Postoperative Hemoglobin Levels Research Articles

Comparison of Maylard and Cherney incisions' outcomes in hysterectomy surgery for benign indications: a double-blind randomized controlled trial

ObjectivesChoosing the incision for surgery depends on a variety of factors, including the surgeon's preference, patient preference, surgical indications, the patient's systemic issues, previous surgical scars, and other considerations. This trial aimed to evaluate and compare the surgical outcomes of two techniques—Maylard and Cherney incisions—in benign hysterectomy procedures for women.Materials and methodsA randomized controlled trial was conducted in Al-Zahra Women’s Tertiary Referral University Hospital. A total of 60 patients undergoing benign hysterectomy were randomly allocated to two groups, with one group undergoing surgery with a Maylard incision and the other with a Cherney incision. Surgeries in both groups were performed by a gynecologist oncologist who was a member of the university faculty, accompanied by an Obstetrics and Gynecology Resident.ResultsThere were no significant differences in hemoglobin levels or clinical or obstetric characteristics before surgery between the two study groups (p > 0.05). The mean time from skin incision to entering the abdominal cavity was 14.23 min for Maylard and 13.6 min for Cherney (p = 0.091). The average blood loss was 506.6 mL in the Maylard group and 429.3 mL in the Cherney group, which was statistically significant (p = 0.031). Postoperative hemoglobin levels were 11.68 g/dL in the Maylard group and 12.07 g/dL in the Cherney group (p = 0.133). Pain scores were higher in the Cherney group than in the Maylard group (p = 0.041). There were no surgical complications after 1 and 3 months in the study groups.ConclusionsNo complications were observed in any of the patients following the surgery. The Mylard incision showed a higher level of bleeding in comparison with the Cherney incision, which was linked to more noticeable pain. Nevertheless, both incisions are deemed as effective options for gynecological surgeries, offering superb visibility to the pelvis.

Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion

PurposeIn this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).MethodsSex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.ResultsOf the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P < 0.001), and surgery time (P < 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P < 0.001) and surgery time (P < 0.001) were independent risk factors for HBL.ConclusionIn patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.

Lipedema: Complications in High-Volume Liposuction Are Linked to Preoperative Anemia.

Background: Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus, we examined the effect of high-volume liposuctions on lipedema patients and the incidence of associated complications. Methods: We analyzed perioperative differences in lipedema patients undergoing low- or high-volume liposuctions. Statistical analyses were performed, investigating postoperative complications and the correlation of patients' BMI, total amount of aspiration, duration of surgery, hospital stay and hemoglobin alterations. Complications were investigated according to the Clavien-Dindo Classification. Patients were divided in two groups based on the volume aspirated at liposuction (low-volume vs. high-volume liposuction). Results: Overall, 121 sessions were investigated. Mean total volume of aspiration was 8227.851 mL ± 3643.891. Mean preoperative hemoglobin levels were 13.646 g/dL ± 1.075 g/dL. Preoperatively, 7.44% of patients were anemic (Hb < 12 g/dL). Mean postoperative hemoglobin was 10.563 g/dL ± 1.230 g/dL. Postoperatively, 90.10% of patients showed Hb levels below 12 g/dL. Hemoglobin loss differed significantly between the two groups (p = 0.001). Significant correlations between pre- (p = 0.015) and postoperative (p < 0.001) hemoglobin levels and pre- (p < 0.001) and postoperative (p < 0.001) anemia with Class II complications were also seen. The total volume of aspiration did not correlate with complication rates (p = 0.176). Conclusions: Complication rates in high-volume liposuctions are hemoglobin-dependent rather than volume-associated. Preoperative anemia was the most influential for the occurrence of postoperative complications. To safely conduct high-volume liposuctions in lipedema patients, adequate patient selection and preoperative patient preparation are imperative.

The effect of intravenous vitamin C administration on postoperative pain and intraoperative blood loss in older patients after intramedullary nailing of trochanteric fractures.

The purpose of this study was to determine the effects of peri and postoperative intravenous vitamin C administration on severity of postoperative pain and intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing. A prospective, single-blinded, controlled, randomised clinical study was conducted. It included 60 patients who were randomly divided into the Vitamin C and Control groups. Baseline characteristics, haemoglobin levels, number of Red Blood Cell (RBC) units transfusion, and metamizole consumption were noted in each group. Visual Analogue Scale (VAS) score was evaluated at 24 and 48h postoperatively. There were no differences between the groups concerning age, gender, length of hospitalisation, fracture type distribution, preoperative and postoperative haemoglobin levels. Postoperative metamizole consumption was higher in the Control group than in the Vitamin C group, with statistically significant difference (p = 0.003). The median VAS scores were higher in the Control group compared to the Vitamin C group at 24 and 48h postoperatively with significant differences (p = 0.001 and p < 0.0005, respectively). Multivariate logistic regression analysis revealed two independent predictors of postoperative blood transfusion: unstable fracture pattern (OR = 0.065, 95% CI 0.007-0.571, p = 0.014), and preoperative haemoglobin level (OR = 903, 95% CI 0.846-0.965, p = 0.003). The results showed significant reduction of subjective pain levels and lower analgesic consumption in patients who received intravenous vitamin C, suggesting that it could be considered as an adjuvant agent for analgesia in older patients with hip fracture. Unstable fracture pattern and preoperative haemoglobin levels significantly contributed to postoperative blood transfusion requirement.

An Analysis of Renal and Surgical Outcomes of Patients with and without Preoperative Ureteral Stenting before Nephron-Sparing Surgery for Renal Malignancies of Higher Complexity by Using a Propensity Score-Based Approach

Introduction: This study aims to evaluate the impact of preoperative ureteral stenting on post-operative outcomes, especially the incidence of urinoma, in patients with complex renal tumours undergoing nephron-sparing surgery (NSS). Methods: A retrospective analysis of 35 patients received preoperative ureteral stenting prior to NSS for complex tumours at the University Hospital of Würzburg between 2002 and 2021. A control group of 115 patients was established through 1:3 propensity score matching based on age, gender, T-stage, and RENAL score. Clinical parameters, surgical outcomes, and complications were assessed, and statistical comparisons were performed using the unpaired Student’s t test and chi-square test. Results: While both groups showed comparable tumour complexity (RENAL: 7 vs. 7, p = 0.58; PADUA: 9 vs. 8, p = 0.62), there were no significant differences in median hospital stay (12 vs. 11; p = 0.068), surgical time (183 vs. 190 min; p = 0.37), post-operative haemoglobin levels (11 g/dL vs. 11.1 day/dL; p = 0.9), and renal function (GFR 65 mL/min/m2 in both groups). Moreover complication severity during NSS, defined by Clavien-Dindo classification, was similar (none vs. grade I; p = 0.29). No significant difference in the rate of urinoma was observed (11% vs. 4%, p = 0.93). Conclusions: This study found no significant benefits of preoperative ipsilateral ureteral stenting on post-operative outcomes, particularly concerning the development of urinoma. Given these findings, preventive ureteral stenting is not recommended prior to partial kidney resection for complex renal tumours.

Optimization of the cardiac delirium index by including age, decrease in butyrylcholinesterase actitivity, preoperative HbA1c, and postoperative hemoglobin levels: results of a secondary analysis of a prospective observational study.

Postoperative delirium (POD) after cardiac surgery significantly affects the perioperative morbidity and mortality. Butyrylcholinesterase (BChE) is an enzyme primarily produced in the liver, which plays a crucial role in the hydrolysis of acetylcholine outside of neuronal synapses, referred to as extraneuronal hydrolysis. The integration of BChE activity into the cardiac delirium (CARDEL) index might increase its predictive power for identifying POD after cardiac surgery. Therefore, the primary aim of this study was to assess the applicability of the CARDEL index and determine whether integrating the BChE activity enables optimization of the predictive model. This secondary analysis of a prospective observational study included patients undergoing elective coronary artery bypass graft surgery. BChE activity is expressed in units per liter (U/L), while the BChE drop refers to the percentage decrease in BChE activity from pre- to postoperative levels. POD risk factors were identified using multivariate regression analysis. The predictive power of the CARDEL index and an optimized model including BChE was calculated with receiver operating characteristic (ROC) analysis. Of 93 included patients, 20 (21.5%) developed POD. Elevated preoperative HbA1c [OR 2.5 (1.2-4.8), p = 0.01], a decrease in BChE activity [%, OR 1.1 (1.0-1.2), p = 0.04], age [1 (0.94-1.1), p = 0.55], and a postoperative hemoglobin change [OR 0.86 (0.78-0.96), p < 0.001] were identified as independent risk factors for POD. While the CARDEL index showed a moderate prediction of POD [AUCROC of 0.74 (0.60-0.87)], the optimization including BChE resulted in a significant prognostic improvement: AUCROC of 0.84 (0.72-0.94, p < 0.001). Despite the small size of this derivation cohort, this study identified elevated HbA1c as the strongest risk factor for the development of POD, followed by a decrease in BChE activity, postoperative anemia, and age, respectively. By including these parameters to the CARDEL index, its predictive power for the identification of POD significantly improved in this derivation cohort. Moving forward, integrating these findings into clinical practice could enhance early risk stratification and targeted intervention for patients at high risk of POD. Therefore, further research should evaluate these results in a larger, external cohort.

Should We Regularly Assess Hemoglobin Levels Following Elective Total Knee Arthroplasty, with the Administration of TXA and Without the Usage Tourniquet? An Observational Study from a Single Center.

Background and Objectives: The aim of this study was to test whether there is a necessity for routine postoperative laboratory testing in patients undergoing primary elective unilateral total knee arthroplasty (TKA), with the administration of Tranexamic Acid (TXA) and without the use of tourniquet. Materials and Methods: This observational, retrospective cohort study was conducted at Meir Medical Center. The data were collected in 2018-2022. Patients were collected in a consecutive manner. There were no exclusion criteria for this study. The inclusion criteria were individuals who underwent elective TKA due to end-stage osteoarthritis (OA). We conducted a multivariable logistic regression analysis to determine the factors associated with postoperative hemoglobin (PoOHb) < 9 g/dL and the optimal cutoff to detect those patients postoperatively. Results: A total of 271 patients were included. The mean preoperative hemoglobin (PrOHb) was 13.02 ± 1.42 g/dL, and the mean PoOHb was 11.5 ± 1.34 g/dL. The mean decrease in Hbg levels following surgery was 1.52 ± 0.91 g/dL. In all, 271 patients had a PoOHb level ≥ 9 g/dL or above. A total of 16 patients received packed red blood cells following surgery. Patients with PoOHb < 9 g/dL had a significantly lower PrOHbg. In the current study, all 11 patients who had PoOHb < 9, 10 (90.9%) had PrOHb ≤ 1011.95 55 g/dL, compared to 25 (49.6%) of the 260 patients who had PoOHb ≥ 9. The odds ratio for having PrOHb ≤ 10.9511.55 g/dL if PoOHb < 9 g/dL was 206.6710.4 (95% CI 24.427.164 to 1749.01415.97). A cut-off of 11.2510.25 would have offered a sensitivity of 99% (specificity 93.5%). Conclusions: In conclusion, this study supports using selective post-TKR Hgb monitoring rather than adhering to routine practice. An association between postoperative anemia and the need for blood transfusion was found only when the preoperative baseline hemoglobin threshold was less than 10.95 g/dL.

Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study

BackgroundLow molecular weight heparin (LMWH) has been the standard treatment for preventing venous thromboembolism after total joint arthroplasty. However, the evidence supporting specific LMWH dosing regimens is limited.ObjectivesThis study assessed the efficacy and safety of three enoxaparin dosing regimens to prevent venous thromboembolism.MethodsParticipants undergoing hip or knee replacement were randomly assigned to receive 20 mg of enoxaparin 6 h postoperatively (Group A), 40 mg 6 h postoperatively (Group B), or 40 mg 12 h postoperatively (Group C). The primary outcomes included thromboembolic and major bleeding events within 3 months, while the secondary outcomes comprised ecchymosis, wound exudation, drainage volume, allogeneic red blood cell transfusion, and first postoperative day hemoglobin levels.ResultsA total of 536 patients were analyzed. The occurrence of thromboembolic events was comparably low across all groups. Group C exhibited the lowest postoperative ecchymosis rate at 19.3%, significantly less than Group A (32.8%, p = 0.004) and Group B (37.7%, p < 0.001). Ecchymosis rates were about double in Group A and 1.5 times higher in Group B compared to Group C. Significant differences were also observed in 24-hour and total postoperative drainage volumes, with Group B having higher volumes than the other groups.Clinical trial registrationThis trial was prospectively registered at the China Clinical Trials Registry (registration date: November 14, 2021; registration number: ChiCTR2100053191).ConclusionNo significant differences in venous thromboembolism rates were seen between the tested enoxaparin dosing regimens after total joint arthroplasty. The 40 mg dose administered 12 h after surgery was associated with reduced postoperative ecchymosis and drainage volumes without an increased thrombosis risk, suggesting it is a safer and more effective option than earlier or lower dosages.Graphical

Minimizing Blood Loss Using Tranexamic Acid in Patients Undergoing Liposuction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Liposuction has become the most sought-after aesthetic surgery across the globe, increasing the demand for more developments in patient safety protocols. Evidence of the efficacy of tranexamic acid (TXA) in reducing intraoperative blood loss with minimal complications have led to its widespread applications across various surgical operations. However, the role and effectiveness of TXA in liposuction is not fully understood. Therefore, the purpose of this systematic review and meta-analysis is to investigate the effectiveness of TXA in minimizing intraoperative blood loss in patients undergoing liposuction. In adherence to the preferred reporting items for systematic reviews and meta-analysis guidelines, a comprehensive search was conducted in multiple databases including, PubMed, Cochrane CENTRAL, and Web of Science. Only randomized controlled trials (RCTs) were included without time frame limitations. Our primary outcomes were hemoglobin levels, hematocrit levels, lipoaspirate volume, and associated complications. This meta-analysis provides a comprehensive analysis of five RCTs published between 2021-2023, involving 334 patients. The pooled mean difference for postoperative hemoglobin levels was statistically significant in favor of local TXA administration (MD 0.54; P = 0.03; I2 = 0%). Analysis of postoperative hematocrit levels (g/dL) and lipoaspirate volume (L) mean differences were statistically insignificant (MD 0.76; P = 0.35; I2 = 0%) and (MD 0.19; P = 0.82; I2 = 85%) respectively. No complications related to the use of TXA occurred. Although a statistically significant difference was seen in postoperative hemoglobin levels, it is imperative that the results are interpreted with caution, given the preliminary nature of the observed effect. Further large well-designed RCTs are required to solidify current TXA protocols and to provide comprehensive guidelines for its application in liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections

Abstract Background NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated. Method Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription. Results 49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups. Conclusion Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.

Comprehensive geriatric assessment for predicting postoperative delirium in oral and maxillofacial surgery: a prospective cohort study

Identifying high-risk patients for developing postoperative delirium (POD) is essential for optimizing the medical field’s human and financial resources through specialty-relevant geriatric assessments that can aid in establishing prehabilitation strategies. This study aims to identify geriatric screening tools to predict preoperative delirium and explore the high-risk elderly patients undergoing oral maxillofacial surgery. A comprehensive geriatric assessment encompassing 23 instruments was used to evaluate inpatients undergoing surgery under general anaesthesia, preoperatively and postoperatively. Selective intraoperative and postoperative variables were also assessed for their relation to POD occurrence. This prospective study included 90 patients (mean age 79.0 years) from August 2022 to August 2023. The POD rate in this cohort was (8.9% n = 8). The Clock-Drawing Test (CDT) was significantly associated with POD occurrence (p = 0.005). Significant associations were found between POD occurrence and operation type (p = 0.018), duration (p = 0.026), length of stay ( p = 0.002), and postoperative hemoglobin levels (p = 0.027). This study highlights the importance of comprehensive geriatric assessments in predicting POD in elderly patients. Future research should build on these findings to enhance preoperative care strategies and improve outcomes.Trial registration: German Register of Clinical Studies, DRKSID DRKS00028614.

Comparison of mean postoperative decrease in hemoglobin level in patients undergoing transurethral resection of prostate with and without preoperative intraprostatic epinephrine.

Objective: To determine and compare the mean decrease in hemoglobin level from the baseline value in patients undergoing TURP with and without preoperative intraprostatic epinephrine injection. Study Design: Analytical Cross Sectional study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Nov 2023 to Feb 2024. Methods: After ERC approval and taking informed consent a total of 40 patients with enlarged prostate and scheduled for TURP, having comparable baseline clinical and laboratory characteristics such as age, preoperative prostate size and baseline hemoglobin were enrolled in the study &amp; were divided in two equal numbered groups called group A and group B, each having 20 patients in it. Before performing monopolar TURP group A patients were given 200mcg of intraprostatic epinephrine injection diluted in 20ml of normal saline (10ml in each right &amp; left lobe) under transrectal ultrasonic guidance via the transperineal route, while no such intervention was done before TURP in group B patients. One pint of whole blood was transfused to the patients of both the groups intraoperatively and blood samples were sent to laboratory on 1st post-operative day to determine the postoperative hemoglobin levels of patients of both the groups. Data was entered on the designated pro forma for analysis. Results: Postoperative hemoglobin levels were significantly higher in group A patients (mean and S.D 11.83 ±1.01 g/dl) as compared to the group B patients (mean and S.D 11.00 ± 1.06 g/dl) with a p value of 0.015, and hence drop of hemoglobin levels from the baseline values were lower in group A patients (mean and S.D 1.28 ± 0.89 g/dl) as compared to the group B patients (mean and S.D 2.31 ± 0.98 g/dl), confirming a statistically significant difference with p value of 0.001. Conclusion: The hemorrhage associated with TURP can be decreased significantly by giving preoperative intraprostatic epinephrine injection. This is a clinically safe technique that can not only reduce the postoperative blood transfusion requirements but can also allow the operating surgeon to resect more tissue within the desired time thus increasing the efficacy of TURP.

Keblish’s Lateral Surgical Approach Enhances Patellar Tilt In Valgus Knee Arthroplasty

Objectives To compare clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. Methods In this randomized controlled trial, twenty-one patients with valgus knee osteoarthritis were randomized to either receive a total knee replacement through medial or lateral approach. Primary outcome was radiographic patellar tilt. Secondary outcomes were visual analogue scale of pain, postoperative levels of hemoglobin and clinical aspect of the operative wound. Results Groups were comparable. Mean lateral tilt of the patella was 3.1 degrees in lateral approach group (Standard Deviation ± 5.3) and 18 degrees in the medial approach group (Standard Deviation ± 10.2), with p=0.02. There were no differences within secondary outcomes. Conclusion Lateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.

Comparison of Efficacy of Suprapatellar and Infrapatellar Approaches for Intramedullary Interlocking Nailing of Tibia in Patients With Tibial Fracture.

Intramedullary interlocking nailingis a common surgical procedure for tibial fractures, enabling early patient mobilization. Traditionally, the infrapatellar approach has been used for intramedullary interlocking nailing of tibial fractures, but the suprapatellar approach is gaining attention for its potential benefits. This randomized controlled study aimed to compare the duration of the surgery, intra-operative blood loss, and fluoroscopy time between the suprapatellar and infrapatellar approaches. We included 38 adult patients with tibial shaft fractures, excluding those with non-union, open fractures, revision surgery, or low Glasgow Coma Scale (GCS). Patients were divided equally into two groups using block randomization: Group A (19 patients) underwent the infrapatellar approach, and Group B (19 patients) underwent the suprapatellar approach. Blood loss was measured using the gravimetric method and by changes in pre-operative and post-operative hemoglobin levels. Surgical duration by calculating the time elapsed between the start and end of the procedure and fluoroscopy time was logged from the fluoroscopy machine. In group A, blood loss averaged 154±30.98 mL, slightly more than in group B (150±32.92 mL), though the difference was not statistically significant (p>0.05). Group A also showed a higher difference in hemoglobin levels (2.20±1.13 g/dL) compared to group B (1.15±0.93 g/dL), which was statistically significant (p=0.02). Fluoroscopy time and duration of the surgery were slightly longer in group A compared to group B but not statistically significant (p=0.693). The suprapatellar approach results in less blood loss, potentially promoting faster recovery, reduced need for blood transfusions, and shorter hospital stays. It also entails shorter fluoroscopy time and surgical duration, though not statistically significant, which may reduce radiation exposure for the surgical team.

Comparison of Tourniquet and Non-Tourniquet Use in Total Knee Arthroplasty: Impact on Postoperative Hemoglobin Changes and Surgical Time

Aim: This study aimed to evaluate the impact of pneumatic tourniquet use on postoperative hemoglobin (Hb) and hematocrit (Hct) levels, changes in Hb/Hct, and surgery duration in total knee arthroplasty (TKA) by comparing outcomes between patients who underwent the procedure with and without tourniquet application. Methods: A retrospective cohort study was conducted on 130 patients with Kellgren-Lawrence grade 3-4 gonarthrosis who underwent TKA. Patients were divided into two groups, each with 65 patients, based on tourniquet use. Preoperative and postoperative day 1 Hb/Hct values, ΔHb/ΔHct, and surgery duration were compared. Patients with comorbidities and significant perioperative complications were excluded. Results: No significant differences were found between the tourniquet and non-tourniquet groups for preoperative or postoperative Hb and Hct levels (p &gt; 0.05). Both groups experienced significant reductions in hemoglobin and hematocrit levels postoperatively. The non-tourniquet group had a slightly greater decrease in hemoglobin and hematocrit, although this difference was not statistically significant (p &gt; 0.05). The tourniquet group demonstrated a significantly shorter operation duration (p = 0.004). Conclusion: Tourniquet use in TKA reduces surgical time without significantly affecting blood loss. The comparable outcomes in both groups suggest that the use of a tourniquet may offer practical advantages, in terms of procedural efficiency in reducing surgical time, but its influence on postoperative Hb and Hct changes is minimal. Study evidence level: A level 3 retrospective cohort study

Robot-assisted Müllerian compartment resection for cervical cancer.

Radical hysterectomy has been established as the standard treatment for early stage cervical cancers. Despite numerous efforts to standardize the technique for radical hysterectomy across varying extents of tumor invasion, success has been inconsistent. Total Müllerian Compartment Resection (TMCR), an ontogenetic compartment-based oncologic surgery initially developed for open procedures by Professor Höckel, offers a standardized approach applicable to all patients with locally confined tumors. This method holds promise for achieving thorough oncologic clearance while maintaining acceptable complication rates. Moreover, robotic-assisted surgery may further reduce morbidity compared to open surgery. In this context, we provide a detailed step-by-step description of robotically assisted Total Müllerian Compartment resection (R-TMCR) for cervical cancer and present feasibility data from a cohort of 20 patients. 20 patients with stage IA1-IB2 cervical cancer, robot-assisted resection of the Müllerian embryonic compartment was undertaken. Key metrics such as operative duration, intraoperative blood loss, and postoperative complication rates were meticulously recorded and analyzed. The duration of the surgery varied from 185 to 500 minutes, with intraoperative blood loss ranging between 5 mL and 300 mL. Postoperative hemoglobin levels dropped by -15 to 40 g/L from their preoperative values. Notably, there were no instances necessitating conversion to open surgery, and no intraoperative complications occurred. The rate of postoperative complications was 0%. Over the follow-up period, which averaged 18 months, there were no observed locoregional recurrences of cervical cancer, nor were there any deaths attributed to cervical cancer during this time. The application of robotic Müllerian compartment resection in the surgical treatment of cervical cancer is both safe and feasible. Utilizing robotic technology enables more precise and refined surgical outcomes. Combining embryonic compartment-based radical hysterectomy with the principles of membrane anatomy can standardize and optimize the surgical process, helping surgeons master radical hysterectomy more quickly and effectively.

Total Knee Replacement Among Elderly: The Role of Tranexamic Acid.

Background Tranexamic acid (TXA) administration in total knee replacement (TKR) surgery has been shown to reduce blood loss and transfusion requirements. However, its efficacy and safety in elderly patients undergoing arthroplasty remain under investigation. This study aimed to assess the impact of TXA on blood loss and post-operative outcomes in TKR patients among a local elderly population. Methodology A prospective descriptive-analytical hospital-based randomized study was conducted, involving 79 TKR patients who received TXA. Demographic data, comorbidities, pre- and post-operative hemoglobin levels, length of hospital stay, transfusion requirements, and post-operative complications were recorded. Statistical analysis was performed using SPSS (IBM Corp., Armonk, NY), including descriptive analysis and comparative tests. Results The mean drop in hemoglobin levels post-operatively was -1.55 g/dL (SD = 0.94). The majority of patients (78, 98.7%) did not require packed red blood cell transfusions post-operatively, and complications were minimal (1, 1.3%). The length of hospital stay was relatively short (mean = 4.84 days). Comparison with existing literature revealed TXA's effectiveness in reducing blood loss compared to studies without TXA administration. Conclusion TXA administration in TKR surgery effectively reduced blood loss, transfusion requirements, and post-operative complications, supporting its use as a standard adjunctive therapy. These findings emphasize the importance of TXA in optimizing patient outcomes and minimizing surgical complications in TKR patients. Limitations of the study include the relatively small sample size and the exclusion of patients with certain comorbidities, which may limit the generalizability of the findings. Further research is warranted to validate these findings in larger patient cohorts and explore long-term effects.

Efficacy of Preoperative Autologous Blood Donation for Surgical Treatment of Thoracic Spinal Stenosis: A Propensity-Matched Cohort Study.

Thoracic spinal stenosis (TSS) surgeries necessitate a substantial amount of allogeneic blood resources. However, the efficacy of preoperative autologous blood donation (PABD) in TSS surgery has not been clearly evaluated. Therefore, we aimed to evaluate the efficacy of PABD for TSS surgery. This study is a retrospective study. Totally 397 patients who underwent TSS surgeries at our institution from January 2019 to June 2023 were included. Propensity score matching (PSM) was used to make the PABD and Non-PABD groups comparable at baseline. Regarding outcome measures, the incidence and amount of allogeneic blood transfusion, changes in postoperative hemoglobin and hematocrit levels, occurrence of postoperative complications, medical costs, drainage time, length of hospital stay, and postoperative neurological function were analyzed. The outcomes were compared between the matched PABD (n = 79) and Non-PABD (n = 79) groups. Univariate analysis methods were used for statistical analysis, including independent samples t-test, Wilcoxon rank-sum test, and chi-square test. The incidence of allogeneic blood transfusion (8.9% vs. 25.3%, p = 0.006) and volume of intraoperative red blood cell (RBC) transfusion (10.12 ± 54.52 vs. 122.78 ± 275.00 mL, p < 0.001) in the PABD group were significantly lower than those in the Non-PABD group. The PABD group had significantly higher average postoperative hemoglobin and hematocrit levels than the Non-PABD group at 1, 3, and 5 days after surgery (p < 0.05). Similarly, the PABD group exhibited a smaller reduction in hemoglobin and hematocrit levels compared with the Non-PABD group on 1, 3, and 5 days postoperatively. There were no significant intergroup differences in terms of transfusion-related complications, medical expenses, neurological function, length of hospital stay, or drainage time. Notably, PABD was an independent protective factor of allogeneic transfusion in the multivariate regression analysis (OR = 0.334, 95%CI = 0.051-0.966). PABD can effectively reduce the incidence of allogeneic blood transfusion and amount of allogeneic blood in TSS surgeries with safety. It also significantly improved the postoperative hemoglobin and hematocrit levels. Under the premise of clear indications, PABD is worth promoting for the surgical treatment of TSS.

Efficacy of Peri-Operative Intra-Articular Compared with Intravenous Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) is an established and reliable surgical procedure but it is associated with substantial perioperative blood loss. Tranexamic acid (TXA) reduces blood loss in this type of surgery. Aim of the Work The main primary outcome of this study is to investigate and compare the clinical effectiveness of intra-articular (IA) topical TXA with intravenous (IV) TXA in patients undergoing primary TKA regarding the efficacy in reducing blood loss. The other secondary targets for this study is to compare and discuss the efficacy of both regimens regarding the level of hemoglobin drop, reducing the need of blood transfusion, checking the safety of both interventions regarding the patient population and possible accompanying comorbidities, and the reduction of length of hospital stay and costs. Materials and Method The electronic search strategy included the following databases: PubMed, and Cochrane Library from January 2010 to January 2020. Published accessible completed studies on the use of tranexamic acid TXA via the intra-articular IA route or the intravenous IV route in patients undergoing primary total knee arthroplasty TKA were identified through searching PubMed, and Cochrane Library using this specific set of keywords: (((((total knee arthroplasty) AND (tranexamic acid)) AND (intravenous)) OR (intraarticular)) AND (primary)) AND (tourniquet). Results This meta-analysis demonstrates the statistically significant favoring of IA-TXA over IV-TXA in reducing blood loss and it demonstrates the statistically significant favoring of IV-TXA over IA-TXA in postoperative hemoglobin level drop. Conclusion Both IV-TXA and IA-TXA are equivalent effectively in reducing the need for postoperative blood transfusion and consequently helps reduce the possible accompanying complications of blood transfusion.

Comparison of Mean Postoperative Hemoglobin Concentrations in Patients Undergoing Total Knee Arthroplasty With Intravenous Versus Intraarticular Administration of Tranexamic Acid.

Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid(TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXAadministered IVvs IAafter TKA. To assess the effectiveness of intraarticular TXA against intravenous administration. The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution"straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant. There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA. This study demonstrates that IAadministration of TXAis more effective in maintaining higher postoperative hemoglobin concentrations compared to IVTXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.