Postoperative Drain Output Research Articles

Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall

Background: Incisional hernia repair is one of the most common procedures performed in general surgery. Onlay and sublay mesh repair both are well established techniques for the locations of mesh placement, but with various benefits and drawbacks. Despite various studies, the debate continues regarding preferring one technique over the other. We aim to compare the outcome of hernia repair between these two techniques. Materials and Methods: Retrospective analysis was done on patients who underwent open onlay/sublay hernia repair from February 2018 to March 2020 at our institute. 9–28 months of follow-up was done. Primary outcome was recurrence. Secondary outcomes included postoperative complications including surgical site infection, hematoma, seroma, wound dehiscence, peri-operative pain, persistent seroma, readmission after 30 days and chronic pain. Results: A total of 87 patients underwent open ventral hernia repair during the study period. Of which, 41 had onlay and 46 had sublay repair (SR). Recurrence occurred in five patients (12.2%) with onlay repair and two patients in sublay group (4.3%) after a follow-up duration of up to 28 months (P = 0.247). Wound complications were more common in onlay group (46.3%) than the sublay group (19.5%) (P = 0.008). The mean standard deviation intraoperative blood loss (mL) was significantly higher in sublay group (156 [96]) than onlay group (123 [110]) (P < 0.0001). The postoperative drain output and the duration of placement were both greater in the onlay group (P < 0.0001). The median (range) of hospital stay was significantly longer in the onlay group (5[3–10] days) than the sublay group (4[2–6] days) (P < 0.001). Conclusion: SR seems to be the better technique taking into account the overall morbidity, although the need for multi-centric trials with patient-centered outcomes should be highlighted to settle the debate.

Evaluation of an Integrated Smart Sensor System for Real-Time Characterization and Digitalization of Postoperative Abdominal Drain Output: A Pilot Study.

Background: For centuries, surgeons have relied on surgical drains during postoperative care. Despite all advances in modern medicine and the area of digitalization, as of today, most if not all assessment of abdominal secretions excreted via surgical drains are carried out manually. We here introduce a novel integrated Smart Sensor System (Smart Drain) that allows for real-time characterization and digitalization of postoperative abdominal drain output at the patient’s bedside. Methods: A prototype of the Smart Drain was developed using a sophisticated spectrometer for assessment of drain output. The prototype measures 10 × 6 × 6 cm and therefore easily fits at the bedside. At the time of measurement with our Smart Drain, the drain output was additionally sent off to be analyzed in our routine laboratory for typical markers of interest in abdominal surgery such as bilirubin, lipase, amylase, triglycerides, urea, protein, and red blood cells. A total of 45 samples from 19 patients were included. Results: The measurements generated were found to correlate with conventional laboratory measurements for bilirubin (r = .658, P = .000), lipase (r = .490, P = .002), amylase (r = .571, P = .000), triglycerides (r = .803, P = .000), urea (r = .326, P = .033), protein (r = .387, P = .012), and red blood cells (r = .904, P = .000). Conclusions: To our best knowledge, for the first time we describe a device using a sophisticated spectrometer that allows for real-time characterization and digitalization of postoperative abdominal drain output at the patient’s bedside.

A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery.

Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, -40.0 to -12.7 mL; P < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (odds ratio, 0.280; 95% CI, 0.076-1.029; P = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, 3 studies found statistically significant reductions in postoperative drain output, and 1 study reported significantly improved surgical site quality for patients who received TXA (P = 0.001). TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation.

Haemostatic devices in parotid surgery: a systematic review.

The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

201. Prospective randomized controlled trial of tranexamic acid use during elective lumbar spine surgery, preliminary results

<h3>BACKGROUND CONTEXT</h3> Current literature demonstrates that tranexamic acid (TXA) use during spine surgery is safe and effective at reducing intraoperative blood loss and need for blood transfusion. TXA use is increasing and it is now being used in both major and minor spine procedures. Literature comparing the use of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rates in elective lumbar spine procedures is scarce. <h3>PURPOSE</h3> This study aimed to compare the efficacy of topical and IV TXA in reducing intraoperative and postoperative blood loss in adult patients undergoing elective lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Prospective randomized controlled trial at a single tertiary academic center. <h3>PATIENT SAMPLE</h3> This is a preliminary report on 125 prospectively enrolled patients who underwent elective decompressive lumbar laminectomy of one to four levels, with or without lumbar fusion. In total, 195 patients will be enrolled; we currently are presenting data from the 125 patients who have completed the protocol to date. <h3>OUTCOME MEASURES</h3> Primary outcomes included intraoperative estimated blood loss, perioperative change in hemoglobin / hematocrit, transfusion rates, and postoperative drain output. Secondary outcomes included operative and anesthesia time, hospital length of stay (LOS), postoperative complications including venous thromboembolism and infection, and postoperative visual analog scale (VAS) pain scores with morphine milligram equivalents (MME) per day. <h3>METHODS</h3> A total of 125 patients were randomized preoperatively into one of three treatment arms: control (n=34), topical TXA (n=35), or IV TXA (n=56). The control group received normal saline and did not receive either topical or IV TXA. The topical TXA group received 3g TXA diluted in 250ml of normal saline, which bathed the surgical site undisturbed for 2 minutes prior to wound closure. The IV TXA group received a 10 mg/kg bolus prior to incision followed by a second 10mg/kg dose three hours after the initial dose. The primary and secondary outcome measures were compared between the three groups. Descriptive, ANOVA, chi-squared, and multiple logarithmic regression analysis were utilized. <h3>RESULTS</h3> No differences were found between the control, IV TXA, and topical TXA groups in intraoperative estimated blood loss (211.2 ± 152.5ml vs 157.1 ± 119.2ml vs 175.6 ± 153ml, p=0.207), postoperative change in hematocrit (7.7 ± 2.9 vs 6.2 ± 3.2 vs 7.0 ± 2.9, p=0.176), and blood transfusion rates (2.9% vs 3.6% vs 0%, p=.5496). Patients who received IV TXA and topical TXA both had significantly less drain output on postoperative day 1 (POD1) than the control group (172 ± 98.2ml vs 72.8 ± 52.9ml vs 52.0 ± 50.0ml, p=0.0001); however, there was no difference in POD1 drain output between the IV and topical groups (p=0.089). There was a decreased risk of requiring pain medication in oral morphine equivalents in the IV and topical TXA groups compared to controls. There were no significant differences in LOS, operative and anesthesia time, pain scores, and postoperative complications. <h3>CONCLUSIONS</h3> There were significant decreases in POD1 drain output and pain medication requirements in IV and topical TXA patients, when compared to controls, in adult elective lumbar spine patients. There were no observed differences between intraoperative blood loss, postoperative change in hematocrit, or transfusion rates. There were no major TXA-related complications. <h3>FDA DEVICE/DRUG STATUS</h3> Tranexamic acid (Approved for this indication).

P119. Does the use of IV tranexamic acid impact postoperative hemoglobin and hematocrit following anterior cervical discectomy and fusion?

<h3>BACKGROUND CONTEXT</h3> Spinal surgery is often complicated by significant blood loss which can lead to increased patient morbidity and mortality. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has shown promise in decreasing blood loss as well as need for postoperative blood transfusion when given during surgery. <h3>PURPOSE</h3> Recent studies have begun to report on the benefits of TXA when given perioperatively during spinal surgery2. Few studies, however, have looked at the effects of TXA in patients undergoing anterior cervical discectomy and fusion (ACDF). In this study we aimed to evaluate the effectiveness of TXA in reducing intraoperative blood loss in a cohort of ACDF patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective, single-surgeon study at academic medical center. <h3>PATIENT SAMPLE</h3> All patients who underwent primary ACDF during this time either with or without the augment of TXA were included. <h3>OUTCOME MEASURES</h3> The mean differences in intraoperative blood loss as well as the change from pre to post-surgical hemoglobin and hematocrit, measured at presurgical testing 1 week prior to surgery and on postop day 1 were analyzed in TXA-treated patients compared to non-TXA-treated patients. Additionally, the number of patients requiring postoperative drain and average drain output on postoperative day #1 were measured. Mean length of stay in between groups was also analyzed. This study was subject to IRB approval. <h3>METHODS</h3> Medical records for all patients who underwent primary ACDF with a single surgeon at a tertiary center over a 3-year period from September 2016-October 2019 were evaluated retrospectively. <h3>RESULTS</h3> A total of 83 patients underwent primary ACDF during the study period. Three additional patients who underwent revision of ACDF were excluded for the purposes of this study. Of the 83 patients who underwent primary ACDF, 14 received TXA perioperatively while 69 did not receive TXA. Preoperative diagnoses included spinal stenosis, disc herniation, and spondylolisthesis. Distribution of diagnoses was equal among study groups. Patient demographics and comorbidities including age, BMI, cardiovascular disease, respiratory disease, diabetes and smoking status were evaluated and there were no significant differences between groups. Patients who received TXA had significantly lower mean operative blood loss than the non-TXA patients (41.1mL vs 77.4mL p<.05). There was, however, no significant difference in postoperative drop in hemoglobin (0.7 vs 1.0, p=.332) or hematocrit (0.0, 1.8, p=.392) between the two groups. A total of 49 patients in the non-TXA group (71%) required drain placement while 6 patients in the TXA group (43%) had a drain placed (p=.062). There was a trend towards decreased drain output on postop day 1 in the TXA group compared to the non-TXA group (32.3mL vs 40.8mL, p=.056), however it was not significant. There was also no significant difference in average length of stay between TXA and non-TXA patients (3.2 vs 3.6 days, p=.564). <h3>CONCLUSIONS</h3> TXA has been reported as a useful perioperative tool to decrease bleeding associated with spinal surgery. We found in our patients who underwent ACDF that intraoperative use of IV TXA led to a significant decrease in intraoperative blood loss, however, there was no difference in the change in pre and postoperative hemoglobin and hematocrit between ACDF patients who received TXA and those who did not. There was also no difference in mean postoperative length-of-stay between the TXA and non-TXA groups. Additionally, while not significant, there was a trend towards TXA patients being less likely to require a drain postoperatively (p=.062) and those requiring a drain having less output in the early postoperative period (p=.056). While use of TXA perioperatively for ACDF was shown in this study to decrease operative blood loss, this change was not reflected in surgical hemoglobin change or overall length of stay. Further analysis of the benefits of TXA on bleeding in ACDF patients is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of tranexamic acid on clinical and hematologic outcomes following total shoulder arthroplasty.

The purpose of this study is to evaluate the impact of intravenous tranexamic acid on clinical and hematologic outcomes after total shoulder arthroplasty. Retrospective review was conducted for 282 consecutive patients undergoing either anatomic shoulder arthroplasty or reverse total shoulder arthroplasty. Univariate analysis and multivariate linear regression were used to compare outcomes for patients receiving intravenous tranexamic acid with those who did not. Of the 282 patients included in this study, 78 patients received intravenous tranexamic acid and 204 did not. Patients who received intravenous tranexamic acid had significantly lower pre- to postoperative change in hemoglobin and hematocrit, and decreased postoperative drain output. In addition, patients receiving intravenous tranexamic acid were significantly less likely to have a postoperative hematocrit <30. There were no significant differences in length of stay, rate of 30 day hematoma, surgical site infection, deep vein thrombosis, or readmission between groups. Intravenous tranexamic acid is associated with a significant reduction in change in hematocrit and hemoglobin and postoperative drain output after both anatomic and reverse total shoulder arthroplasty. Despite improving hematologic outcomes for these patients, tranexamic acid appears to have little impact on clinical outcomes such as length of stay and 30-day complication rates.

Self-assembling peptide haemostatic gel reduces incidence of pelvic collection after total mesorectal excision: Prospective cohort study

BackgroundPelvic surgery has the potential to leave behind a large raw surface, which can bleed and ooze postoperatively. The adoption of precision surgical approach for rectal cancers has led to reduction in blood loss. We aimed to assess 1) the feasibility and 2) the safety of using a self-assembling peptide (SAP) haemostatic agent (PuraStat®) after rectal cancer surgery to reduce the incidence of pelvic collections. Materials and methodsThis prospective cohort pilot study compared the results of 25 consecutive cases of total mesorectal excision (TME) with use of 5–10 ml of SAP, and 25 consecutive cases without PuraStat® application (CON, control group). The groups were compared for complications (Clavien-Dindo grade III and IV classification), postoperative drain output and length of hospital stay (LOS). Statistical analysis was carried out using paired samples T test and Fisher's exact test ResultsFifty patients (SAP = 25, CON = 25) were enrolled into this study. Mean drain outputs (ml) on day 1, day 2 and day 3 were 60 ± 18, 89 ± 42 and 64 ± 45 in SAP group, and 102 ± 31, 95 ± 52, 66 ± 37 in CON group. This was significantly better for SAP group in day one after surgery. The mean LOS was shorter in SAP group (5.7 versus 7.4 days in CON, p 0.04). Clavien-Dindo III & IV complications were seen in two and five cases respectively (p 0.18). R0 resection rate (p 0.32) and lymph node harvest (p 0.13) were similar in both groups. There were no complications seen in relation to the application of the SAP. ConclusionsThese initial data suggest that SAP is a safe product, and feasible to apply in the pelvis after TME surgery. It appears to shorten the LOS and reduce the postoperative drain output and may reduce the incidence of Clavien-Dindo grade III & IV complications.

Efficacy and Safety of Tranexamic Acid in Resection and Endoprosthetic Reconstruction of Distal Femoral Osteosarcomas in Children: A Retrospective Cohort Study.

This study aimed to investigate the effect of intravenous tranexamic acid (TXA) on blood loss and transfusion rates in children who underwent resection and endoprosthetic reconstruction of distal femoral osteosarcomas. The medical records of 56 patients who underwent resection and endoprosthetic reconstruction for distal femoral osteosarcomas between 2017 and 2019 were retrospectively reviewed. Patients were divided into 2 groups: group 1 consisted of 25 patients (11 male and 14 female, mean age 15.2±3 y) who received preoperative 15 mg/kg intravenous TXA, and group 2 consisted of 31 control patients (18 male and 13 female, mean age 14.3±2.6 y) who did not receive TXA. The groups were compared based on their total blood loss, intraoperative blood loss, hidden blood loss, postoperative drain output, transfusion requirements, preoperative and postoperative hemoglobin (Hb) and hematocrit (Htc) difference, length of hospital stays, operative time, and complications. The mean total blood loss was lower in intravenous TXA group (1247.5±300.9 mL) when compared with control group (1715.7±857.0 mL) (P=0.018). The mean intraoperative blood loss in intravenous TXA group (386±109 mL) was lower than that in control group (977.4±610.7 mL) (P<0.001). Postoperative drain output at 24 and 48 hours was 198.0±61.8 and 72.4±27.4 mL in intravenous TXA group, respectively, and was low compared with 268.4±118.2 and 117.1±67.8 mL in control group (P=0.028 and 0.006). The rate of patients requiring transfusion was significantly lower in intravenous TXA group (56%) than in control group (83.9%). Preoperative and postoperative 6, 24, and 72 hours Hb and Htc differences were significantly lower in intravenous TXA group [(-1.7±1.8 g/dL P<0.001; -2.0±1.5 g/dL P<0.001; -2.3±1.7 g/dL P<0.001, for Hb) (-5.7±4.6, P<0.001; -6.9±4.0, P<0.001; -9.6±9.1, P<0.001, for Htc)]. Intravenous TXA group had shorter hospital stay time in comparison to control group (P<0.001). The operative time was significantly longer in the control group (P<0.05). No increase in pulmonary embolism or venous thromboembolism rate was observed with intravenous TXA use. We conclude that administration of intravenous TXA reduces intraoperative and postoperative blood loss, transfusion rates, and hospital stay in resection and endoprosthetic reconstruction of the distal femoral osteosarcomas in children. This was a retrospective comparative study. Level III.

Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery

Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves’ disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.

Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

IntroductionRe-explorations after open-heart surgery are often required if the patient is bleeding or shows features of cardiovascular instability and does not improve with conservative measures. Our study aims to determine whether timely re-exploration of patients who are bleeding has an impact on the morbidity and mortality of the patients.MethodsA retrospective analysis of 75 patients that underwent open-heart surgery and subsequently underwent chest re-exploration for excessive bleeding between March 2018 and March 2020. Patients who were reopened post-op for indications other than excessive bleeding were excluded.ResultsA total number of cases were 700, out of which 75 (9.3%) patients were reopened, as compared to the literature, which shows worldwide 2-11% being reopened. Post-operative drain output was 1000ml to 1500ml in 47 (62.7%) and more than 1500ml in 28 (37.3%) patients before they were reopened. In 67 (89.3%) patients, three to five units of blood were transfused, and in eight (10.7%) patients, more than five units of blood were transfused. We believe our mortality in the reopened patients was low, because of timely intervention and early re-exploration, and is probably the reason why our figures land in a higher range (2-11%) of reopened cases (9.3%). Reopening time was less than five hours in 49 (65.3%) patients and less than 10 hours in 26 (34.7%) patients in our study. We tried to minimize the loss of blood and re-explored the patients before they lose excessive blood, the average time for reopening in our study was less than 10 hours. The average intensive care unit (ICU) stay was 4.2 days (range three to six days). Wound infections were reported in one of three patients. There was no mortality in these patients. Surgical site of bleeding was identified in 54 (72%) patients and no particular site was found in 21 (28%) patients. Suggesting that it is common to have a surgical bleeder than coagulopathy induced bleeding in post-cardiac surgery patientsConclusionsWe believe our low mortality (0%) is due to early reopening in patients who are bleeding excessively after cardiac surgery.

Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery

Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves’ disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.

Which Criterion for Wound Drain Removal is Better Following Posterior 1-Level or 2-Level Lumbar Fusion With Instrumentation: Time Driven or Output Driven?

Case-control study. To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II (P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance (P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups (P > 0.05). This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.

Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis.

To evaluate the effectiveness of the use of topical tranexamic acid (tTXA) in spinal deformity correction in AIS patients METHODS: Sixty consecutive operative AIS patients were reviewed from a single institution and divided into two groups with similar demographics. Standardized peri-operative blood salvage techniques were utilized in all 60 patients. In the latter 30 patients, tTXA soaked sponges (1g mixed in 500ml Normal Saline) was utilised for wound packing during the entire surgical procedure compared to dry sponges as used in the former 30 patients. Both the groups were compared for the magnitude of deformity corrected, EBL per level fused, total EBL, blood transfused, drain output and peri-operative events. Sixty AIS patients (mean age 14.4 yrs, 43 females, mean BMI 21.5, mean levels 10.7) were included. Both groups achieved similar change in Coronal Cobb correction. The EBVL (Estimated blood volume loss) % lost in the topical TXA group was 38% less than the control group (11.2 vs. 18.3%, p = 0.006). Similarly, the EBL/level was significantly lower in the topical TXA group (41 ± 30ml vs. 57 ± 26ml, p = 0.03). Three of 30 patients in the control group required at least 1 unit of blood transfusion, whereas only 1 patient in the topical TXA group required transfusion (10 vs. 3.3%, p = 0.001). No differences were noted in post-operative drain output, change in hemoglobin levels, and peri-operative complication rates. When used as an adjunct to the conventional blood salvage techniques in spinal deformity correction procedures, the use of tTXA resulted in reduced operative blood loss, and blood transfusion requirements.

Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Background: Hemarthrosis after anterior cruciate ligament (ACL) reconstruction procedures can delay rehabilitation and have toxic effects on the cartilage and synovium. Tranexamic acid is widely used in adult reconstruction procedures; however, its use in ACL reconstruction is a novel topic of study. Purpose: To analyze the available literature on hemarthrosis, pain, functional outcomes, and complications after administration of tranexamic acid in ACL reconstruction procedures. Study Design: Meta-analysis. Methods: A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of ACL reconstruction procedures. The studied outcomes included postoperative joint drain output, hemarthrosis grade, visual analog scale scores for pain, range of motion, Lysholm score, postoperative rates of deep venous thrombosis, and pulmonary embolism. Outcomes were pooled to perform a meta-analysis. Results: Five prospective randomized controlled trials met inclusion criteria for analysis. Four studies administered intravenous tranexamic acid in bolus or infusion form before ACL reconstruction, while 2 studies administered tranexamic acid via intra-articular injection. Specifically, tranexamic acid was administered intravenously (preoperative 15-mg/kg bolus 10 minutes before tourniquet inflation with or without 10 mg/kg/h for 3 hours postoperatively) or intra-articularly (10 mL [100 mg/mL] intraoperatively), and 1 study consisted of tranexamic acid administration in combined intravenous and intra-articular forms (15-mg/kg bolus 10 minutes before tourniquet inflation and intra-articular 3 g 10 minutes before tourniquet deflation). Tranexamic acid use in ACL reconstruction cases resulted in a mean reduction of 61.5 mL in postoperative drain output at 24 hours (95% CI, –95.51 to −27.46; P = .0004), lower hemarthrosis grade (P < .00001), improved Lysholm scores, and reduction in visual analog scale scores for pain (−1.96 points; 95% CI, −2.19 to −1.73; P < .00001) extending to postoperative week 6. Range of motion was improved in the immediate postoperative period, and the need for joint aspiration within 2 weeks was reduced (P < .001). There was no difference in venous thromboembolic event rate between the experimental and control groups. Conclusion: The use of intravenous tranexamic acid in ACL reconstruction surgery results in reduced joint drain output and hemarthrosis and improved pain scores and range of motion in the initial postoperative period without increased complications or thromboembolic events.

Clinical Outcomes and Experience of a Multiyear Consecutive Case Series of Total Knee Arthroplasty Procedures Conducted with a Bipolar Sealer System for Hemostasis

Maximizing hemostasis during total knee replacement procedures remains a key challenge in current practice. Bipolar sealer technology achieves intraoperative hemostasis through tissue sealing and coagulation with adjustable radio frequency energy and a saline-irrigated tip. Optimal surgical site hemostasis is important to avoid potential complications such as hemarthrosis, wound drainage, increased pain, delayed discharge, and readmissions. The aim of this study is to evaluate the safety and effectiveness of the bipolar sealer device in primary knee replacement in the largest consecutive series to date. A consecutive, treatment-control series of subjects who underwent a primary total knee arthroplasty (TKA) utilizing a bipolar sealer for hemostasis, one subgroup with concomitant tranexamic acid (TXA) administration (n = 1599) and one subgroup without TXA administration (n = 3582), compared with a control group of primary TKA under tourniquet only (n = 667). Statistical analyses were performed through two-tailed unpaired t-tests. There was less total postoperative drain output and a lower overall transfusion rate in the bipolar sealer group (807ml ± 428) (2.5%) than the tourniquet only group (1290 ± 658, p = 0.001) (8.4%, p = 0.0001), respectively. Drainage output in bipolar sealer + TXA (450 ± 297 ml) was lower than the other two groups (bipolar sealer 807 ± 428 mL, p = 0.0001; tourniquet only 1290 ± 658 ml, p = 0.0001). The bipolar sealer group had a higher hematocrit at postoperative day 1 (POD1) (bipolar sealer: 33.1 ± 4.3 cc, tourniquet only: 32.5 ± 4.3 cc, p = 0.001) and at discharge (POD2, bipolar sealer: 31.5 ± 3.7 cc, tourniquet only: 30.2 ± 3.9 cc, p = 0.0001). There were zero reported serious adverse events related to hemostasis management in any group. The bipolar sealer system is a safe and effective instrument to achieve intraoperative hemostasis during primary TKA. The bipolar sealer group required significantly fewer postoperative blood product transfusions and maintained a higher hematocrit concentration at the time of discharge compared with subjects treated solely with tourniquet mediated hemostasis. Addition of TXA to local hemostasis methods may further reduce blood loss and transfusion requirements. LEVEL OF EVIDENCE: This is a Level III study.

A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast

BackgroundAxillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM.MethodsA parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared.ResultsGroup A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups.ConclusionUltrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.

COMPARISON BETWEEN POSTOPERATIVE DRAIN OUTPUT AFTER THYROIDECTOMY WITH AND WITHOUT USE OF HARMONIC SCALPEL DEVICE

Abstract:&#x0D; Introduction: Thyroid gland is one of the most important endocrine organs in human body performing multiple functions to maintain homeostasis. Thyroid nodular disease is a frequently encountering problem in surgical OPD that could be malignant or benign. It is more common in females than in males and is expecting that after a decade or so, it will be the 2nd most common malignancy in women. Ultrasound guided fine-needle aspiration (FNA) and core needle biopsy (CNB) are two modalities use to diagnose thyroid swelling preoperatively. Multiple techniques are used to manage thyroid swellings, depending on type and size of thyroid enlargement. Total thyroidectomy, radical and subtotal thyroidectomies are few examples. As thyroid has rich blood supply, ensuring early hemostasis is of vital importance as it directly affects duration of operation as well as visibility of surgical site and intra operative bleeding. Newer techniques include use of harmonic scalpel device that can seal and dissect blood vessels simultaneously by coagulating proteins present in blood vessels, decreasing duration of operation and better hemostasis.&#x0D; Objective: This study was done to evaluate the operative duration, post-operative complications and drain output after thyroidectomy with and without use of harmonic scalpel device. &#x0D; Material and Methods: Randomized controlled trial was conducted at Surgical Unit 3 of Lahore General Hospital between July 2018 and June 2019. Written informed consent was acquired from all of the patients. All participants underwent near total or total thyroidectomy and were euthyroid at the time of surgery. All participants were randomly allocated to one of the two study groups using lottery method. All the data was collected using preformed questionnaire and was evaluated through SPSS v 25.&#x0D; Inclusion criteria: Age group of 20–70 years and American Society of Anesthesiologists (ASA) physical status I–II.&#x0D; Exclusion criteria: Morbidities (e.g., coagulopathy, diabetes, hypertension, ischemic heart disease).&#x0D; Results: Out of 50 patients 35 patients were female with mean age group of 47±4.8 years. 25 participants were enrolled in group in which Harmonic Scalpel device was used while 25 patients underwent conventional method. Mean duration of thyroidectomy from skin incision to skin closure in group with use of harmonic scalpel was 104.19±13.67 minutes while in conventional group it was 128.62 ± 11.76 minutes. Mean output of fluid/blood in drain post operatively in group treated with harmonic scalpel was 48.82±16.56 while in conventional group, post-operative drain output was 89.45±23.21ml.&#x0D; Conclusion: Harmonic device is both useful and widely used hemostatic tool in thyroid gland surgery. This device is safe and more compelling than the conventional monopolar diathermy.

A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery.

Introduction:The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG).Methods:This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients’ clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant.Results:The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001).Conclusion:Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.

Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis.

ObjectiveThis was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on drain output and transfusion requirements following adult spinal deformity surgery. MethodsOne hundred forty-seven patients undergoing posterior instrumented thoracolumbar fusion of ≥ 3 vertebral levels at a single institution who received low-dose PTXA infusion (0.5–1 mg/kg/hr) for 24 hours were compared to 292 control patients who did not receive PTXA. The cohorts were propensity matched based on age, sex, American Society of Anesthesiologist physical status classification, body mass index, number of surgical levels, revision surgery, operative duration, and total intraoperative TXA dose (n = 106 in each group). Primary outcome was 72-hour postoperative drain output. Secondary outcomes were number of allogeneic blood transfusions. ResultsThere was no significant difference in postoperative drain output in the PTXA group compared to control (660 ±420 mL vs. 710 ±490 mL, p = 0.46). The PTXA group received significantly more crystalloid (6,100 ±3,100 mL vs. 4,600 ±2,400 mL, p < 0.001) and red blood cell transfusions postoperatively (median [interquartile range]: 1 [0–2] units vs. 0 [0–1] units; incidence rate ratio [95% confidence interval], 1.6 [1.2–2.2]; p = 0.001). Rates of adverse events were comparable between groups. ConclusionContinuous low-dose PTXA infusion was not associated with reduced drain output after spinal deformity surgery. No difference in thromboembolic incidence was observed. A prospective dose escalation study is warranted to investigate the efficacy of higher dose PTXA.