Postoperative Blood Transfusion Research Articles

Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis

Introduction: Malnutrition has been shown to cause perioperative complications, which can be particularly detrimental following total knee arthroplasty (TKA). These complications can lead to increased morbidity, extended hospital stays, and significant financial burdens on both patients and healthcare systems. To evaluate the nutritional status and body mass index (BMI) of patients undergoing TKA and monitor them for complications immediately postoperatively, at one week, and three months after surgery. Methods: This prospective study included 88 patients who underwent TKA at government medical college Kozhikode, Kerala, India. Nutritional status was assessed using serum albumin, ferritin, haemoglobin, and BMI (body mass index) levels. Patients were followed up for three months postoperatively to identify any complications. Data analysis was conducted to determine the relationship between malnutrition and postoperative complications. Results: Of the 88 patients, 5 developed major wound complications, with 4 of these patients exhibiting hypoalbuminemia. Hypoalbuminemia was found to have a statistically significant association with major wound complications (p<0.001). Malnutrition was associated with higher rates of major wound complications, increased need for postoperative blood transfusions, and longer hospital stays. Conclusion: Identifying modifiable risk factors such as malnutrition in patients undergoing TKA is crucial for reducing the risk of postoperative complications, which can otherwise lead to disastrous outcomes. Preoperative optimization of nutritional status can significantly improve surgical outcomes and reduce complications.

Intraoperative Factors Affecting Pain Management and Postoperative Narcotic Use in Cranial Vault Remodeling: A Retrospective Review

Perioperative pain control in open cranial vault reconstruction (CVR) poses significant challenges. Narcotic use may confound signs of neurological deterioration and cause medication-induced complications. Previous studies have shown improved health outcomes in CVR with reduced narcotic use. The purpose of this study was to investigate the relationship between modifiable intraoperative factors on postoperative narcotic use. A retrospective cohort study was performed on 237 patients with craniosynostosis who presented to a tertiary pediatric hospital over a 10-year period for open CVR. There was a statistically significant relationship between total fluid volume infused intraoperatively (mL/kg) and total morphine equivalents (MEs, mL/kg) given throughout hospitalization (P< 0.001). Longer operative times were associated with greater total hospitalization ME (P ≤ 0.006) and total intraoperative blood products transfused (P ≤ 0.001). Patients who received drains were given significantly higher total hospitalization ME compared with those who did not (P< 0.001). Patients who received postoperative nonsteroidal anti-inflammatory drugs required significantly fewer total ME compared with children who did not (P< 0.005) and patients who received intraoperative tranexamic acid were less likely to require postoperative blood transfusion (P< 0.001). Postoperative nonsteroidal anti-inflammatory drug use is associated with decreased narcotic requirements during the immediate postoperative period whereas increased fluid requirements intraoperatively, longer operative durations, and drain placement are associated with higher narcotic use. Modifying intraoperative factors like these may lead to decreased postoperative pain, thus limiting narcotic use for patients, and improving overall outcomes.

Comparative analysis of retro vs. transperitoneal laparoscopic pyelolithotomy for large renal stones.

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Body mass index and its impact on outcomes in CABG surgery: the paradox of obesity and underweight risks.

Objective: To explore the impact of BMI on the short-term mortality and morbidity of patients undergoing CABG. Study Design: Retrospective Cross Sectional study. Setting: Department of Cardiac Surgery Rehman Medical Institute, Peshawar, Pakistan. Period: 1st June 2017 to 31st December 2022. Methods: The data was collected from the data base of the cardiac surgery department. Results: Total of 2599 isolated CABG patients were included with mean age of 57.86±9.2 years. The majority was overweight (42%). Approximately 78.1% were male. Hypertension was our dominant co-morbidity (68.7%) followed by dyslipidemia (65.4%) &amp; DM (50.1%). Majority of patients had NYHA-III symptoms (51.2%). A significant proportion of individuals who are classified as underweight are elderly. Generally, there is a significant increasing trend of DM &amp; HTN incidence with increasing BMI. In terms of intra-operative parameters there is increasing trend of intra-operative transfusions and higher rate of IABP insertion in underweight patients. Generally the underweight patients has the higher trend of adverse outcomes (e.g., prolonged mechanical ventilation, blood product requirement, reopening &amp; re-intubation), but not significant. However, they have significantly longer mechanical ventilation time compared to normal. On the other extreme, morbidly obese patients had the highest in-hospital mortality (11.3%) while overweight had the lowest (2.6%) with a P-value of 0.008. Multivariate regression analysis showed that mean age (P 0.034), cross-clamp time (P 0.018) &amp; mechanical ventilation (P &lt;0.001) were significantly associated with in-hospital mortality. Conclusion: Morbidly obese patients undergoing CABG surgery face significantly higher in-hospital mortality rate, conversely overweight patients exhibits the lowest mortality rates confirming a partial obesity paradox. However, underweight patients experience the worst outcomes, including increased requirements for postoperative blood transfusions, a higher incidence of surgical reopening, and significantly extended mechanical ventilation hours, which indicates either extreme of BMI group is associated with worst outcomes.

Our experience of laparoscopic vesicovaginal fistula repair in a tertiary care center

Objective: Laparoscopic repair of vesicovaginal fistula (VVF) is gaining popularity day by day, but we have limited literature on it. This study is to evaluate the safety, feasibility, and outcomes of laparoscopic VVF repair in a tertiary care center in Eastern India. Subjects and Methods: This study is a single-center retrospective study in which 11 patients of supratrigonal VVF were evaluated who underwent laparoscopic repair. Preoperative workup included history, examination, computed tomography urography, cystoscopy, and vaginoscopy. After informed consent, laparoscopic VVF repair was done under general anesthesia. Duration of surgery, the need for conversion to open procedure, intraoperative bowel injury, the need for postoperative blood transfusion, postoperative hospital stay, postoperative urinary leak, and any incontinence after catheter removal were noted. Results: All the patients had primary supratrigonal fistula of approximate size in the range of 1.5–2.0 cm. All the included patients were operated on successfully by laparoscopic technique with a mean duration of surgery of 177.91 ± 6.14 min. The mean duration of postoperative hospital stay was 4.45 ± 0.52 days. There was no incidence of postoperative urine leak in any patient. After urethral catheter removal, all the patients voided well without any incontinence. Conclusions: Laparoscopic VVF repair is a safe and feasible option with satisfactory intraoperative and postoperative outcomes.

Association of Race and Postoperative Outcomes in Patients with Inflammatory Bowel Disease.

Previous literature suggests that rates of postoperative complications following inflammatory bowel disease (IBD) surgery differ based on race. The purpose of this study was to examine the association between race and adverse events and wound complications in patients with IBD. This was a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement Program Inflammatory Bowel Disease Collaborative from 2017 to 2022. The data was collected from 15 high-volume IBD centers across the United States. The data was analyzed using crude and multivariable logistic regressions. 4284 patients were included in the study. Overall rates of adverse events and wound complications were 20.3% and 11.3%, respectively, and did not differ based on race on bivariate analysis. Rates of adverse events were 20.0% vs 24.6% vs 22.1%, p = 0.13 for white, black and other minority subjects, respectively. The adjusted odds of adverse events were higher for black subjects (1.46 [95%CI 1.0-2.1], p = 0.03) compared to white subjects. No difference in adverse events was found between other minority subjects and either black or white subjects (1.29 [0.7-2.3], p = 0.58). Race was not associated with likelihood of wound complications in the final analysis. We found that a subset of black patients with IBD continue to experience more adverse events compared to white patients, primarily driven by a higher need for postoperative blood transfusion. Nonetheless, known risk factors, including comorbid conditions, decreased BMI, open surgery, and emergency surgery have a stronger association with postoperative complications than race alone.

Comparative analysis of the quality of the cement mantle in hip hemiarthroplasty after femoral neck fracture between three different surgical approaches: a single-center retrospective observational study.

Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. A non-interventional, retrospective case-control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3days vs 11.3 and 13days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients.

Application value of domestic single-port robot in nephron sparing surgery

Objective: To explore the application value of the domestic precision ®single-port robotic system in nephron sparing surgery. Methods: The clinical data of patients with renal masses underwent nephron sparing surgery using the domestic precision ®single-port robotic system at the PLA General Hospital, Gulou Hospital Affiliated to Nanjing University School of Medicine, Zhongnan Hospital of Wuhan University and the First Affiliated Hospital of Nanchang University from September to November 2023 were retrospectively included. Perioperative clinical data, pathological examination results, and postoperative complications were summarized. Results: A total of 12 patients were included, including 8 males and 4 females, with 26-75 (56±16) years. Body mass index (BMI) was (25.1±2.7) kg/m2. There were 6 cases on the left side and 6 case on the right side. The surgical approach was transabdominal in 9 cases and retroperitoneal in 3 case. The maximum diameter of the lesions was (2.7±0.7) cm, the warm ischemia time [M (Q1, Q3)] was 19 (15, 26) minutes, the surgical time was 180 (149, 216) minutes, and the intraoperative blood loss was 50 (28, 100) ml. Postoperative visual analogue scale (VAS) was (2.9±1.5) points. Postoperative pathology revealed malignant renal clear cell carcinoma in 9 cases, with nuclear grading of 3 cases for Grade 1, 3 cases for Grade 2, and 3 cases for Grade 3. Eight cases of pathological TNM staging were pT1aN0M0 and 1 case was pT3aN0M0, with no cancer at the resection margin. Three cases showed benign renal vascular smooth muscle lipoma. There were no postoperative blood transfusions and no complications such as fever, urine leakage and poor wound healing. Conclusion: The prliminary experience reveals that the domestic precision ®single-port laparoscopic robotic system has good clinical application value in urological nephron sparing surgery.

What Factors Influence In-Hospital Mortality Following Aseptic Revision Total Hip Arthroplasty? A Single-Center Analysis of 13,203 Patients

BackgroundRevision total hip arthroplasty (rTHA) is associated with an extended surgical period, an increased hospitalization period, expanded blood loss, and high mortality rates. The purpose of the present study was to assess the risk factors that contribute to in-hospital mortality following aseptic rTHA. MethodsWe performed a retrospective examination of the medical records of all patients who underwent elective rTHA surgery at our tertiary referral arthroplasty center between March 1996 and March 2019. The study involved a group of 13,203 patients, including 70 who expired during hospitalization and 13,133 in the control group. Baseline characteristics, medical history, comorbidities, and surgery-related parameters of the patients were recorded. Logistic regression analyses were performed to examine the association between independent variables and in-hospital mortalities, which were presented as odds ratios (ORs) and confidence intervals (CIs). ResultsPatient factors associated with in-hospital mortality included hepatitis C (OR 75.5, 95% CI 3.5 to 1,625.2), chronic obstructive pulmonary disease (OR 30.7, 95% CI 6.5 to 145.7), rheumatoid arthritis (OR 28.9, 95% CI 3.8 to 218.5), history of myocardial infarction (OR 24.9, 95% CI 4.4 to 140.8), history of cerebrovascular disease (OR 23.1, 95% CI 3.8 to 142), congestive heart failure (OR 18.9, 95% CI 3.8 to 94.2), and diabetes mellitus (OR 10.2, 95% CI 2.4 to 42.6). Surgical factors included the history of multiple prior revisions (OR 1.75, 95% CI 1.1 to 2.7), postoperative blood transfusion (OR 2.8, 95% CI 1.1 to 7.3), and decreased preoperative hemoglobin (OR 2.3, 95% CI 1.7 to 3.1). ConclusionsSeveral patient-related and intraoperative factors significantly increased the risk of in-hospital mortality following aseptic rTHA. Vigilance and close perioperative monitoring are essential for patients undergoing this complex surgery. Level of EvidenceIII.

Ferric carboxymaltose in reducing blood transfusions and infections after cardiac surgery

ObjectiveIron supplementation may reduce postoperative anemia, blood transfusions, and infections in patients undergoing surgery. We sought to assess efficacy and safety of prophylactic intravenous iron supplementation in patients without anemia undergoing cardiac surgery. MethodsIn this investigator-initiated industry-sponsored single-center randomized double-blind parallel group trial, we enrolled patients undergoing coronary bypass, aortic or mitral valve or ascending aortic surgery who fulfilled prespecified iron blood test safety criteria. Patients were randomized to receive either a single intravenous 1000 mg dose of ferric carboxymaltose (FCM) or placebo (saline only). Independent unblinded study nurse administered the infusion with masked lines and cannula 2 to 21 days before surgery. Primary efficacy end point was a composite of in-hospital blood transfusions >2 U and nosocomial infection. The trial was registered in Eudract (2017-004901-41). ResultsAltogether 171 patients were screened and 78 randomly assigned to FCM (n = 39) or placebo (n = 39). Trial was prematurely discontinued for futility with regard to reaching the primary end point by the recommendation of the independent data monitoring committee. The primary end point occurred in 3 (7.7%) versus 3 (7.7%) (P = 1.00) of patients assigned to FCM and placebo, respectively, with no difference in blood transfusions >2 U. Fewer hospital readmissions by 3 months follow-up (1 [2.6%] vs 8 [20.5%]; P = .028) were noted in FCM group in a post hoc analysis. Ferritin levels were higher in the FCM group at 3 months indicating more preserved iron stores. ConclusionsProphylactic treatment with FCM was safe but did not reduce the need for blood transfusions or postoperative infections at index hospitalization in patients without anemia undergoing cardiac surgery.

Subcutaneous Onlay Laparoscopic Approach for small ventral hernias associated with divarication of rectus abdominis muscle

BackgroundVentral hernias when associated with divarication of rectus abdominis if repaired without concomitant repair of the divarication is plagued by higher rates of recurrences. Out of the many options available for the repair, Subcutaneous Onlay Laparoscopic Approach (SCOLA) with concurrent plication of the divarication is gaining popularity. MethodsAll patients with a ventral hernia associated with divarication of recti were included in this prospective study. The calculated sample size was 34 with a confidence level of 95% and a margin of error of 5%. The patient demographics, operative time, intraoperative and postoperative complications, need for post-operative blood transfusion, and the recurrence were recorded. Categorical data were compared using Student's t-test, whereas chi-square test was used to compare the nominal variables between the two groups. A P-value of <0.05 was considered to be statistically significant. ResultsThirty-six patients were analysed for the study with a mean age of 43.40 years. A total of 55.55% patients were female. Twelve patients had co-morbidities. Umbilical hernia was the most common hernia. The mean size of the hernial defect was 3.67 cm, and the mean operative time was 156.66 min (±31.02 min). The first 15 cases took longer time for the surgery (mean operative time 183.53 min [±19.73 min]). No intraoperative complications were recorded, except for one patient in whom we encountered an excessive bleeding but was tackled with harmonic scalpel. Eight patients (22.2%) had complications with Seroma formation being the commonest. ConclusionSCOLA is feasible and advantageous because of faster recovery and minimal complication and recurrence rates.

Intraoperative cell salvage reduces postoperative allogeneic blood transfusion and shortens off-bed time in simultaneous bilateral total hip arthroplasty: a single-center retrospective study

BackgroundSimultaneous bilateral total hip arthroplasty (SI-THA) results in more blood loss and a greater need for postoperative allogeneic blood transfusion (ABT). Previous studies have reported that multimodal patient blood management (PBM) strategies were associated with a smaller effect of intraoperative cell salvage (ICS) in unilateral total hip arthroplasty. However, there are few studies on the role of ICS in SI-THA. This study aims to explore the effect of ICS with multimodal PBM strategies on SI-THA and to identify risk factors associated with ABT.MethodsThis retrospective matched cohort study included 72 patients in the ICS group and 72 patients in the control group who were matched according to age, sex, and year of hospitalization. Demographic data, hematological indicators, blood loss, and ABT were compared between the two groups. Logistic regression analysis was performed to identify independent risk factors for postoperative ABT. Postoperative outcomes were also recorded.ResultsIn the cohort of 144 patients, 27 patients (37.5%) in the ICS group while 45 patients (62.5%) in the control group received postoperative ABT after SI-THA. Compared with the control group, the ICS group showed significant differences in terms of blood loss, postoperative hemoglobin and hematocrit. The transfused volume of allogeneic red blood cells per ABT patient was also lower in the ICS group. Multivariate logistic regression analysis indicated that sex, the utilization of ICS, and preoperative hematocrit level were identified as independent factors associated with postoperative ABT. The utilization of ICS significantly shortened off-bed time and length of hospital stay, but had no effect on early pain and functional outcomes.ConclusionThe utilization of ICS can significantly affect postoperative ABT in SI-THA patients with multimodal PBM strategies. Sex, the utilization of ICS and preoperative hematocrit level were identified as independent factors associated with postoperative ABT. The utilization of ICS promoted weight-bearing functional exercises, but had no effect on early outcomes.

The impact of sarcopenia on the incidence of postoperative outcomes following spine surgery: Systematic review and meta-analysis.

Sarcopenia is considered to be an important predictor of adverse outcomes following spinal surgery, but the specific relationship between the two is not clear. The purpose of this meta-analysis is to systematically review all relevant studies to evaluate the impact of sarcopenia on spinal surgery outcomes. We systematically searched PubMed, Embase and the Cochrane Library for relevant articles published on or before January 9, 2023. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated in a random effects meta-analysis. The main outcome was the risk of adverse outcomes after spinal surgery, including adverse events and mortality. This systematic review and meta-analysis was conducted following the PRISMA guidelines to evaluate the impact of sarcopenia on spinal surgery outcomes. In addition, we also conducted a subgroup analysis and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. Twenty-four cohort studies, with a total of 243,453 participants, met the inclusion criteria. The meta-analysis showed that sarcopenia was significantly associated with adverse events (OR 1.63, 95% CI 1.17-2.27, P < 0.001) but was no significantly associated with mortality (OR 1.17, 95% CI 0.93-1.46, P = 0.180), infection (OR 2.24, 95% CI 0.95-5.26, P < 0.001), 30-day reoperation (OR 1.47, 95% CI 0.92-2.36, P = 0.413), deep vein thrombosis (OR 1.78, 95% CI 0.69-4.61, P = 0.234), postoperative home discharge (OR 0.60, 95% CI 0.26-1.37, P = 0.002) and blood transfusion (OR 3.28, 95% CI 0.74-14.64, P = 0.015). The current meta-analysis showed that patients with sarcopenia have an increased risk of adverse events and mortality after spinal surgery. However, these results must be carefully interpreted because the number of studies included is small and the studies are significantly different. These findings may help to increase the clinicians' awareness of the risks concerning patients with sarcopenia to improve their prognosis.

Huaxi integrated blood management reduces the red blood cell transfusion for on-pump cardiac surgery: A quasi-experimental study

ObjectiveAs many as half of patients undergoing on-pump cardiac surgery require red blood cell transfusion, emphasizing the need for effective strategies that can reduce this need. We conducted this analysis to assess the effectiveness of Huaxi Integrated Blood Management strategy at our medical center. DesignBefore and after study. ParticipantsPatients who underwent on-pump cardiac surgery were included from January 2019 to December 2021. Two cohorts were compared, one before implementation of the strategy (1 January 2019 until 31 May 2020) and one after implementation (1 June 2020 until 31 December 2021). MeasurementsWe evaluated temporal trends in blood transfusion, safety, and efficacy of this strategy. Primary outcomes were the incidence and volume of intra- and postoperative blood transfusions of packed red blood cells. Secondary outcomes are intraoperative and postoperative transfusion of other blood products, all-cause mortality during hospitalization, and incidence of new-onset complications. Main resultsOur results demonstrated that this integrated strategy effectively decreased both the perioperative packed red blood cell transfusion volume and incidence for patients who underwent the on-pump cardiac surgery. Following the implementation, the incidence of packed red blood cell transfusions decreased by 8.1% during the intraoperative period and by 12.3% during the postoperative period. The mean volume of such transfusions decreased by 0.28 units during the intraoperative period and by 0.49 units during the postoperative period. Hemoglobin concentrations were significantly higher after implementation, and the maximal mean increase was 4.72 g/l on postoperative day 1. Similar benefit of the strategy was observed across subgroups of patients who underwent different types of surgery. ConclusionsThe Huaxi Integrated Blood Management strategy may be effective at reducing the need for packed red blood cell transfusion and enhancing patient care.

Analysis of neoadjuvant therapy effect on 30-day postoperative outcomes in gallbladder cancer

BackgroundThe role of neoadjuvant therapy (NAT) in gallbladder cancer (GBC) is not well established. We sought to evaluate the effect of NAT on postoperative outcomes following surgical resection of GBC. We hypothesized that patients receiving NAT would have similar rates of 30-day mortality, readmission, and postoperative complications (e.g. bile leakage and liver failure) compared to those who did not receive NAT. MethodsThe 2014–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Hepatectomy database was queried for patients that underwent surgery for GBC. Propensity scores were calculated to match patients in a 1:2 ratio based on age, comorbidities, functional status, and tumor staging. ResultsA total of 37 patients undergoing NAT were matched to 74 patients without NAT. There was no difference in any matched characteristics. Compared to the NAT group, the no NAT cohort had similar rates of postoperative bile leakage (NAT 13.5 % vs. no NAT 10.8 %, p = 0.31), postoperative liver failure (5.4 %, vs. 8.1 %, p = 0.60), 30-day readmission (10.8 % vs. 10.8 %, p = 1.00), and 30-day mortality (10.8 % vs. 2.7 %, p = 0.075). All 30-day complications were similar except for a higher rate of postoperative blood transfusion (NAT 32.4 % vs. no NAT 10.8 %, p = 0.005). ConclusionIn patients undergoing surgical resection for GBC, those with and without NAT had similar rates of readmission and 30-day mortality, however NAT was associated with an increased risk for transfusion. Despite use of a large national database, this study may be underpowered to adequately assess the effect of NAT on perioperative GBC outcomes and thus warrants further investigation.

Vascular loops mimicking herniated lumbar discs: fair warning.

The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.

Establishment of a predictive model for blood transfusion after femoral head replacement in elderly patients.

The study aimed to establish a nomogram predictive model for blood transfusion after artificial femoral head replacement surgery in elderly patients with intertrochanteric fractures. Two hundred five elderly patients (55 males, 150 females; mean age: 82.1±6.6 years; range, 63 to 103 years) with intertrochanteric femoral fractures who underwent artificial femoral head replacement surgery between January 2015 and May 2023 were retrospectively analyzed. The patients were randomly divided into two groups: the training group (n=143) and the validation group (n=62). Within the training group, patients were further categorized into the nontransfused (n=86) and transfused (n=57) groups. Perioperative data were collected for logistic regression analysis to identify risk factors for postoperative blood transfusion. A nomogram model was developed to predict the need for blood transfusion, with assessments including the C-index, receiver operating characteristic curve, decision curve analysis, and clinical impact curve. Logistic regression analysis showed that low preoperative hemoglobin levels, high intraoperative bleeding volume, high drainage volume, the use of wire reinforcement, and history of cerebral infarction were the independent risk factors for transfusion after femoral head replacement. Both decision curve analysis and clinical impact curves indicated that the prediction model could be used as a good prediction tool for blood transfusion after artificial femoral head replacement for intertrochanteric femoral fractures in the elderly. A nomogram prediction model that effectively assesses the risk of blood transfusion in elderly patients undergoing femoral head replacement for intertrochanteric femoral fractures was established in this study. This model demonstrated high predictive accuracy and consistency, providing a valuable tool for clinicians to identify high-risk patients and implement early interventions to reduce the need for postoperative blood transfusions.

Native nephrectomies in patients with autosomal dominant polycystic kidney disease: retrospective cohort study.

Approximately 1 in 5 patients with autosomal dominant polycystic kidney disease (ADPKD) will undergo a native nephrectomy in their lifetime. These can be emergent or planned and the indications can range from space for kidney transplant, pain, hematuria and frequent urinary tract infections (UTIs). Due to the diverse nature of presentations, there is a lack of certainty about outcomes and optimal management. This study aimed to evaluate preoperative indications and perioperative/postoperative complications in this patient cohort. This retrospective review included 41 patients with ADPKD who underwent unilateral or bilateral nephrectomy in a single hospital between 2010 and 2020. We collected data on patient demographics, surgical indications, histological results and postoperative complications. We sourced this information using the hospital's patient medical records. The main indications for nephrectomy were pain (39.5%) and bleeding (41.8%). Further indications included recurrent UTIs (16.3%), space for transplantation (27.9%), query malignancy (4.7%) and compressive gastropathy (2.3%). With regard to side, 55.8% were right-sided, 23.3% were left-sided, and 20.9% were bilateral. Seven percent of nephrectomy specimens demonstrated malignancy. Postoperative morbidity included requiring blood transfusion and long hospital stay. Thirty-seven percent of patients received a postoperative blood transfusion. There was no immediate or postoperative mortality associated with any of the cases reviewed. In conclusion, this study demonstrates that native nephrectomy remains a safe operation for patients with ADPKD. Although further research is needed into, transfusion protocols, adjunctive therapies, such as TAE and research into timing of nephrectomy are still needed.

Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trail.

Tourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients. A prospective, single-blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non-tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test are used in this study. No significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D-Dimer level on postoperative day 3 when compared with non-tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05). Tourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.