Perioperative Transfusion Rates Research Articles

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...

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.

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.

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 < 0.05). The HCT and Hb levels were highest in Group C, followed by Group B and then Group A (p < 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.

Clinical application of a modified predeposit autologous red blood cell apheresis in multistage spinal fusion: a single-center retrospective study.

This study aimed to evaluate the efficacy and safety of predeposit autologous RBC apheresis (PARA) in patients undergoing multilevel spinal fusion surgery. A total of 112 patients from January 2020 to June 2022 were divided into two groups according to PARA: the PARA group (n = 51) and the control group (n = 61). The baseline characteristics of the patients, outcomes, transfusion cost, hospitalization cost, length of stay, complications, and changes in hemoglobin and hematocrit levels between the two groups were compared. The baseline characteristics were similar in both groups. No significant differences were found in functional outcomes, including VAS score (p = 0.159), ODI score (p = 0.214), JOA score (p = 0.752), and SF-36 score (p = 0.188) between the PARA and control groups. The amount and rate of intraoperative and perioperative allogeneic RBC transfusion were significantly higher in the control group than in the PARA group (p < 0.001). The postoperative (9.04 ± 3.21 vs. 11.05 ± 3.84, p = 0.004) and total length of stay (15.78 ± 3.79 vs. 17.36 ± 4.08, p = 0.038) in the PARA group were significantly lower than those in the control group, respectively. Despite no difference in hospitalization cost (p = 0.737), the total blood transfusion cost in the PARA group was significantly lower, compared with the control group (p < 0.001). For safety evaluation, there were no significant differences in Hb and Hct levels between the two groups at admission, on postoperative day 1, and postoperative day 3, respectively (p > 0.05). Moreover, the number of postoperative infections in the PARA group was significantly lower than that in the control group (p = 0.038). PARA was a novel, safe, and highly efficient technique for mass autologous blood preparation in a quite short preparation time. This method could significantly reduce the amount of allogeneic blood transfusion and length of stay, which could provide a theoretical basis for following clinical practice about the technique.

Risks and benefits of partial nephrectomy performed with limited or with zero ischaemia time.

To test the hypothesis that longer warm ischaemia time (WIT) might have a marginal impact on renal functional outcomes and might, in fact, reduce haemorrhagic risk intra-operatively. Data from 1140 patients treated with elective partial nephrectomy (PN) for a cT1-2 cN0 cM0 renal mass were prospectively collected. WIT was defined as the duration of clamping of the main renal artery with no refrigeration and was tested as a continuous variable. The primary outcome of the study was evaluation of the effect of WIT on renal function (estimated glomerular filtration rate [eGFR]) postoperatively, at 6 months and in the long term (measured between 1 and 5 years after surgery). The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri-operative transfusions. Multivariable linear, logistic and Cox regression analyses, accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used and the potential nonlinear relationship between WIT and the study outcomes was modelled using restricted cubic splines. A total of 863 patients (76%) underwent PN with WIT and 277 (24%) without. The baseline median eGFR was 87.3 (68.8-99.2) mL/min/1.73m2 for the on-clamp population and 80.6 (63.2-95.2) mL/min/1.73m2 for the off-clamp population. The median duration of WIT was 17 (13-21) min. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (estimate: -0.21, 95% confidence interval [CI] -0.31; -0.11 [P < 0.001]). Conversely, no association between WIT and eGFR was recorded at 6-month or long-term follow-up (all P > 0.8). At multivariable analyses predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (estimate: -21.56, 95% CI -28.33; -14.79 [P < 0.001]) and peri-operative transfusion rate (estimate: -0.009, 95% CI -0.01; -0.003 [P = 0.002]). No association between WIT and positive surgical margin status was recorded (all P = 0.1). Patients and clinicians should be aware that performing PN with very limited or even with zero WIT might increase bleeding and the need for peri-operative transfusion while not improving long-term renal function outcomes.

The Effects of Hospital Volume on Short-Term Outcomes of Laparoscopic Surgery for Rectal Cancer: A Large-Scale Analysis of 37,821 Cases on a Nationwide Administrative Database

Introduction: Laparoscopic low anterior resection (L-LAR) has become widely accepted for the treatment of rectal cancer. However, little is known about the superiority of L-LAR in a real-world setting (including low-volume hospitals) and the association between the short-term outcomes and hospital volume focusing on L-LAR. Methods: This is a retrospective cohort study. A total of 37,821 patients who underwent LAR for rectal cancer were analyzed using the Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. The short-term surgical outcomes were analyzed using a multilevel analysis. Hospital volumes were divided into quartiles, including low (1–31), middle (32–55), high (56–91), and very-high volume (92–444 resections per 4 years). The effects of hospital volume on the outcomes were investigated. Results: The study population included 8,335 patients (22%) who underwent open low anterior resection (O-LAR) and 29,486 patients (78%) who underwent L-LAR. The in-hospital mortality and morbidity were consistent with previous reports. In patients who underwent L-LAR, the in-hospital mortality (0.12% vs. 0.41%; OR: 0.33; p = 0.005), the rate of reoperation (3.76% vs. 6.48%; OR: 0.67; p < 0.001), and the perioperative transfusion rate (3.81% vs. 5.90%; OR: 0.66; p < 0.001) were significantly lower in very-high-volume hospitals than in low-volume hospitals. These effects of hospital volume were not observed in O-LAR. Conclusions: Our present study demonstrates that high volume improves outcomes in patients who underwent L-LAR in a real-world setting.

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.

Efficacy and safety of tranexamic acid in elderly patients with femoral neck fracture treated with hip arthroplasty: A systematic review and meta-analysis

BackgroundElderly patients with femoral neck fracture have high perioperative blood loss according to the trauma and hip arthroplasty surgery. Tranexamic acid is a fibrinolytic inhibitor and has been widely used in hip fracture patients to against perioperative anemia. The aim of the present meta-analysis was to evaluate the efficacy and safety of Tranexamic acid (TXA) in elderly patients with femoral neck fracture undergoing hip arthroplasty. MethodsWe performed search using Pubmed, EMBASE, Cochrane Reviews, and Web of Science databases to identify all relevant research studies published from inception to June 2022. Randomized controlled studies and high-quality cohort studies that reported the perioperative use of TXA in patients with femoral neck fractures treated with arthroplasty, and made a comparison with the control group were included. Meta-analysis was performed using Review Manager 5.3 to assess the efficacy and safety of TXA. Subgroup analysis was conducted to further investigate the impact caused by surgery types and administration routes on the efficacy and safety outcomes. ResultsFive randomized controlled trials (RCTs) and eight cohort studies published from January 2015 to June 2022 were included in this meta-analysis. The results showed significant reductions in the rate of allogeneic blood transfusion, total blood loss (TBL) and postoperative hemoglobin (Hb) drop in the TXA group compared with the control group, while no significant difference was found in the intraoperative blood loss, postoperative drainage, hospital length of stay (LOS), re-admission rate, and wound complications between the two groups. The incidence of thromboembolic events and mortality showed no significant difference. Subgroup analysis indicated that surgery types and administration routes did not change the overall tendency. ConclusionThe current evidence shows that both intravascular administration (IV) and topical administration of TXA can significantly decrease the perioperative transfusion rate and TBL without increasing the risk of thromboembolic complications in elderly patients with femoral neck fracture.

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.

Can hydroxyapatite charged collagen sponge help reduce perioperative blood loss in adolescent idiopathic scoliosis surgery? Preliminary results in 68 patients.

Patient blood management has been recently emphasized to avoid perioperative blood transfusion in AIS surgery. Hydroxyapatite charged collagen sponge (HCS) is a bone substitute material made of collagen and ceramized hydroxyapatite, with associated haemostatic properties. The goal of this study was to assess the impact of HCS in the perioperative blood loss in AIS surgery. After IRB approval, all AIS patients undergoing primary correction were prospectively included over a 15-month period. Patients receiving HCS at the end of the procedure were compared to a control group (matched for age, gender, and fusion levels) without any haemostatic agent or bone substitute. The same perioperative blood saving strategies were used in both groups. Two subfascial drains were used for 48h in all patients. Perioperative blood loss and transfusion rates were analysed. A total of 34 patients were included in each group. No difference in drainage volume was observed at day 1, but the reduction was statistically different at day 3 (1135mL [800-1640] versus 930 [480-1510], p = 0.028, 0.63ml/Kg/h [0.4-0.92] versus 0.46 [0.29-0.7], p = 0.042). Multivariate analysis found that the use of HCS was associated with a decrease in the postoperative blood loss (OR = 1.17 [1.10-1.25]). The transfusion rate was lower in the HCS group [0 (0% vs. 3(8.8%), p = 0.076)]. No infection occurred, and no complication was reported. With 27% reduction in drain volume, hydroxyapatite charged collagen sponge can be considered as a blood salving strategy in AIS surgery. The role of the biomaterial in fusion rate still needs to be further assessed.

Efficacy of ferric carboxymaltose in iron deficiency anemia patients scheduled for pancreaticoduodenectomy.

Perioperative transfusion is reported to be an independent risk factor not only for postoperative complications but also for early recurrence of periampullary carcinoma after pancreaticoduodenectomy (PD). The purpose of this study was to evaluate the safety and efficacy of ferric carboxymaltose (FCM) in reducing the need for perioperative transfusion in iron deficiency anemia patients scheduled for PD. Twenty-two male patients (hemoglobin [Hb] 7 to <13 g/dL) and 18 female patients (Hb 7 to <12 g/dL) were enrolled in the study group and administered FCM 1-3 weeks before PD. The perioperative transfusion rate was the primary endpoint; morbidity, length of postoperative hospital stay, change in hematological parameters after FCM injection, and adverse effects of FCM were also investigated. The perioperative transfusion rate of the study group was 22.5% (9 of 40). Hb level was significantly higher on the day of the operation compared to baseline (P < 0.001). Levels of Hb, transferrin saturation, and ferritin were higher at the follow-up compared to baseline (P = 0.008, P = 0.033, and P < 0.001, respectively). FCM administration was associated with a reduced need for perioperative transfusion and can safely stabilize hematological parameters.

ÁCIDO TRANEXÂMICO NA CIRURGIA DE ESCOLIOSE EM ADOLESCENTES: REVISÃO SISTEMÁTICA

ABSTRACT The objective of this study was to conduct a systematic literature review to evaluate the impact of perioperative blood loss reduction and blood transfusion rate in patients undergoing adolescent idiopathic scoliosis correction surgery and to correlate these results with the different doses of tranexamic acid used in the literature. Ten databases (BVS, COCHRANE, EBSCOHOST, EMBASE, EPISTEMONIKOS, PROQUEST, PUBMED PMC, PUBMED, SCOPUS, WEB OF SCIENCE) were searched to find studies on the effectiveness of tranexamic acid in idiopathic scoliosis surgery. The mean differences in bleeding and transfusions were combined using a random-effects meta-analysis. A total of 17 studies with 1608 patients were included in the evaluation, demonstrating an Odds Ratio of 2.8 (95% CI: 0.8-4.3) as a measure of association for the risk of bleeding and transfusion in the control group (non-users of tranexamic acid), efficiency in reducing bleeding (p=0.03). Additionally, a mean reduction in bleeding of approximately 700 ml was observed. There was no statistical difference between the doses used. The systematic review showed that tranexamic acid effectively reduces bleeding and the need for transfusions, but there were no significant differences in the results between different doses of tranexamic acid. Level of Evidence II; Systematic Review.

Surgical Delay Increases the Perioperative Blood Transfusion Rate In Percutaneous Nephrolithotomy.

We aimed to investigate the effect of prolonged time from diagnosis to treatment (TDT) on surgical outcomes in patients undergoing percutaneous nephrolithotomy (PNL). This study included a total of 544 patients who underwent PNL in our clinic between November 2017 and November 2021. Clinicodemographical, radiological, and perioperative data of the patients were recorded. The stone-free rate as assessed by abdominal computed tomography at 3 months was estimated. The possible relation of the stone-free rate and perioperative complications with TDT was examined. The median age was 48 (range, 38-58) years, the median stone size was 405 (range, 250-700) mm2, and the median stone density was 1,000 (range, 730-1,221) Hounsfield units. The median TDT was 75 (range, 42-133) days. Twenty-seven patients (5.0%) required perioperative blood transfusion (PBT). There was a statistically significant correlation between TDT and the need for PBT (p=0.022). However, there was no significant correlation between TDT and stone-free rate (p>0.05). Using a cutoff value of 90.5 days, TDT could predict the need for PBT with 59.3% sensitivity and 60% specificity. Our study results suggest that the need for PBT increases in patients undergoing PNL longer than 90.5 days after the diagnosis. However, further large-scale, prospective studies are warranted to elucidate the effect of prolonged TDT on surgical outcomes in this patient population.

Tranexamic versus aminocaproic acids in patients with total hip arthroplasty: a retrospective study

BackgroundRecently, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) have been applied in total hip arthroplasty (THA). However, doubts in clinicians’ minds about which medicine is more efficient and economical in THA need to be clarified. Therefore, this study compared the efficacy and cost of the intraoperative administration of TXA and EACA per surgery in decreasing perioperative blood transfusion rates in THA.Methods This study enrolled patients who underwent THA between January 2019 to December 2020. A total of 295 patients were retrospectively divided to receive topical combined with intravenous TXA (n = 94), EACA (n = 97) or control (n = 104). The primary endpoints included transfusions, estimated perioperative blood loss, cost per patient and the drop in the haemoglobin and haematocrit levels.ResultsPatients who received EACA had greater total blood loss, blood transfusion rates, changes in HGB levels and mean cost of blood transfusion per patient (P < 0.05) compared with patients who received TXA. In addition, both TXA and EACA groups had significantly fewer perioperative blood loss, blood transfusion, operation time and changes in haemoglobin and haematocrit levels than the control group (P < 0.05). Cost savings in the TXA and EACA groups were 736.00 RMB and 408.00 RMB per patient, respectively.ConclusionsThe application of perioperative antifibrinolytics notably reduces the need for perioperative blood transfusions. What’s more, this study demonstrated that TXA is superior to EACA for decreasing blood loss and transfusion rates while at a lower cost per surgery. These results indicate that TXA may be the optimum antifibrinolytics for THA in Chinese area rather than EACA.

Preoperative Misoprostol to Reduce Blood Loss and Related Morbidities During Abdominal Hysterectomy: a Systematic Review and Meta-analysis of 10 Randomized Placebo-Controlled Trials.

The objective of this study is to perform a meta-analysis of all randomized controlled trials (RCTs) that surveyed the efficacy and safety of preoperative misoprostol versus placebo during abdominal hysterectomy. Six databases were screened from inception until 3 August 2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model. Ten RCTs with 1076 patients (misoprostol = 537, placebo = 539 patients) were analyzed. Six and four RCTs had an overall low and high risk of bias (single-blinded), respectively. The mean intraoperative blood loss (n = 10 RCTs, MD = - 78.97ml, 95% [- 130.89, - 27.06], p = 0.003), mean difference in hemoglobin drop (n = 10 RCTs, MD = - 0.42g/dl, 95% CI [- 0.69, - 0.14], p = 0.003), and mean length of hospital stay (n = 5 RCTs, MD = - 0.2 d, 95% CI [- 0.24, - 0.16], p < 0.001) were significantly reduced in favor of the misoprostol group compared with the placebo group. However, there were no significant differences between both groups regarding the mean operative time (n = 8 RCTs, MD = - 0.63min, 95% CI [- 5.07, 3.81], p = 0.78), rate of perioperative blood transfusion (n = 7 RCTs, RR = 0.83, 95% CI [0.53, 1.3], p = 0.42), and rate of drug-related adverse events (i.e., nausea, vomiting, diarrhea, headache, chills, and fever). Leave-one-out sensitivity analyses revealed stability for all endpoints, except hospitalization stay. There was no publication bias for all endpoints, except perioperative blood transfusion. Among patients undergoing abdominal hysterectomy, preoperative administration of misoprostol was largely safe and linked to substantial decrease in blood loss-related morbidities.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Preoperative Intravenous Iron Treatment in Colorectal Cancer: Experience From Clinical Practice.

Anemia is associated with increased postoperative morbidity and mortality in abdominal surgery. In clinical trials, preoperative i.v. iron treatment increases the preoperative hemoglobin (Hb) concentration but the effect on transfusion rates are not consistent. This study reports on the experience with preoperative i.v. iron treatment in surgical colorectal cancer (CRC) patients in clinical practice. A registry-based cohort study. Surgical colorectal cancer patients with iron deficiency anemia were compared after division into two groups; those who preoperatively received i.v. iron treatment and those who did not. Primary outcomes were preoperative changes in Hb and the difference in perioperative red blood cell transfusion (RBCT) rates. Postoperative complications and mortality rates were analyzed and a descriptive analysis on what triggered blood transfusions were performed. A total of 170 patients were included. Of these, 122 had received preoperative i.v. iron treatment and 48 had not. The perioperative transfusion rate was 45% (55/122) in the treatment group and 40% (19/48) in the control group (non-significant difference). The preoperative changes in Hb levels were not different between the two groups. Transfusion practice appeared more liberal and preceded by higher Hb levels that was guided by the National transfusion guideline. I.v. iron treated patients had a higher rate of postoperative complications. No differences were found on length of stay (LOS) or postoperative mortality. Preoperative i.v. iron treatment was neither associated with a rise in Hb concentrations at the time of surgery, nor with a reduction in the likelihood of receiving perioperative red blood cell transfusions (RBCT) in colorectal cancer (CRC) patients with iron deficiency anemia.

Aplicación de un programa de ahorro de sangre en cirugía cardiaca: análisis y resultados

Introduction and objectivePreoperative anemia, reexploration for bleeding and need for transfusion are common problems in patients undergoing mayor cardiac surgery and are associated with an increase morbidity and mortality. The objective of the present report is to evaluate our surgical results focusing on hematological parameters after the implementation of a Patient Blood Management (PBM) program. MethodsBetween March 2021 and May 2022, we have consecutively operated on 104 mayor cardiac surgery patients with the PBM program. The mean patient age was 65±11 years, 66% of the patients were male, 21% had a EuroScore II>5, 24% had preoperative anemia, and 2,8% were Jehovah's Witnesses who refused transfusions. The 19,2% of the procedures were off-pump coronary artery bypass grafting, 8,7% endocarditis, 10,6% redo operations, 2,9% acute aortic syndromes, and 34% urgent or emergent cases. ResultsThe incidence of reexploration for bleeding was 1,9% and the perioperative transfusion rate was 25%; 87,5% of the patients operated on electively and 90,5% of the isolated coronary patients did not receive blood components. The mean number of red blood cell concentrates (total transfusion index), fresh frozen plasma, and pooled platelets transfused per patient was 0.47, 0.16, and 0.07, respectively. ConclusionsThe PBM has allowed us to achieve our quality objectives in terms of reintervention for bleeding and perioperative transfusion rate.