Posthemorrhagic Anemia Research Articles

Diagnosis and treatment of transient neonatal thrombocytopenia (Draft clinical recommendations for discussion by specialists)

Transient neonatal thrombocytopenia occurs with a frequency of 0.7–0.9% and is divided by etiological factor into primary (alloimmune and transimmune) and secondary (symptomatic) thrombocytopenia, according to the time of occurrence of thrombocytopenia is divided into early and late. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome of varying severity, which occurs in 20–30% of newborns with thrombocytopenia, in other newborns thrombocytopenia is asymptomatic. The most severe clinical symptom is intracranial hemorrhages, which occur in 10–30% of cases. The most common types of bleeding of the platelet-vascular type are petechiae, ecchymoses, nosebleeds, melena, hematuria, cephalohematoma and other types of bleeding. In dynamics, symptoms of posthemorrhagic anemia may appear with massive bleeding (pallor, tachycardia, tachypnea, decreased blood pressure). The main criterion for the diagnosis of transient neonatal thrombocytopenia is a decrease in the number of platelets below the reference values for a given gestational and chronological age of a newborn child. To diagnose the type of thrombocytopenia, a thorough collection of maternal anamnesis is necessary, examination of parents if they suspect the immune nature of the disease, diagnosis of the disease as a result of which thrombocytopenia has developed, if it is secondary. Correction of thrombocytopenia, if indicated, is carried out by intravenous administration of platelet concentrate. If the immune nature of thrombocytopenia with severe thrombocytopenia is suspected and/or the presence of moderate and higher hemorrhagic syndrome, the administration of normal human immunoglobulin is recommended. If immunoglobulin therapy for immune thrombocytopenia is ineffective, glucocorticoids are prescribed.

Trends and outcomes in colorectal cancer surgery: a multicenter cross-sectional study of minimally invasive versus open techniques in Germany

BackgroundThe objective of this study was to assess the trend from open to modern minimally invasive (laparoscopic and robot-assisted) surgical techniques for colorectal cancer (CRC) in Germany, with a particular focus on hospital mortality, postoperative complications, and length of hospital stay.MethodsA multicenter cross-sectional study was conducted using data from 36 German hospitals, encompassing 1,250,029 cases from January 2019 to December 2023. The study included all hospitalized patients aged ≥ 18 with CRC who underwent surgery. Surgical cases were categorized as open or minimally invasive. Outcomes assessed included in-hospital mortality, morbidity, and hospital length of stay. Statistical analyses involved multivariable logistic and linear regression models adjusted for main diagnosis, metastasis presence, age, sex, and comorbidities.ResultsThe study included 4525 CRC cases: 2767 underwent open surgery and 1758 underwent minimally invasive surgery (173 robotic). In-hospital mortality was significantly higher in open surgery (6.1% vs. 1.7%). Open surgery was also significantly associated with higher rates of acute post-hemorrhagic anemia (OR: 2.38; 95% CI: 1.87–3.02), respiratory failure (OR: 1.71; 95% CI: 1.34–2.18), and intraoperative and postprocedural complications (OR: 3.64; 95% CI: 2.83–4.70). Average hospital stay was longer for open surgery (19.5 days vs. 11.0 days).ConclusionDespite the advantages of minimally invasive surgery, including reduced mortality, morbidity, and shorter hospital stays, open surgery remains the predominant approach for CRC in Germany. These findings underscore the need for increased adoption of minimally invasive techniques and highlight the potential benefits of shifting toward minimally invasive methods to enhance the overall quality of CRC care.Graphical abstract

Mortality rate and factors associated with in-hospital mortality in patients hospitalized with pulmonary embolism in Germany.

Pulmonary embolism (PE) is a life-threatening condition, the prognosis of which is determined in particular by acute decompensation and hospitalization. The goal of this study was to investigate the prevalence of and the factors associated with the in-hospital mortality of patients hospitalized with acute PE. This multicenter cross-sectional study was based on the data of PE patient cases from 36 hospitals across Germany. A multivariable logistic regression analysis was conducted to assess the associations between demographic and clinical variables and in-hospital mortality. A total of 7136 hospitalization cases were included (mean age: 68.6years, 49.2% female). 60.2% of patients received PE as primary and 39.8% as secondary diagnosis. The mortality rate was 13.2%. Age group 71-80years (OR: 1.49; 95% CI: 1.18-1.88) and > 80years (OR: 2.06; 95% CI: 1.61-2.62), PE as secondary diagnosis (OR: 2.12; 95% CI: 1.676-2.56), respiratory failure (OR: 2.88; 95% CI: 2.44-3.41), acute renal failure (OR: 2.65; 95% CI: 2.14-3.27), hypokalemia (OR: 1.51; 95% CI: 1.28-1.79), heart failure (OR: 1.43; 95% CI: 1.18-1.73), and acute posthemorrhagic anemia (OR: 1.34; 95% CI: 1.04-1.74) were associated with an increased mortality risk. Our findings underscore the significant impact of age, acute renal failure, and respiratory complications on the mortality of patients with PE. While our study provides a comprehensive snapshot of in-hospital mortality in acute PE patients, it also highlights the need for ongoing research to deepen our understanding of the interplay between various risk factors.

Mortality and Morbidity After Open Surgical Lower Extremity Revascularization in Patients With Peripheral Artery Disease and Concurrent Abdominal Stoma.

Patients with peripheral artery disease (PAD) often require treatment with open lower extremity revascularization (LER). Patients with PAD often have other comorbidities and associated conditions that affect procedural outcomes, including abdominal stomas. The aim of this work is to investigate the impact that stomas may have on postoperative outcomes and complications. We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined. 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01). Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.

Metabolic Syndrome Components and Its Impact on Acute Kidney Injury After Total Joint Arthroplasty

BackgroundMetabolic syndrome (MetS) is an independent risk factor for postoperative complications. This study aimed to evaluate the associated risk of MetS for perioperative complications, especially urinary complications, in patients who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). MethodsWe used a publicly available all-payer administrative database to identify patients undergoing TKA and THA from 2016 to 2020. The primary exposure of interest was MetS. Multivariable adjusted models based on propensity score matching were used to evaluate the association of MetS components with acute kidney injury (AKI), urinary tract infection (UTI), and acute posthemorrhagic anemia (APHA) in patients who underwent TKA and THA. A counterfactual-based mediation analysis was conducted to investigate the mediating effect of APHA on the relationship between MetS and AKI. ResultsThe analysis included 2,097,940 (16.4% with MetS) THA and 3,073,310 (24.0% with MetS) TKA adult hospitalizations. Multivariable adjustment analysis indicated MetS was associated with an increased risk of AKI (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.69 to 1.89 for THA; OR 1.88, 95% CI 1.79 to 1.96 for TKA), UTI (OR 1.13, 95% CI 1.03 to 1.23 for THA; OR 1.26, 95% CI 1.17 to 1.35 for TKA), and APHA (OR 1.17, 95% CI 1.14 to 1.20 for THA; OR 1.7, 95% CI 1.15 to 1.19 for TKA). The risk of AKI increased with the number of MetS components, with ORs ranging from 2.58 to 9.46 in TKA patients and from 2.22 to 5.75 in THA patients. This increase was particularly associated with diabetes and hypertension, which were the most significant associated risk factors. Furthermore, APHA mediated the association between MetS and AKI. ConclusionsThe prevalence of MetS is increasing in TKA and THA patients. Metabolic syndrome was associated with increased risk of AKI, UTI, and APHA. The risk of AKI increased with each additional MetS component, with diabetes and hypertension contributing most. In addition, APHA may play a partial mediating role in MetS-induced AKI.

Nephrotransplantectomy Using Radiosurgical Techniques

Introduction. Aſter the loss of kidney transplant function, patient curation can be a difficult task. Nephrotransplantectomy (NTE) is the method of choice between reduction of immunosuppression with the abandonment of a non-functioning kidney transplant and embolization. This is an operation with potentially significant indicators of blood loss, complications and mortality. Along with traditional NTE, we began to use endovascular isolation of the allograſt as a method of preoperative preparation before its removal.The aim of the work is to investigate the effect of the use of radiosurgical minimally invasive techniques on the surgical tactics of nephrotransplantectomy, the degree of blood loss, the frequency of complications and blood transfusion.Materials and methods. A retrospective analysis of the data of 52 patients aſter NTE was performed. Depending on the method, patients are divided into two groups. In group 1 (main, n = 22), the operation was performed with pre-performed endovascular embolization of the graſt arteries (EEAT), in group 2 (control, n = 30) — without EEAT. The analysis of the results of the examination, intra- and postoperative indicators in patients by groups was carried out.Results. In group 1, intraoperative blood loss was 10–80 ml, on average (35.4±19.9) ml; in group 2 — from 100 to 600 ml, on average (289.7±138.4) ml (p &lt; 0.001). In group 2, damage to the main vessels occurred more oſten (n = 4) (13.3 % vs. 0 %), hemotransfusion was performed in 53.3 % of cases (n = 16) to correct posthemorrhagic anemia. Postoperative complications in the control group were recorded in 8 patients (26.7 %).Discussion. Preventive endovascular embolization of the arteries of a kidney transplant significantly reduces the frequency ofintra- and postoperative complications, allows nephrectomy to be performed on a planned basis andin a delayed manner.

Hospital Length of Stay and Associated Factors in Patients with Osteoarthritis from Germany: A Cross-Sectional Study.

Objective: There is a scarcity of data on hospital length of stay (LOS) in the osteoarthritis population. Therefore, this study aimed to investigate hospital LOS and associated factors in patients with osteoarthritis from Germany. Methods: The present cross-sectional study included patients hospitalized for osteoarthritis in one of fourteen hospitals in Germany between 2018 and 2023 (hospital database; IQVIA). The study outcome was the duration of hospital stay in days. Study covariables included age, sex, hospital department, osteoarthritis type, co-diagnosis, and hospitalization-related procedure. Associations between covariables and hospital LOS were analyzed using hierarchical linear regression models. Results: There were 8770 patients included in the study (mean [standard deviation] age 68.7 [10.8] years; 60.2% women). The mean (standard deviation) hospital LOS was 8.5 (5.0) days. Factors positively and significantly associated with hospital LOS were older age, female sex, orthopedic surgery and other medical specialty departments (compared with other surgery departments), knee and other and unspecified osteoarthritis (compared with hip osteoarthritis), multiple co-diagnoses (e.g., acute posthemorrhagic anemia, other disorders of fluid, electrolyte, and acid-base balance, and disorders of purine and pyrimidine metabolism), and several hospitalization-related procedures (i.e., geriatric rehabilitation, hip arthroplasty, and knee arthroplasty). Conclusions: The mean hospital LOS was higher than eight days in this osteoarthritis population from Germany, with a spectrum of demographic, clinical, and hospitalization-related factors associated with this hospital LOS. In this context, interventions are needed to reduce the LOS of hospitalizations for osteoarthritis in Germany.

Effectiveness of blood transfusion to cats suffering flea infestation

Donation and transfusion of whole blood and its components in cats are relevant issues in veterinary practice. Blood transfusion to cats helps effectively treat anemia of diverse causes or at least stabilize a patient for further examinatons and searh of solutions for particular pathologies. Measures ensuring blood matching of donor and recipient cats must be conducted with the utmost care and thoroughness possible. At the very least, the blood group A/B/AB of both cats should be checked, and ideally further cross-sampling should be performed so as to detect Mik antigenes and other incompatibilities. Unlike dogs, cats have natural antibodies. Donor cats must be clinically healthy, vaccinated, 2–8 years old, weigh over 4 kg, with hematocrit over 30% (preferably more than 35%). Also, a donor cat should be examined for blood-transmitted infections, including feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), and Mycoplasma haemofelis (pathogen of infectious feline anemia). The article presents clinical cases of using blood transfusion to treat feline anemia and results of the conducted laboratory studies, showing effectiveness of the performed medical procedures. After blood transfusion, the cats had positive dynamics in the general clinical state and increases in the main morphological blood parameters up to the norm or to values close to it. However, the issue of posthemorrhagic anemia requires more in-depth research in each separate case, particularly regarding the underlying case, since it can return the animal’s state and its main morphological blood parameters to the initial level, with no recovery, or at least long remission. It was found that whole-blood transfusion to the recipient animals with flea invasion increased the number of red blood cells, hemoglobin content, and hematocrit, which positively affected blood oxygenation and redox processes in the recipient animals, and accordingly their general clinical state.

In-Hospital Mortality and Associated Factors among Colorectal Cancer Patients in Germany.

In the present study, we used the data from 14 hospitals to systematically evaluate the in-hospital mortality of patients with colorectal cancer as well as its influencing factors in Germany. This multicenter cross-sectional study included hospitalized patients with a main diagnosis of colorectal cancers in the period between January 2019 and July 2023. The outcome of the study was the prevalence of in-hospital mortality. To access the associations between demographic and clinical variables and in-hospital mortality, univariable and multivariable logistic regression analyses were conducted. A total of 4146 colorectal cancer patients (mean age: 70.9 years; 45.3% female) were included. The in-hospital mortality rate was 8.7%. In a multivariable regression, seven variables were significantly associated with an increased in-hospital mortality, including ages of 71-80 years (OR: 2.08; 95% CI: 1.01-4.29), an age group >80 years (OR: 2.44; 95% CI: 1.18-5.05) as compared to an age group ≤ 50 years, patient clinical-complexity level (PCCL) 3 (OR: 3.01 95% CI: 1.81-4.99) and PCCL 4 (OR: 3.76; 95% CI: 2.22-6.38) as compared to PCCL 0, the presence of distant metastases (OR: 4.95; 95% CI: 3.79-6.48), renal failure (OR: 2.38; 95% CI: 1.80-3.14), peritonitis (OR: 1.87; 95% CI: 1.23-2.85), acute posthemorrhagic anemia (OR: 1.55; 95% CI: 1.11-2.15), and respiratory failure (OR: 3.28; 95% CI: 2.44-4.41). Our findings underscore the critical role of renal failure, peritonitis, acute posthemorrhagic anemia, and respiratory failure in influencing the mortality outcomes of colorectal cancer patients during hospitalization. The awareness and management of these risk factors may guide clinicians in formulating targeted interventions to improve patient outcomes and enhance the quality of care for individuals with colorectal cancer.

Institutional Experience With Robotic Lobectomy After Neoadjuvant Immunotherapy and Chemotherapy

BackgroundThe real-world safety of robotic resections after neoadjuvant chemoimmunotherapy remains poorly defined in patients with non-small cell lung cancer. Due to reported increased operative challenges after neoadjuvant immunotherapy, we aim to describe our early institutional experience and outcomes after robotic resection in this clinical context. MethodsWe performed a retrospective chart review of patients with non-small cell lung cancer who underwent a robotic lobectomy, comparing patients from June 1, 2022, through October 31, 2023, who were treated with neoadjuvant chemoimmunotherapy consistent with the Checkmate-816 protocol and a control group with upfront resection. ResultsA total of 21 patients underwent neoadjuvant chemoimmunotherapy and robotic lobectomy in our cohort, and 64 patients were in the control group. Compared with control, the median tumor size was 3.2 cm vs 2.0 cm (P = .001). The most common clinical stage was IIIA (11 patients, 52%) in the neoadjuvant chemoimmunotherapy group and IA2 in the control group (26 patients, 45%) (P < .001). Operative time was greater in the neoadjuvant chemoimmunotherapy group (224 vs 177 minutes, P = .011). The median quantity of lymph nodes resected in the neoadjuvant chemoimmunotherapy group was greater (21 vs 16.5, P = .042). A R0 resection was achieved in all cases and no conversions to an open lobectomy occurred. Postoperative length of stay was 2 days in both groups (P = .92), and there were similar rates of postoperative air leak (33% vs 48%, P = .23) and acute post-hemorrhagic anemia (19% vs 14%, P = .58). ConclusionsIn our cohort, robotic-assisted lobectomy was safe and of comparable quality in the setting of neoadjuvant chemoimmunotherapy.

The results of the cross-sectional study of platelet aggregative function in children with hemorrhagic syndrome

Background. Early diagnosis of thrombocytopathies in children is a relevant objective of pediatrics. Diagnostics helps prevent the development of bleeding, chronic posthemorrhagic anemia, reduces the risk of thrombosis.The aim of the study is an assessment of the incidence of platelet aggregation disorders in children with manifestations of hemorrhagic syndrome against the background of chronic pathology.Methods. The study was conducted on the basis of the Research Institute of Pediatrics and Children’s Health, Scientific Center No. 2, Petrovsky National Research Centre of Surgery in the period from January — until December 2022. 62 children were included in the study, of which 50 children were selected (21 boys and 29 girls) aged 2 years 3 months to 17 years 11 months. The median age was 9.4 (7.2; 13.4). Aggregometry was performed using an impedance semiautomatic aggregometer in whole blood.Results. Depending on the diagnosis, the children were divided into the following groups: cardiovascular diseases (CVD), lysosomal storage disorders (LSD), monogenic hereditary diseases (MHD), children with dysplastic syndrome (DS), children with pathology of the nervous system (NS). Hypoaggregation with thrombin-activating peptide (TRAP test) was detected in 28% of cases (n = 14), more often in children from the group with MHD — 10% (n = 5) and with the presenceof DS — 10% (n = 5). Hypoaggregation with adenosine diphosphate (ADP test) was detected in 20% of cases (n = 10), with arachidonic acid (ASPI test) was detected in 14% (n = 7). Hyperaggregation with the TRAP test was detected in 12% (n = 6), with the ADP test detected in 8% of cases (n = 4). Hyperaggregation with ASPI test was detected in 18% of cases (n = 9).Conclusion. The analyzed results of laboratory tests of platelet aggregation function, hypoaggregation with inducers was observed in more than half of the children, hyperaggregation was observed was present in almost half of the patients.

Post-Operative Complications Associated with Long-Term NSAID or Long-Term Opioid Use Prior to Lumbar Spinal Fusion Surgery

ObjectiveLower back pain (LBP) has been implicated as a significant cause of chronic pain in the United States, often requiring analgesic use. In this study, we investigate the trends in long-term preoperative NSAID (LTN) and Opioid (LTO) use in patients with low back pain in the United States, and the resultant postoperative complications following lumbar fusion. MethodsIn this retrospective cohort study of patients with lumbar pathologies, multivariate population-based regression models were developed using the 2010–2017 National Readmission Database. Short-term complications (30-, 90-day) and long-term complications (180-, 300-day) were analyzed at readmission. ResultsOf patients diagnosed with LBP (N = 1427,190) we found a rise in LTO users and a fall in LTN users following 2015. We identified 654,264 individuals who received a lumbar spine fusion, of which 22,975 were LTN users and 11,213 were LTO users. LTO users had significantly higher total inpatient charges (p-value<0.0001) and LOS (p-value<0.0001), while LTN users had lower rates of acute infection (OR: 0.993, 95% CI: 0.987–0.999, p = 0.017) and acute posthemorrhagic anemia (OR: 0.957, 95% CI: 0.935–0.979, p < 0.001) at primary admission. Readmission analysis showed that LTN use had significantly lower odds of readmission compared to LTO use at all time points (p < 0.01 for all). LTN use had significantly higher odds of hardware failure (OR: 1.134, 95% CI: 1.039–1.237, p = 0.005) within 300-days of receiving a lumbar fusion. ConclusionsLTO users had significantly higher readmission rates compared to LTN. In addition, we found that LTN use was associated with significantly higher odds of hardware failure at long-term follow-up in patients receiving lumbar fusion surgery.

ETIOLOGY OF REGENERATIVE ANEMIA IN DOGS AND CATS

The study was conducted between March 2020 – December 2022 on 129 dogs and 63 cats, different breeds and age, both males and females, clinically diagnosed with anemia. All individuals were subjected to a full hematology test including blood analysis and blood smear assessment where regenerative reaction was confirmed in 22 dogs and 9 cats. To understand the ability of the hematogenous bone marrow to respond and develop new red blood cells (RBCs) and the effectiveness of the therapy is important to recognize the main causes of anemia that lead to the destruction, loss or deficit in production. The research highlighted post-hemorrhagic anemia as the most important cause of regenerative reaction in dogs (68,2%) while in cats, hemolytic anemia was the primary reason of reticulocytosis (55,6%). Correctly identifying the type of anemia in terms of hematogenous bone marrow responsiveness is of utmost importance in tailoring the treatment, preventing complications or monitoring the progress of the patient and one of main tools used to assess and differentiate between the RBCs disorders

The combined use of erythropoietin and iron preparations for the management of postpartum anemia: a systematic review and meta-analysis

INTRODUCTION: There are limited data on the effectiveness of erythropoietin in combination with oral ferrotherapy for the management of postpartum anemia. OBJECTIVE: To evaluate the efficacy of erythropoietin in combination with oral iron compared with oral ferrotherapy in puerperas with postpartum haemorrhage. MATERIALS AND METHODS: MEDLINE, Scopus, EBSCOhost and 5 other databases (January 1980 to February 2023) were searched for articles on the use of oral iron in combination with and without erythropoietin for the treatment of post-hemorrhagic anemia in puerperas. Primary outcomes: hemoglobin level, hemoglobin increase, hematocrit, number of blood transfusions, secondary outcomes: ferritin level, serum iron, lactation capacity. The analysis was carried out in accordance with the PRISMA guidelines, 2020. RESULTS: 4 studies were analyzed, 198 women were included. When using erythropoietin in combination with oral ferrotherapy, the cumulative value of the increase in hemoglobin concentration after 5 days, 2 weeks of treatment was significantly higher compared with the control group (mean difference [MD]: 11.83 g/L, 95% CI 4.43–19.23; р = 0.002, MD 10.13 g/L, 95% CI 4.97–15.29; р = 0.0001), respectively. The cumulative mean hemoglobin concentration after 40 days of treatment was significantly higher in the erythropoietin group (MD 11.00 g/L, 95% CI 1.70–20.30; р = 0.02). The cumulative mean hematocrit after 2 weeks of treatment was significantly higher in the erythropoietin group (MD 3.35 %, 95% CI 0.31–6.39; р = 0.03). The use of erythropoietin in combination with oral iron reduces the likelihood of blood transfusion (relative risk 0.12, 95% CI 0.02–0.95; р = 0.04). CONCLUSIONS: A faster hematological response was shown with the combined use of erythropoietin with oral ferrotherapy compared with monotherapy with iron preparations in the management of postpartum anemia. Further studies with sufficient sample sizes are required.

Gender, BMI, Patient Comorbidities, and Hospital Characteristics Influence 30-Day Readmission Following Vertical Sleeve Gastrectomy.

Obesity impacts 300 million people worldwide and the number continues to increase. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric procedures offered to help these individuals achieve a healthier life. Here, we report 30-day readmission rates and risk factors for readmission after gastrectomy. We used the US Healthcare Utilization Project's Nationwide Readmission Database (NRD) from 2016 to 2019 for patients who underwent laparoscopic gastrectomy and evaluated 30-day readmission rates, comparing readmitted patients to non-readmitted patients. Confounder adjusted and unadjusted analysis were proceeded to the potential factors. The study population consisted of 235,563 patients, with a 3.0% readmission rate. Factors associated with a higher readmission rate included older age, male gender, higher BMI, Medicare as the primary payer, longer length of stay, higher total charge, higher Charlson Comorbidity Index, higher Elixhauser-Comorbidity Index, lower household income, non-elective admission type, and non-routine disposition. Additionally, larger hospital bed size, and private, invest-own hospital ownership were associated with higher readmission rates. After adjusting for confounders, several comorbidities and complications were found to be significantly associated with readmission, including ileus, abnormal weight loss, postprocedural complications of digestive system, acute posthemorrhagic anemia, and history of pulmonary embolism (all p < 0.001). Patient characteristics including age, BMI, and payment source, as well as hospital characteristics, can impact the 30-day readmission after LSG. Such factors should be considered by CMS when deciding on penalties related to readmission.

Sex-Specific Postoperative Outcomes of Primary Total Hip Replacements: The Performance of Total Hip Replacement Procedures Leads to Worse Outcomes in Men.

The demand for primary total hip arthroplasty (THA) is expected to increase significantly in the coming years, and women are expected to account for the greatest proportion of this increased demand. The purpose of this study was to determine, using a national database, the effect of sex on 90-day outcomes in primary THA patients while matching for confounding variables. Specifically, we evaluated: (1) in-hospital lengths of stay; (2) 90-day readmission rates; (3) 90-day medical complications; (4) and total global 90-day episode-of-care (EOC) costs in men and women. Using the 100% Medicare Standard Analytical Files (SAF), a query from January 1, 2005 to March 31, 2014 from a nationwide database was performed to analyze patients who received a primary THA. The series was divided into two cohorts: men (n=436,737) and women (n=436,737). Male and female patients were matched according to age and Elixhauser-Comorbidity Index (ECI). Uni- and multi-variable regression analyses were performed to analyze the effects of sex on in-hospital lengths of stay, 90-day readmission rates, 90-day medical complications, and total global 90-day EOC costs. Men had greater overall 90-day medical complications compared to women following primary THA (1.28 vs. 1.19%, p<0.001). Men were found to have higher rates of acute kidney failure (0.12 vs 0.05%, p<0.0001), acute pancreatitis (0.02 vs. 0.01%, p<0.0001), cerebrovascular accidents (0.03 vs. 0.01%, p<0.0001), deep vein thromboses (0.06 vs. 0.04%, p<0.0001), and myocardial infarctions (0.02 vs. 0.01%, p<0.0001). Women were found to have higher rates of acute post-hemorrhagic anemiae (0.31 vs. 0.30%, p<0.001) and urinary tract infections (UTI; 0.40 vs. 0.28%, p<0.0001) compared to men. Men had shorter in-hospital lengths of stay (LOS) (3.42 vs. 3.54 days, p<0.001) but greater 90-day readmission rates (7.67 vs. 6.39% p<0.0001). Both cohorts had similar total global 90-day EOC costs ($14,869.85 ± $12,333.50 vs. $14,957.34 ± $10,915.61, p=0.36). Men undergoing THA have a greater number of overall 90-day medical complications and readmission rates while women have higher incidence of UTI, post-hemorrhagic anemia, and longer LOS. Understanding sex-based differences in complication rates and outcomes can help surgeons with preoperative counseling and targeted preoperative optimization.

ПРИЧИНЫ ЛЕТАЛЬНЫХ ИСХОДОВ ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ 2 ТИПА И БЕЗ В МНОГОПРОФИЛЬНОМ СТАЦИОНАРЕ Г.ИРКУТСКА В ПЕРИОД ПИКА ПАНДЕМИИ COVID-19

Introduction. Numerous literature data report a significant increase in mortality during the peak of the incidence of COVID-19, even in patients without confirmed coronavirus infection. The most vulnerable group during this period were patients with diabetes mellitus (DM) due to more frequent comorbid conditions. Materials and methods. An analysis of all protocols for the autopsy of deceased patients for 2020 and 2021 was carried out. in a multidisciplinary hospital, when the institution provided emergency medical care to the population of the city of Irkutsk in the surgical and therapeutic profile without a confirmed coronavirus infection. Groups of patients with and without type 2 DM were analyzed separately by pairwise comparisons (92 groups of patients matched by sex and age). Results. An analysis of the annual dynamics of nosocomial mortality showed an increase in the indicator during the peak of the pandemic by about 2.5 times (in 2018 - 65 cases, in 2019 - 109 cases, in 2020 - 254 cases, in 2021 - 244 cases, in 2022 – 81 cases). In the structure of the causes of deaths in both groups, diseases associated with atherosclerosis dominated - in 44% of cases, significantly more often in the group of patients with DM (53% vs 36%, p≤0.05). Also, patients with DM had a higher incidence of stenosing coronary atherosclerosis (86% vs 73%, p=0.03). In second place in terms of frequency of occurrence were infectious causes of death - 16%, malignant neoplasms - 17%, comparable in both groups, as well as surgical pathology of the gastrointestinal tract (GIT) - 17%, which was more common in the group of patients without DM (24 % vs 10%, p≤0.05). An analysis of the immediate causes of death in patients without DM and with type 2 DM was comparable in most indicators, with the exception of the number of bleeding and posthemorrhagic anemia, which occurred in a larger percentage of cases in patients without DM (11% vs 3%, p = 0.003), which due to the predominance of surgical pathology of the gastrointestinal tract in these patients. Thus, the leading direct cause of death among all patients was pulmonary edema - in 81%, then in descending order - pulmonary embolism in 34%, sepsis in 23%, bleeding in 14%, acute myocardial infarction and peritonitis in 12% of cases. The analysis of comorbidities in both groups of patients did not reveal significant differences, with the exception of arterial hypertension, which was more common in patients with DM (76% vs 61%, p=0.03). Histological changes in the kidneys (glomerulosclerosis, interstitium sclerosis, arteriological alinosa) were equally common in patients without and with type 2 diabetes (92% vs 86%, p≥0.05), which is probably due to high comorbidity in both groups . Thus, signs of histologically confirmed pyelonephritis were detected in almost every second patient in the study groups (with DM - in 63%, without DM - in 65%, p≥0.05), which exceeds the literature data by 2-3 times. Conclusion. In a multidisciplinary hospital during the COVID-19 pandemic, there was a significant increase in mortality (by 2.5 times). In the structure of the causes of deaths in both groups, diseases associated with atherosclerosis dominated, significantly more often in the group of patients with DM. In the group of patients with DM, stenosing coronary atherosclerosis and arterial hypertension were more common. In patients without DM, one of the leading causes of mortality was surgical pathology of the gastrointestinal tract, which was accompanied by significantly higher cases of bleeding. Attention is drawn to the high frequency of histologically confirmed pyelonephritis in both groups (over 60%), which can make a significant contribution to thanatogenesis.

СЕМЕЙНЫЙ СЛУЧАЙ НАСЛЕДСТВЕННОЙ ГЕМОРРАГИЧЕСКОЙ ТЕЛЕАНГИЭКТАЗИИ

The article provides an observation of the clinical detection of familial hereditary hemorrhagic &#x0D; telangiectasia (Osler-Weber-Rondu disease), which is manifested by a tumor of the transformation of small &#x0D; foci in multiple telangiectasias, on the skin, mucous and serous membranes, arteriovenous shunts in the internal &#x0D; organs and aneurysms, which is manifested by bleeding. This rare defect had various clinical manifestations &#x0D; in the mother and caused relapses of pulmonary circulation in the child and, as a result, posthemorrhagic ane mia. The given obligatory observation by a pediatrician should be directed to severe symptoms of the disease &#x0D; and obligatory compliance with the requirements and treatment

Association Between Age-stratified Cohorts and Perioperative Complications and 30-day and 90-day Readmission in Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion.

Retrospective analysis. To assess perioperative complication rates and readmission rates after ACDF in a patient population of advanced age. Readmission rates after ACDF are important markers of surgical quality and, with recent shifts in reimbursement schedules, they are rapidly gaining weight in the determination of surgeon and hospital reimbursement. Patients 18 years of age and older who underwent elective single-level ACDF were identified in the National Readmissions Database (NRD) and stratified into 4 cohorts: 18-39 ("young"), 40-64 ("middle"), 65-74 ("senior"), and 75+ ("elderly") years of age. For each cohort, the perioperative complications, frequency of those complications, and number of patients with at least 1 readmission within 30 and 90 days of discharge were analyzed. χ 2 tests were used to calculate likelihood of complications and readmissions. There were 1174 "elderly" patients in 2016, 1072 in 2017, and 1010 in 2018 who underwent ACDF. Their rate of any complication was 8.95%, 11.00%, and 13.47%, respectively ( P <0.0001), with dysphagia and acute posthemorrhagic anemia being the most common across all 3 years. They experienced complications at a greater frequency than their younger counterparts (15.80%, P <0.0001; 16.98%, P <0.0001; 21.68%, P <0.0001). They also required 30-day and 90-day readmission more frequently ( P <0.0001). It has been well-established that advanced patient age brings greater risk of perioperative complications in ACDF surgery. What remains unsettled is the characterization of this age-complication relationship within specific age cohorts and how these complications inform patient hospital course. Our study provides an updated analysis of age-specific complications and readmission rates in ACDF patients. Orthopedic surgeons may account for the rise in complication and readmission rates in this population with the corresponding reduction in length and stay and consider this relationship before discharging elderly ACDF patients.

Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review

Patients hospitalized with COVID-19 pneumonia are at risk for thrombotic complications. At the same time, they need respiratory support, and they frequently require nursing in a prone position. From March to May 2020, 57 patients with acute respiratory distress syndrome were admitted to our departments. Our therapeutic protocol included anticoagulant treatment and prone positioning. We have treated three obese women affected by severe pneumonia and pectoral hematoma with post-hemorrhagic anemia. We have already described two of these cases in our previous publication; in this new article, we describe a third similar case and review clinical reports from 2020 to 2022 about hemorrhagic complications during COVID-19. Reports confirm that pectoral hematomas and bleeding in unusual sites are a complication of COVID-19. Pectoral hematomas are likely to be related to COVID-19 severity, heparin dosage, and traumatism due to cough and pronosupination.