the blood conservation effects of IA MPH powder and TXA in patients undergoing primary TKA. We retrospectively analyzed 103 patients who underwent primary TKA between June 2020 and December 2021. MPH powder was applied to the IA space before capsule closure (MPH group, n = 51). TXA (3 g) was injected via the drain after wound closure (TXA group, n = 52). All patients underwent drain clamping for three postoperative hours. The primary outcome was the drain output, and the secondary outcomes were the postoperative hemoglobin (Hb) levels during the hospitalization period and the perioperative blood transfusion rates. An independent Student’s t-test was used to determine differences between the two groups. The drain output in the first 24 h after surgery was significantly higher in the MPH group than in the TXA group. The postoperative Hb levels were significantly lower in the MPH group than in the TXA group. In patients with simultaneous bilateral TKA, there was a significant difference in the blood transfusion volumes and the rates between groups. It is considered that IA MPH powder cannot replace IA TXA because of an inferior efficacy in reducing blood loss and maintaining postoperative Hb levels in the early postoperative period after primary TKA. Moreover, in the case of simultaneous bilateral TKA, we do not recommend the use of IA MPH powder because it was notably less effective in the field of transfusion volume and rate.

Assessment of the safety and efficacy of intravenous versus topical tranexamic acid in patients undergoing primary total hip and knee arthroplasty surgeries with respect to decreasing peri-operative blood loss and blood transfusion rates: a prospective and comparative study

Background: Synthetic antifibrinolytic agent like tranexamic acid has been increasingly used in Arthroplasty surgeries to decrease the peri-operative blood loss. The current study was undertaken to compare the efficacy between the intravenous and Topical route of TXA in deceasing the blood loss and transfusion rate in patients undergoing primary total hip and knee arthroplasty (THR and TKR) surgeries. Methods: A total of 120 patients were enrolled in the study with 60 each undergoing THR and TKR surgeries with 30 each given TXA in IV and Topical routes. Outcomes were assessed in terms of mean 24 hours drain output, mean blood loss, mean drop in hemoglobin blood transfusion rate. Results: The mean drain output was more in the IV group in both THR and TKR patients (p&gt;0.05). The mean blood loss was more in the Topical group in both THR and TKR patients (p&gt;0.05). The mean drop in hemoglobin was more in the Topical group, with the difference being significant in the THR patients (p&lt;0.05) and being insignificant in TKR patients (p&gt;0.05). In IV group 9 patients (15%) and in Topical group 25 patients (41.67%) needed blood transfusions, the difference being statistically significant. Conclusions: Both IV and Topical routes of TXA are equally effective in decreasing the peri-operative blood loss and transfusion rates in patients undergoing primary arthroplasty surgeries, with IV route having slightly upper hand as compared to the Topical route.

Thermal ablation versus liver resection for hepatocellular carcinoma in patients with cirrhosis: a systematic review and meta-analysis of propensity-score matched studies

The outcomes of cirrhotic patients with hepatocellular carcinoma (HCC) after thermal ablation (TA) versus liver resection (LR) are debated. We aimed to compare the overall survival (OS), disease-free survival (DFS), and operative outcomes after TA and LR for HCC in patients with cirrhosis. Until November 15, 2022, we searched PubMed, Embase, and Cochrane databases by using Medical Subject Heading terms and other terms, and used the Newcastle-Ottawa literature evaluation scale to assess the quality of selected studies. OS, DFS, and operative outcomes were extracted and analyzed. The meta-analysis showed that 5 propensity-score matched (PSM) studies including 933 patients (463 TA vs. 470 LR) were included. After analysis, TA and LR had similar results at 1-year OS (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.01–2.78; P = 0.05) and 3-year OS (OR 0.76; 95% CI 0.56–1.04; P = 0.08), whereas LR increased 5-years OS (OR 0.37; 95% CI 0.18–0.74; P = 0.005). In addition to the DFS, the 1-year DFS was significantly higher in patients with LR. However, there were no obvious differences in 3-year and 5-year DFS when comparing TA and LR. The length of operative time and hospital stay were longer in the LR group. Besides, the LR group had significantly higher rate of perioperative blood transfusions and major complications. Our research proved that LR took advantage of OS and DFS for HCC patients with cirrhosis. Additional well-designed randomized controlled trials are needed.

Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma

IntroductionBenchmarking in surgery has been proposed as a means to compare results across institutions to establish best practices. We sought to define benchmark values for hepatectomy for intrahepatic cholangiocarcinoma (ICC) across an international population.MethodsPatients who underwent liver resection for ICC between 1990 and 2020 were identified from an international database, including 14 Eastern and Western institutions. Patients operated on at high-volume centers who had no preoperative jaundice, ASA class <3, body mass index <35 km/m2, without need for bile duct or vascular resection were chosen as the benchmark group.ResultsAmong 1193 patients who underwent curative-intent hepatectomy for ICC, 600 (50.3%) were included in the benchmark group. Among benchmark patients, median age was 58.0 years (interquartile range [IQR] 49.0–67.0), only 28 (4.7%) patients received neoadjuvant therapy, and most patients had a minor resection (n = 499, 83.2%). Benchmark values included ≥3 lymph nodes retrieved when lymphadenectomy was performed, blood loss ≤600 mL, perioperative blood transfusion rate ≤42.9%, and operative time ≤339 min. The postoperative benchmark values included TOO achievement ≥59.3%, positive resection margin ≤27.5%, 30-day readmission ≤3.6%, Clavien-Dindo III or more complications ≤14.3%, and 90-day mortality ≤4.8%, as well as hospital stay ≤14 days.ConclusionsBenchmark cutoffs targeting short-term perioperative outcomes can help to facilitate comparisons across hospitals performing liver resection for ICC, assess inter-institutional variation, and identify the highest-performing centers to improve surgical and oncologic outcomes.

Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study.

The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

Robotic-assisted versus conventional hip arthroplasty: a comparative analysis of perioperative blood management and early outcomes

Purpose: This study aimed to evaluate the impact of Robotic-Assisted Total Hip Arthroplasty (RATHA) versus Conventional Total Hip Arthroplasty (CTHA) on perioperative blood loss and blood transfusion requirements in patients with hip arthritis. Methods: This was a prospective cohort study, conducted at a high-volume tertiary care center from January 2021 to January 2023. Two hundred patients undergoing primary THA, were equally divided between RATHA (using the MAKO SmartRobotics system) and CTHA cohorts. Primary outcomes measured were perioperative hemoglobin changes, estimated blood loss (EBL), and transfusion rates. Secondary outcomes included operative times, hospital stays, and transfusion-related adverse events. Results: The mean pre-operative hemoglobin levels were comparable between the cohorts. However, the RATHA group demonstrated significantly lower post-operative day 1 hemoglobin drops, reduced EBL (1212.7 mL vs. 1565.24 mL in CTHA; p &lt; 0.0001), and fewer transfusions (7 vs. 29 in CTHA; p &lt; 0.0001). Operative times were shorter in the RATHA group (68.01 min vs. 77.1 min in CTHA; p &lt; 0.0001). All robotic cohort patients were discharged within 3 days, while 14% (N = 7) of the CTHA group required extended hospital stay. Conclusion: This study demonstrates that RATHA significantly reduces perioperative blood loss, hemoglobin drop, and blood transfusion rates compared to CTHA. The observed decrease in operative time and hospital stay in the RATHA group further suggests that robotic assistance may enhance procedural efficiency and support faster patient recovery.

Safety and Efficacy of a Novel Hemostatic Powder in Total Knee Arthroplasty.

This retrospective study evaluated the safety and efficacy of SURGICEL® Powder-Absorbable Hemostatic Powder (SP) made from oxidized regenerated cellulose (ORC) in total knee arthroplasty (TKA). Ninety-one patients who underwent TKA at Peking University Third Hospital between January 2024 and July 2024 were retrospectively analyzed. Hemostatic effectiveness was evaluated by comparing perioperative blood loss, hemoglobin (Hb) levels, hematocrit (HCT), and transfusion rates. Clinical safety was assessed by comparing complication rates, operation time, visual analog scale (VAS) scores, and postoperative fever. Finally, 85 patients were included: 43 in the SP group (using SP) and 42 in the control group (not using SP). There were no significant differences in age, sex, height, weight, preoperative HCT, or Hb levels. The volume of perioperative blood loss within 3 days in the SP group was reduced by approximately 154 ml compared with that in the control group. The Hb and HCT levels in the SP group were higher on the first, second, and third days after surgery, and there were significant differences between the two groups in terms of repeated measurements of HCT and Hb levels within 3 days postoperatively. There were no statistically significant differences in the operation time, postoperative VAS scores, complications, transfusion rates, or postoperative fever. In conclusion, this study confirmed that SP can significantly reduce perioperative blood loss in TKA without negatively affecting clinical outcomes.

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum

To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40g (group 1), 41-200g (group 2), and >200g (group 3). Various preoperative, perioperative, and postoperative variables were collected. HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P=.022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P=.019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P=.048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups. HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.

Comparison of transfusion rates between robotic- and video-assisted lobectomy: a propensity score matching analysis.

The objective is to compare the perioperative blood transfusion rate and postoperative complications between robot-assisted surgery and thoracoscopic surgery in lung cancer patients. This is a single-center retrospective study. Patients underwent lung cancer minimally invasive resection at Fujian Cancer Hospital from April 1, 2022, to April 30, 2023, were enrolled in this study. Patients were divided into robotic-assisted lobectomy (RAL) and video-assisted lobectomy (VAL) groups according to the surgical methods. Data, including demographics, clinic variables, and endpoint outcomes were collected from the electronic medical record. Propensity score matching(PSM) was performed to analyze the baseline data of patients. The RAL group and the VAL group were matched 1:1. Then, the blood transfusion rates and short-term outcomes of the two groups were compared. A logistic regression was performed to analyze the independent risk factors of perioperative blood transfusion. A total of 558 patients were enrolled in this study. 166 of 558 patients were divided into the RAL group, and 392 patients were into the VAL group. A total of 118 patients were selected and analyzed following propensity score matching. After PSM, there was no difference in perioperative transfusion rates, including RBC transfusion and frozen plasma transfusion, between the VAL and RAL groups (P > 0.05). TheRAL group had fewer days of drainage tubes (P = 0.036). There was no difference in other short-term outcomes, including the volume of thoracic drainage, the volume of intraoperative blood loss, the length of hospitalization, and the rate of postoperative pulmonary infection (P > 0.05). Volume of intraoperative blood loss, volume of thoracic drainage, and preoperative hemoglobin were independent risk factors of perioperative red blood cell or frozen plasma transfusion; however, RAL or VAL was not. The study showed that the rates of perioperative blood transfusion were comparable between RAL and VAL. RAL is superior for patient recovery in terms of short-term outcomes.

Efficacy of erythropoietin combined with tranexamic acid in reducing perioperative blood loss and blood transfusion rate in elderly patients with femoral intertrochanteric fractures

Purpose: To investigate the efficacy of exogenous recombined human erythropoietin (rhEPO), combined with tranexamic acid (TXA) and administered by different routes, in the treatment of elderly patients with femoral intertrochanteric fractures.Methods: 252 elderly patients in Suzhou Xiangcheng People's Hospital were randomly divided into groups (A, B and C), with 84 patients in each group. All the patients were given rhEPO and iron sucrose, followed by TXA which was administered via topical injection at the fracture site in Group A, via intravenous infusion in Group B, and via topical injection combined with intravenous infusion in Group C. The perioperative actual total blood loss, occult blood loss, hematocrit (HCT), platelet count (PLT), hemoglobin (Hb), and activated partial thromboplastin time (APTT) were assessed. Also evaluated were prothrombin time (PT), fibrinogen (FIB), blood transfusion rate and incidence of deep venous thrombosis (DVT) of the lower limbs. The results were then compared among the three groups.Results: Perioperative total blood loss and occult blood loss as well as the blood transfusion rate were lowest in Group C, followed by Group B and then Group A. The differences were statistically significant (p &lt; 0.05). The HCT and Hb levels were highest in Group C, followed by Group B and then Group A (p &lt; 0.05).Conclusion: Multi-modal administration of drugs (rhEPO combined with topical injection and intravenous infusion of TXA) is effective in treating elderly patients with femoral intertrochanteric fractures. The strategy efficiently reduces perioperative blood loss and blood transfusion rate, and also improves relevant blood biochemical indicators.

A Randomized Trial of Three Routes of Tranexamic Acid Administration in Total Knee Arthroplasty.

Tranexamic acid (TXA) has been shown to decrease blood loss and transfusion rates across a variety of routes of administration and doses in the setting of total knee arthroplasty (TKA). Oral TXA is less studied but has decreased cost and increased ease of administration. This prospective, randomized study compared the efficacy and cost of three routes of TXA administration in the setting of primary TKA. Primary outcomes were 24-hour hemoglobin loss, calculated blood loss, and blood transfusion rate. One-way analysis of variance, Pearson's chi-square test, and Fisher's exact test were used for statistical analysis. One hundred eleven patients were enrolled. The mean 24-hour hemoglobin loss for the intravenous (IV), oral, and topical TXA groups was 2.50±0.95 g/dL, 2.64±0.94 g/dL, and 2.52±0.90 g/dL, respectively, with no clinical or statistically significant differences among the groups (P=.79). Calculated blood loss was not significantly different (P=.61) among the IV TXA (1067±371 mL), oral TXA (1127±455 mL), and topical TXA (1027±454 mL) groups. No patients in any treatment group required a blood transfusion. IV, oral, and topical routes of TXA administration offer similar clinical benefits for perioperative bleeding and blood transfusion rate in TKA. Oral TXA provides a cost-benefit relative to the other routes of administration ($14 vs $114 per patient), making it a more cost-effective choice. Oral TXA has additional logistical challenges compared with other routes of administration due to increased absorption time, which may impact its use in clinical practice. [Orthopedics. 2023;46(5):285-290.].

Validation of the Nottingham Hip Fracture Score in Predicting Postoperative Outcomes Following Hip Fracture Surgery.

Although several prognostic models have been developed for patients who underwent hip fracture surgery, their preoperative performance was insufficiently validated. We aimed to verify the effectiveness of the Nottingham Hip Fracture Score (NHFS) for predicting postoperative outcomes following hip fracture surgery. This was a single-center and retrospective analysis. A total of 702 elderly patients with hip fractures (age ≥ 65 years old) who received treatment in our hospital from June 2020 to August 2021 were selected as the research participants. They were divided into the survival group and the death group based on their survival 30 days after surgery. The multivariate logistic regression model was used to identify the independent risk factors for the 30-day mortality after surgery. The NHFS and American Society of Anaesthesiologists (ASA) grades were used to construct these models, and a receiver operating characteristic curve was plotted to assess their diagnostic significance. A correlation analysis was performed between NHFS and length of hospitalization and mobility 3 months after surgery. There were significant differences in the age, albumin level, NHFS, and ASA grade between both groups (p < 0.05). The length of hospitalization in the death group was longer than the survival group (p < 0.05). The perioperative blood transfusion and postoperative ICU transfer rates in the death group were higher than in the survival group (p < 0.05). The death group's incidence of pulmonary infections, urinary tract infections, cardiovascular events, pressure ulcers, stress ulcers with bleeding, and intestinal obstruction was higher than the survival group (p < 0.05). The NHFS and ASA III were independent risk factors for the 30-day mortality after surgery, regardless of age and albumin level (p < 0.05). The area under the curve (AUC) of the NHFS and ASA grade for predicting the 30-day mortality after surgery was 0.791 (95% confidence interval [CI] 0.709-0.873, p< 0.05) and 0.621 (95% CI 0.477-0.764, p> 0.05), respectively. The NHFS positively correlated with hospitalization length and mobility grade 3 months after surgery (p< 0.05). The NHFS demonstrated a better predictive performance than the ASA score for the 30-day mortality after surgery and positively correlated with the hospitalization length and postoperative activity limitation in elderly patients with hip fractures.

Is thyroid disease associated with post-operative complications after total joint arthroplasty? A systematic review of the literature.

This comprehensive systematic review aims to assess the literature regarding the risk of postoperative complications in patients undergoing total joint arthroplasty (TJA) with concomitant thyroid dysfunction. Studies were identified by searching PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ClinicalTrials.gov (end of search: May 2022). Randomized control and case-control studies, cohort and observational clinical studies were included, which focused on postoperative complications and outcomes of patients undergoing TJA operations of major joints (knee, hip, ankle, elbow). All studies were assessed according to their level of evidence, the number and age of patients, and treatment complications. Nine studies were included in this review that demonstrated a higher risk of postoperative anemia, perioperative blood loss, hemoglobin decrease, and transfusion rates in hypothyroid patients after TJA. Hypothyroidism has been identified as a potential but modifiable risk factor for increased rates of deep venous thrombosis, acute kidney injury, pneumonia, and non-specified cardiac complications among hypothyroid patients who underwent TJA as well as increased rates of periprosthetic joint infection. No significant differences in the prosthesis-related mechanical complication rates have been calculated when comparing hypothyroid and euthyroid patients.