Postoperative Hb Levels Research Articles

Dose tranexamic acid reduce blood loss associated with simultaneous bilateral distal tibial tubercle-high tibial osteotomy?

BackgroundSimultaneous bilateral distal tibial tubercle high tibial osteotomy (SBDTT-HTO) can result in increased blood loss. The aim of this study is to evaluate the actual hemostatic effect of different tranexamic acid (TXA) treatment regimen in SBDTT-HTO.MethodsWe conducted a retrospective case–control study including 54 patients who underwent SBDTT-HTO. The single-dose group (n = 18) received 1 g of intravenous TXA 15–30 min before surgery, the two-dose group (n = 18) received an additional 1 g of intravenous TXA 6 h after surgery, and the multiple-dose group (n = 18) received an additional 1 g intravenous TXA per-day until discharge. Blood loss, hemoglobin levels, occurrence of any adverse events,functional analysis, quality of life, and pain assessmentswere compared among the three groups.ResultsThe total blood loss, hidden blood loss, drainage volumes, and haemoglobin level in the multiple-dose group all occupy a significant advantage.(p < 0.05). In addition, better quality of life were observed in patients belonging to the multiple-dose group then single-dose group.(p < 0.05).ConclusionsBased on our results, for patients undergoing SBDTT-HTO, sequential intravenous TXA administration can effectively and safely reduce blood loss,maintain postoperative Hb levels,and with the advantage of accelerating recovery.

The First 24 h Hemodynamic Management in NICU after Revascularization Surgery in Moyamoya Disease.

Objective To evaluate whether hemodynamic factors are risk factors for prognosis in moyamoya disease (MMD). Materials and Methods The retrospective study reviewed a single-center MMD cohort in Huashan Hospital from August 2017 to January 2020. Stroke events in 30 days and follow-up modified Rankin Scale (mRS) grade were recorded. Systematic assessments with perioperative mean arterial pressure (MAP), red blood cell (RBC) parameters, and fluid management were also conducted. Logistic regressions were applied to evaluate the predictors of worse outcomes. Data was analyzed using SPSS 24.0. Results Admission to neurological intensive care unit (NICU) totalled about 347 after revascularization surgery. The result showed that the higher the postoperative MAP level (favorable group 95.7 ± 11.4 mmHg vs. unfavorable group 103.6 ± 10.4 mmHg, p < 0.001) and the greater the MAP variability (favorable group 0.26 ± 13.2 vs. unfavorable group 7.2 ± 13.5, p = 0.006) were, the higher the patient's follow-up mRS grade was. What is more, a higher early postoperative Hb level also seemed to predict a worse long-term clinical outcome (favorable group 116.9 ± 17.1 g/L vs. unfavorable group 123.7 ± 13.0 g/L, p = 0.03), but the difference disappeared after adjusting sex and age. Logistic regression analyses showed that a higher level of postoperative MAP (β = 0.024, 95% CI (0.004, 0.044), and p = 0.02) within the first 24 h in NICU might be the short-term risk factor. For long-term outcome, a higher level (β = 1.058, 95% CI (1.022, 1.096), and p = 0.001) and a greater variability (β = 30.982, 95% CI (2.112, 454.414), and p = 0.01) of postoperative MAP might be the negative predictors of mRS grade. Conclusions The early postoperative hemodynamic management might be extremely critical for patients with MMD. Both high postoperative MAP levels and large MAP variability might affect the prognosis. What is more, we also found that a higher postoperative Hb level might be related with a worse outcome.

MINI PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF NON LOWER POLAR HIGH DENSITY RENAL STONE 10-20 MM (A PROSPECTIVE RANDOMIZED STUDY)

Background: The optimal management of medium sized renal stones differs from one patient to another according to different factors. Stone attenuation value (SAV) is one of these factors which affect stone free rate (SFR) after extracorporeal shock wave lithotripsy (ESWL) with limited effect on mini-percutaneous nephrolithotomy (mini-PCNL). Objective: To compare safety and SFR of mini-PCNL and ESWL in the treatment of non-lower pole renal stones with high density and size of 10-20 mm. Patients and Methods: This prospective randomized study was carried out at Sayed Galal, Al Azhar University Hospital, Cairo, Egypt from November 2019 to October 2020 and included 70 patients with non-lower pole renal calculi 10 to 20 mm. Patients were randomly allocated in 2 equal groups: Group A was treated by mini-PCNL and group B was treated by ESWL. The primary end point was SFRs (no stone or residual 3>mm) in ESWL and mini-PCNL in this category of stone. The secondary end points were the complication rate, retreatment rate, and need for auxiliary procedures in each group. Results: The overall operative time was significantly lower in mini-PCNL group (median: 50.00; IQR: 20.00) compared to ESWL group (median: 55.00; IQR: 28.00) (p= 0.001). The overall fluoroscopy time was significantly lower in mini-PCNL than ESWL (3.2 versus 3.6 minutes, p=0.040). In mini-PCNL group, 32 out of 34 (94.1%) patients were stone free. In ESWL group, 10 out of 33 (30.1%) were rendered stone free after the third ESWL session. The SFR was significantly higher in mini-PCNL group (p < 0.001). In mini-PCNL group, none of cases needed a second look PCNL. The 2 failed cases had significant residual fragments that migrated into inaccessible calyx during pneumatic lithotripsy. In ESWL group, all cases had normal hemoglobin (Hb) level at each follow-up visit. In mini-PCNL group, when comparing pre- and post-operative Hb, a very highly significant differences were observed between pre- and post-operative Hb level (p < 0.001). Conclusions: Mini-PCNL is superior to ESWL in treatment of non-lower pole medium sized renal stones of high density with high SFR, and low complication rate as need for re-hospitalization or need for auxiliary procedure.

Combination of Topical Use of a Thrombin-Based Hemostatic Matrix and Tranexamic Acid does not have a Synergic Effect on Reducing Postoperative Blood Loss in Minimally Invasive Total Knee Arthroplasty. A Prospective Randomized Controlled Study

Background: There is limited information regarding the blood-conservation effect of combined topical Tranexamic Acid (TXA) and Thrombin-Based Hemostatic Matrix (TBHM) in Total Knee Arthroplasty (TKA). This study is to evaluate whether there is synergic effect of combined use of TXA and TBHM to reduce blood loss during TKA. Materials and Methods: Sixty-nine patients (69 knees) who underwent primary TKA were randomly assigned into a TXA group (n=34), who received intra-articular administration of 3g of TXA in 60mL saline, and a TXA + TBHM group (n=35), who received intra-articular TBHM and TXA (3g) in 60mL saline after TKA. The primary outcomes were Total Blood Loss (TBL) and postoperative Hemoglobin (Hb) level. Secondary outcomes included the transfusion rate and the incidence of Venous Thromboembolism (VTE). Results: The mean TBL in the TXA + TBHM group was 678 ± 203 mL , which was similar to that in the TXA only group at 733 ± 217 mL (p=0.276). There were no differences in the postoperative Hb level between the two groups. The transfusion rate was similar in the TXA + TBHM group and the TXA only group (2.9% versus 0%, p=0.242). No patients in either group developed VTE within 3 months. Conclusions: Our prospective randomized controlled study did not show a synergic blood-conservation effect of combined use of topical TBHM and TXA in patients undergoing TKA. Further investigation with a larger sample size may be required.

A Cost-Effective Implementation of Pre-Operative Protocol with Sucrosomial® Iron Supplementation

Low peri-operative hemoglobin (Hb) values in orthopedic surgery patients are associated to a longer hospital stay, higher red blood cells transfusion (RBCT) rates and mortality. Compared to non-anaemic patients, anaemic patients have a 42% higher risk of mortality and a 35% higher risk of serious complications [1]. Timely prevention of peri-operative anemia and iron stores can improve patient outcome and reduce RBCT requirements, since pre-operative anaemia appears to be also related to poor prognosis. Sucrosomial® iron (Sideral® Forte, PharmaNutra) is a formulation where iron is covered by phospholipids plus sucrose esters of fatty acids matrix, allowing a higher absorption of iron compared to ferrous sulfate and avoiding typical gastrointestinal side effects. Sucrosomial® iron appears to have high tolerability and to be effective in improving the patient's anaemic condition in terms of serum iron, Hb and ferritin, which have been confirmed by several studies, even in comparison with IV iron treatment, showing similar results [2, 3, 4, 5]. Thus, for these reasons, the efficacy of sucrosomial® iron supplementation in prosthetic hip surgery patients was assessed in terms of Hb levels, length of hospital stay (LOS) and RBCT.The study was conducted between 2015 and February 2017 on patients undergoing prosthetic hip surgery. The period taken into consideration was a follow-up period after the implementation of the pre-operative protocol, which was gradually implemented from 2011 to 2014 with the introduction of sucrosomial® iron. The protocol includes a full blood count, including CRP and ferritin, 21-28 days prior to surgery during the pre-operative visit. In case of a ferritin level <100 mcg/L and/or Hb level <14 g/dL for male and 13 g/dL for female, sucrosomial® iron is prescribed at a dosage of 1 cps/day corresponding to 30mg of elemental iron, for 21-28 days before and 7-10 days after surgery.Between 2015 and January 2017, 5869 patients were evaluated, of these 551 patients were anemic and 1958 were iron deficient. Thus, these patients received iron supplementation with an adherence to the treatment of 87%. Since the introduction of Sucrosomial® iron supplementation there was a reduction in the RBCT rate of 67% and the amount of RBCT significantly decreased from 10% in 2015 to 0% units in 2017 in the population treated. Moreover, sucrosomial® iron led to a reduced in the LOS from an average of 15.19 days in 2014 and to an average of 10.36 days in 2017 (Figure 1), which can be associated to a faster Hb recovery after surgery. Indeed, in January 2017 median Hb level at discharge was 11.2 g/dL, 1.3 g/dL higher than in 2014. The estimated saving for the shorter LOS was calculated as 2000 euro/patient, plus additional saving gained from a more efficient use of hospital beds (Figure 1) in addition to the saving derived from a reduced use of RBCT allowing a better allocation of hospital resources. Indeed, it was estimated an overall saving of 385,000 euro for the period taken into consideration.Pre-operative sucrosomial® iron supplementation 3\\4 weeks prior to prosthetic hip surgery patients contained the fall in post-operative Hb levels and determined a faster recovery of Hb levels and functional recovery after surgery, corresponding to a shorter LOS and decreased surgery-related costs.Bibliography1. Musallam KM, et al. Lancet (London, England). 2011;378:1396-407.2. Capra AP, et al. Hematology. 2017:1-6.3. Mafodda A, et al. Supportive care in cancer. 2017.4. Parisi F, et al. The Journal of Maternal-Fetal & Neonatal Medicine. 2016:1-21.5. Pisani A, et al. NDT Journal 2015;30:645-52. [Display omitted] DisclosuresPera:Pharmanutra S.p.A.: Employment. Tarantino:Pharmanutra S.p.A.: Employment.

Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis

BackgroundAlthough intravenous tranexamic acid administration (ivTXA) has prevailed in clinical antifibrinolytic treatment, whether it increases thromboembolic risks has remained controversial. As a potent alternative to ivTXA, topical use of TXA (tTXA) has been successfully applied to attenuate blood loss in various surgical fields while minimizing systemic exposure to TXA. This meta-analysis was conducted to gather scientific evidence for tTXA efficacy on reducing postoperative drainage, blood loss, and the length of hospital stay in spine surgeries.ObjectivesTo examine whether topical use of TXA (tTXA) reduces postoperative drainage output and duration, hidden blood loss, hemoglobin level drop, hospital stay, and adverse event rate, we reviewed both randomized and non-randomized controlled trials that assessed the aforementioned efficacies of tTXA compared with placebo in patients undergoing cervical, thoracic, or lumbar spinal surgeries.MethodsAn exhaustive literature search was conducted in MEDLINE and EMBASE databases from January 2000 through March 2020. Measurable outcomes were pooled using Review Manager (RevMan) version 5.0 in a meta-analysis.ResultsSignificantly reduced postoperative drainage output (weighted mean difference [WMD]= − 160.62 ml, 95% confidence interval (95% CI) [− 203.41, − 117.83]; p < .00001) and duration (WMD= − 0.75 days, 95% CI [− 1.09, − 0.40]; p < .0001), perioperative hidden blood loss (WMD= − 91.18ml, 95% CI [− 121.42, − 60.94]; p < .00001), and length of hospital stay (WMD= − 1.32 days, 95% CI [− 1.90, − 0.74]; p < .00001) were observed in tTXA group. Pooled effect for Hb level drop with tTXA vs placebo crossed the equivalent line by a mere 0.05 g/dL, with the predominant distribution of 95% confidence interval (CI) favoring tTXA use.ConclusionsWith the most comprehensive literature inclusion up to the present, this meta-analysis suggests that tTXA use in spinal surgeries significantly reduces postoperative drainage, hidden blood loss, and hospital stay duration. The pooled effect also suggests that tTXA appears more effective than placebo in preserving postoperative Hb level, which needs further validation by future studies.

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision.

Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study. A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2-3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated. Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups. In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.

Retrospective Evaluation of Effects of Preoperative Anaemia Treatment in Gynaecological and Obstetric Surgical Patients.

ObjectiveIn anemic patients undergoing surgery, there is an increase in the requirement of blood transfusion, longer hospital stay and higher intensive care unit adimission. In this study we aimed to evaluate the efficacy of iv iron treatment before elective obstetric or gynecological operations retrospectively.MethodsAfter obtaining approval of ethics committee, records of 5688 patients underwent either obstetric or gynecological surgery between January 1st of 2016 to December 31st of 2018 were documented retrospectively and 241 anemic cases were identified. Eighty-one anemic patients who did not receive any iv iron treatment preoperatively were excluded and 160 cases treated with either iv iron (either sucrose or ferric carboxy maltose) were included. The laboratory results including haemoglobin (Hb), MCV,MCH and serum iron binding capacities, ferritin, iron and transferrin levels were documented before (preoperative) and after iv iron treatment (postoperative 10th day) were collected from files. Difference between preoperative and postoperative Hb, MCV, MCH, TIBC, serum ferritin, iron and transferrin levels of these cases were determined.ResultsIn 97 obstetric cases, the differences of Hb, MCV, MCH, serum iron, ferritin, iron binding capacity values before surgery and postoperative 10th day were respectively found as 1.3 g dL−1 (p=0.000); 1.9 fL (p=0.000); 0.3 pg (p=0.01); 44.4 μg dL−1 (p=0.008); 85.9 μg L−1 (p=0.009); 211.7 μg dL−1 (p=0.001). In 63 gynecologic cases, same measurements were evaluated and similar differences in Hb, MCV, MCH, serum ferritin and transferrin saturation values were 1.25 g dL−1 (p=0.000); 2.2 fL (p=0.000); 0.8 pg (p=0.000); 215.6 μg L−1 (p=0.002); 41.5% (p=0.044). Two obstetric patients and 7 gynaecologic patients were transfused erytrocyte suspensions after surgery.ConclusionEfficacy of preoperative iv iron therapy in gynaecologic-obstetric patients with IDA has been demonstrated and its importance has been revisited once again.

Can an outpatient risk assessment tool predict who needs postoperative haemoglobin monitoring?

Recent improvements in surgical technique and perioperative blood management after total joint replacement (TJR) have decreased rates of transfusion. However, as many surgeons transition to outpatient TJR, obtaining routine postoperative blood tests becomes more challenging. Therefore, we sought to determine if a preoperative outpatient assessment tool that stratifies patients based on numerous medical comorbidities could predict who required postoperative haemoglobin (Hb) measurement. We performed a prospective study of consecutive unilateral primary total knee arthroplasties (TKAs) and total hip arthroplasties (THAs) performed at a single institution. Prospectively collected data included preoperative and postoperative Hb levels, need for blood transfusion, length of hospital stay, and Outpatient Arthroplasty Risk Assessment (OARA) score. A total of 504 patients met inclusion criteria. Mean age at time of arthroplasty was 65.3 years (SD 10.2). Of the patients, 216 (42.9%) were THAs and 288 (57.1%) were TKAs. Six patients required a blood transfusion postoperatively (1.19%). Transfusion after surgery was associated with lower postoperative day 1 Hb (median of 8.5 (interquartile range (IQR) 7.9 to 8.6) vs 11.3 (IQR 10.4 to 12.2); p < 0.001), longer length of stay (1 day (IQR 1 to 1) vs 2 days (IQR 2 to 3); p < 0.001), higher OARA score (median of 60.0 (IQR 40 to 75) vs 5.0 (IQR 0-35); p = 0.001), and total hip arthroplasty (p < 0.001). All patients who received a transfusion had an OARA score > 34; however, this did not reach statistical significance as a screening threshold. Risk of blood transfusion after primary TJR was uncommon in our series, with an incidence of 1.19%. Transfusion was associated with OARA scores > 60. The OARA score, not American Society of Anesthesiologists grade, reliably identified patients at risk for postoperative blood transfusion. Selective Hb monitoring may result in substantial cost savings in the era of cost containment. Cite this article: Bone Joint J 2021;103-B(1):65-70.

Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis.

Objective To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery. Methods Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the Cochrane Reviewer's Handbook. Results Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: WMD = −1737.55, 95% CI: (-2247.16, -1227.94), P < 0.001, I2 = 0%; low dose: WMD = −528.67, 95% CI: (-666.06, -391.28), P < 0.001, I2 = 0%), intraoperative blood loss (IBL) (high dose: WMD = −301.48, 95% CI: (-524.3, -78.66), P = 0.008, I2 = 60.3%; low dose: WMD = −751.14, 95% CI: (-967.21, -535.08), P < 0.001, I2 = 0%), and blood transfusion rates (high dose: RR = 0.19, 95% CI: (0.1, 0.37), P < 0.001, I2 = 0%; low dose: RR = 0.4, 95% CI: (0.18, 0.91), P = 0.029, I2 = 57%). High-dose IV TXA use was associated with more vertebral fusion segments (WMD = 0.53, 95% CI: (0.23, 0.82), P < 0.001, I2 = 31.2%). Low-dose IV TXA use was associated with shorter operative time (WMD = −18.43, 95% CI: (-26.68, -10.17), P < 0.001, I2 = 0%). Conclusion High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy.

The purpose of this study was to investigate the efficacy of tranexamic acid (TXA) in patients undergoing open-wedge high tibial osteotomy (OWHTO). Patients from August 2018 to May 2020 were retrospectively studied. Clinical data were obtained including gender, age, height, weight, body mass index (BMI), smoking, alcohol consumption, hypertension, diabetes, history of aspirin, prepostoperative hematocrit (Hct) and hemoglobin (Hb), thrombotic events, blood transfusion requirement, hospital length of stay, size of osteotomy gap, and wound complications such as wound hematoma and infection. 52 patients were enrolled in the tranexamic acid group (TA group), and 48 patients were enrolled in the nontranexamic acid group (NTA group); there were no significant differences between both groups in terms of gender, age, BMI, preoperative Hb, size of osteotomy gap, incidence of smoking, alcohol consumption, hypertension, diabetes, history of aspirin, thrombotic events, blood transfusion requirement, and wound hematoma and infection. The mean hospital length of stay was 9.4 ± 1.0 days in the TA group and 11.0 ± 1.2 days in the NTA group (P < 0.001), the blood loss was 296.0 ± 128.7 ml in the TA group and 383.3 ± 181.3 ml in the NTA group (P < 0.05), and the postoperative Hb level was 120.8 ± 15.0 g/l in the TA group and 109.5 ± 13.8 g/l in the NTA group (P < 0.001). In conclusion, the administration of TXA is beneficial to patients undergoing OWHTO via decreasing hospital length of stay, reducing blood loss, and maintaining higher postoperative Hb levels.

Orthostatic retractor placement reduces operating time and post-operative inflammatory response during the learning curve of anterior approach THA

IntroductionHandheld retractor placement (HHRP) is prone to repetitive repositioning. This could lead to muscle damage especially during a procedure with a steep learning curve. In an attempt to minimize retractor repositioning during the learning curve of direct anterior approach (DAA) total hip arthroplasty (THA), we used a table mounted orthostatic retractor placement (ORP) device. PurposeTo investigate whether ORP would reduce the extent of muscle damage, OR-time and post-operative inflammatory response. Materials and methods29 Patients were operated by 2 surgeons who randomly used HHRP or ORP during their learning curve of DAA THA. There were 14 patients in a control group who were operated by an experienced surgeon. Blood levels of Creatine Kinase (CK), C-Reactive Protein (CRP), Hemoglobin (Hb), Lactate Dehydrogenase (LDH) and Erythrocyte Sedimentation Rate (ESR) were measured at 1 h pre- and 24 and 48 h post-operatively. ResultsThe mean OR-time was 67 and 50 min in the HHRP and ORP cohort, respectively (p < 0,001). Post-operative CRP levels were significantly higher in the HHRP cohort at 24 h (HHRP 60.64 mg/L (25.20–143.20); ORP 34.67 mg/L (9.30–71.20)) (p = 0.003) and 48 h post-operatively (HHRP 154.54 mg/L (65.90–369.00); ORP 81.60 mg/L (21.30–219.40) (p = 0.004). The post-operative Hb-levels were significantly lower in the HHRP cohort at 24 h (HHRP 11.11 g/dL (9.10–12.30); ORP 11.37 g/dL (8.80–14.00)) (p = 0.0008) and 48 h (HHRP 10.86 g/dL (9.50–12.00); ORP 11.25 g/dL (8.60–14.10)) (p = 0.03). Post-operative ESR levels were significantly higher in the HHRP cohort 48 h post-op (HHRP 45.21 mm/h (14.00–83.00); ORP 23.73 mm/h (2.00–73.00)) (p = 0.004). No significant differences were found for the CK and LDH levels at any time postoperatively. There were no complications in any group. ConclusionThe use of an orthostatic retractor placement device allows for reducing the OR-time, post-operative blood loss and post-operative inflammatory response during the learning curve of DAA THA.

EFFECT OF DUTASTERIDE (5 ALPHA-REDUCTASE INHIBITOR) TREATMENT ON REDUCING BLOOD LOSS, IN PERIOPERATIVE PERIOD OF OPEN PROSTATECTOMY DONE IN LARGE PROSTATE.

Objective- Open prostatectomy (OP) is still a very valid option in treatment of very large volume prostates in the absence of holmium laser enucleation ( holmium laser is a rarity and expensive in govt and self funded medical colleges), its main complication being intra and perioperative bleeding. Preoperative use of dutasteride has shown to decrease perioperative bleeding in TURP (transurethral resection of prostate), though till date OP being a standard procedure in large prostate management ,there is no study showing effect of dutasteride in perioperative bleeding in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP could reduce blood loss in surgery, as high watt holmium laser is still not available in most of the medical colleges ,treating patients for free . Material and Methods- Data of 218 patients who underwent OP for BPH (benign prostatic hyperplasia), were investigated retrospectively. Of 218 patients ,46 were pretreated with dutasteride for 6 weeks and the rest were not under dutasteride treatment. Age, prostate volume , prostate specific antigen(PSA) levels, coagulation profile, platelet count, pre and post operative hemoglobin(Hb) levels ,and blood transfusion history were recorded .Blood loss was estimated as follows : pre operative Hb(-) post operative Hb(+) amount of blood transfusion. The 2 groups were compared by independent samples t-test and a p value of 0.05 was considered significant. Results- The groups were similar in terms of age , prostate volume ,platelet counts, coagulation tests and post operative Hb levels. Preoperative Hb levels were lower in dutasteride group (13.4 vs 14.3,p=0.002) and amount of bleeding (-2.72g/dl vs.-1.93g/dl, p=0.01) was shown to be significantly lower in dutasteride group. Conclusion -Our result showed that pretreatment with dutasteride for 6 weeks before OP for very large prostates, reduces perioperative bleeding , and can be used in medical colleges where treatment is free ,instead of using holmium laser, though further prospective randomized trials would support the effectiveness of such treatment.

Tek seferlik yüksek doz topikal traneksamik asit uygulamasının total diz artroplastisi sonrası kanama ve komplikasyonlar üzerine etkisi: Retrospektif klinik çalışma

Aim: There is no consensus on the optimal method of Tranexamic acid (TA) usage in orthopaedic surgery in the literature. The aim of this study is to evaluate the effects of single high dose (3g) topical TA application on postoperative bleeding and complications in total knee arthroplasty (TKA) surgery.&#x0D; Material and Methods: We retrospectively evaluated patients who underwent TKA in our clinic between January 2016 and June 2018. The patients were divided into two groups according to TA administration: Group 1 (topical TA, n=105/242) and Group 2 (non-TA, n=137/242). Demographic parameters, comorbidities, high-risk factors, preoperative hemoglobin (Hb) level, lowest postoperative Hb level, change in Hb, total drainage output, presence or absence of a transfusion, amount of blood transfused, length of stay, and complications were evaluated.&#x0D; &#x0D; Results:In group 1, postoperative first- and second-day Hb levels were significantly higher than those in group 2. The blood loss on the day of surgery, the blood loss on the first postoperative day and total drain blood loss were significantly lower in group 1. It was determined that the patients in group 2 needed significantly more blood transfusions and had more length of hospital stay. There was no statistical difference in complications between the two groups. &#x0D; Conclusion:Topical TA application effectively and significantly reduces blood loss and transfusion rates after surgery, without serious side effects, in patients undergoing primary TKA. This also reduces the length of the hospital stay.

Effectiveness of tranexamic acid in reducing blood loss in cervical laminoplasty: A retrospective observational study

Background: Tranexamic acid (TXA) has been proved effective in reducing perioperative blood loss in patients undergoing orthopedic operations. However, given the heterogeneity in the diagnoses and spinal operations, there are only limited studies comparing patients with uniform diagnoses and procedures performed. Methods: A comparative observational control study was performed on 62 patients with cervical myelopathy. They were divided into control (32) and TXA (30) groups according to whether they had received TXA before and during surgery. Cervical laminoplasty from C3 to C6/7 was performed for all patients using a consistent procedure. Preoperative and postoperative hematological data and perioperative blood loss were compared. Results: There were no statistically significant differences between the two groups in terms of age, gender, body mass index, and operating time. The TXA group had significantly less intraoperative (310 ± 215 ml vs. 144 ± 90 ml, p &lt; 0.05) and postoperative blood loss than the control group (150 ± 50 ml vs. 249 ± 94 ml, p &lt; 0.01). The drop of hemoglobin (Hb) level in the TXA group was also significantly lower (0.5 ± 0.42 g/dl vs. 2.1 ± 1.03 g/dl, p &lt; 0.01). No thromboembolic complications found. Conclusion: TXA significantly reduced perioperative blood loss and reduced drop of postoperative Hb level in cervical laminoplasty.

"Blood loss and tourniquet in total knee replacement surgery: A randomised control study"

BackgroundThe primary aim of the study was to determine the efficiency of tourniquet in reduction of blood loss during Total Knee Arthroplasty. MethodA total of 105 patients were randomised into two groups each consisting of 52 patients in one group and 53 in another. Pre-operative Haemoglobin (Hb) and Packed Cell Volume (PCV) measurement was done in every case. Every individual received Injection Tranexamic acid 1gm slow intravenous infusion before incision was given and one dose after 8hrs post-surgery. Meticulous care was taken to measure blood loss during surgery. A drain was placed in every case and removed after 24 h. Amount of blood loss in the drain was measured and post-operative Hb and PCV levels were ordered. ResultsNo statistically significant difference in the amount of total blood loss was found between the two groups. However, the amount of blood loss during surgery was significantly lesser in patients who underwent surgery with tourniquet in comparison to patients who were operated without tourniquet. At the same time blood loss through drain during post op period was clearly found to be more in patients who were operated with tourniquet as compared to another group. ConclusionOur study concludes that there is no impact on blood loss as a result of tourniquet use in total knee arthroplasty. The study further proved that the decrease in blood loss during surgery with the use of tourniquet is associated with proportionate rise in blood loss in the post op period from the drain. Furthermore, our study concluded that optimisation of patient’s pre surgery blood parameters can eliminate the need for post op transfusion.

Перкутанная нефролитотрипсия при камнях единственной почки

Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the literature review was to analyze the results of PCNL in patients with large stones in the solitary kidney. The literature search was conducted in databases Embase, Medline, Google Scholar, Scopus for the period from 2010 to 2019. A total 94 articles were selected, of which 16 papers were included in the review after analyzing the abstracts. Data was pooled and analyzed using SPSS Statistics 22.0. The primary stone-free rate for PCNL in these patients was 68.3+/-14.2%, and the final stone-free rate increased by 86.5+/-4.9%. The average duration of the operation was 86+/-25 (43.7-138.3) min, the length of stay was 5 (2-6) days. The baseline creatinine level was 137 (110-200) mmol/L, compared to 142 (122-183) mmol/L postoperatively. The mean difference between the baseline and postoperative Hb level was 7.8 (1.3-17.5) g/l. The estimated glomerular filtration rate (GFR) before PCNL was 62.3+/-7.5 ml/min/1.73 m2, and it did not exceed 62.5+/-9.3 ml/min/1.73 m2 postoperatively. The overall complication rate ranged from 10.6 to 68.8%, averaging 29.9%. In most cases, there were grade I and II complications, according to Clavien-Dindo classification, which didnt require additional interventions. PCNL is a highly effective treatment method for patients with large stones in solitary kidney. Complications rate is relatively low, which is achieved by an individual approach, with a consideration of the condition and all risk factors.

Hidden blood loss in direct anterior total hip arthroplasty: a prospective, double blind, randomized controlled trial on topical versus intravenous tranexamic acid.

Despite a plethora of literature reporting on the use of tranexamic acid (TXA) in total hip arthroplasty (THA), little is available on its effect on post-operative hidden blood loss and even less on its use in the direct anterior approach (DAA), which is gaining popularity. This study was designed as a prospective, double blind, single centre, randomized controlled trial. Sixty patients were allocated to intravenous administration of 1.5g of TXA just before wound closure while 60 patients were allocated to topical application of 3.0g of TXA via a subfascial drain at the end of the procedure. Post-operative blood loss was (1) calculated via a well-established formula based on pre- and post-operative Hb levels, patients characteristics and intra-operative blood loss and (2) measured via the amount that collected in the subfascial drain over time. No statistical significant difference in post-operative blood loss was found, neither when the formula was used (0.55L [topical] vs 0.67L [IV]; p = .140) nor when looking at the drain output (0.25L [topical] vs 0.29L [IV]; p = .108). No significant difference in secondary outcome measures, such as transfusion of units of packed red blood cells, length of hospital stay or the occurrence of venous thromboembolisms, could be found either. This study provides detailed insights into the intra- and post-operative blood loss in DAA THA and shows that topical and IV TXA have similar effects on hidden blood loss. Clinical Trial Number: NCT01940692. Level I-Randomized Controlled Trial.

Myomektomi uygulanan kadınlarda vücut kitle indeksi ile klinik parametreler arasındaki ilişkinin değerlendirilmesi

ABSTRACTAim: To evaluate the association between body mass ındex and clinical parameters in women underwent abdominal myomectomy by using correlation analysis. Material and Method: In this retrospective study a total of 273 women underwent abdominal myomectomy during the study period. The patients were classified into two groups according to BMI (≤30 kg/m2 and &amp;gt; 30 kg/m2). Risk factors recorded involved were; age, body mass index (BMI), gravidity, parity, diameter of the fibroid (DOF), preoperative and postoperative hemoglobin (hb) levels, white blood cell and trombocyte count, neutrophil-lymphocyte ratio (NLR), Ca125, Ca15-3, Ca19-9, CEA, AFP levels, duration of postoperative hospital stay and postoperative complications. Pearson correlation analysis was used to evaluate the association between body mass index and clinical parameters. Results: The obese group consisted of 64 patients and the nonobese group consisted of 209 patients. In obese group, DOF was larger postoperative hb was lower, length of hospital stay was longer, level of AFP and the presence of complications was higher than in nonobese group. According to the correlation analysis, there were positive correlation between BMI and DOF and AFP levels, while there were negative correlation between BMI and postoperative hb level and length of hospital stay. Conclusion: We think that obesity adversely affects the clinical outcomes of patients underwent abdominal myomectomy.

The efficacy and safety of tranexamic acid in the treatment of intertrochanteric fracture: an updated meta-analysis of 11 randomized controlled trials.

This meta-analysis was performed to investigate the efficacy and safety of tranexamic acid (TXA) in the elderly patients undergoing intertrochanteric fracture surgery from the current literatures. The electronic literature database of PubMed, Embase and Cochrane library were searched in October 2019. The intraoperative blood loss, hidden blood loss, postoperative drainage and total blood loss, postoperative hemoglobin, length of stay, transfusion rate, mortality rate, thromboembolic events and wound complications were extracted. Stata 14.0 software was used for our meta-analysis. A total of 11 RCTs (3 new RCTs in 2019) with 1202 patients met our inclusion criteria. This meta-analysis showed that administration of TXA can reduce intraoperative blood loss (P = 0.009), hidden blood loss (P = 0.000), total blood loss (P = 0.000), length of stay (P = 0.003), transfusion rate (P = 0.000) and the occurrence of wound complications (P = 0.006). Furthermore, administration of TXA was associated with an increase in the postoperative Hb level at day 1, 2 and 3 (P = 0.000, P = 0.000 and P = 0.000, respectively) after surgery. However, no significant difference was found between the TXA group and control group regarding the occurrence of thromboembolic events (P = 0.978, including deep vein thrombosis, P = 0.850; pulmonary embolism, P = 0.788; cerebrovascular accident, P = 0.549; myocardial infarction, P = 0.395) and mortality rate (P = 0. 338). Our meta-analysis suggested that administration of TXA is effective in reducing intraoperative blood loss, hidden blood loss, total blood loss, length of stay, transfusion rate, wound complications and enhancing postoperative Hb without increasing the risk of thromboembolic events and mortality rate in intertrochanteric fracture surgery. More large multi-center and high-quality RCTs are required for further research.