Postoperative Hemoglobin Levels Research Articles

The Lebanese percreta group: A retrospective cohort study of both radical and conservative management outcomes of abnormally invasive placenta.

The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon. We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death). The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively. Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed.

Impact of anemia on incidence of perioperative lower limb deep vein thrombosis in patients undergoing total hip arthroplasty

To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT ( P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT ( P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT ( P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT ( P<0.05). The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.

The Impact of Epidural Analgesia on Immobility and extended Hospital Stay After Periacetabular Osteotomy.

Early mobilisation after periacetabular osteotomy (PAO) represents an important goal after surgery. The purpose of this study was to determine whether the use of epidural aznalgesia (EA)is associated with prolonged immobility and an increased length of stay (LOS) after PAO surgery. From January 2022 to July 2023,the study included a cohort of 150 PAO procedures all performedby the same surgeon (SSA).Patients were categorized into two distinct groups: those who received epidural analgesia (EA) (79 PAOs) and those who did not receive EA (71 PAOs). "Ready for discharge" was defined as the ability to ascend and descend a standardized flight of stairs independently. Multivariable linear regression was used to identify additional factors influencing LOS after PAO. Patients in the EA group were ready for discharge 5.95 ± 2.09 days after surgery which was significantly longer than in the No EA group´saverage of 4.18 days ± 2.5, (p < 0.001). While the reduction in the number of patients experiencing pulmonary embolism in theNo EA group did not reach statistical significance, it still demonstrated a relevant decrease from two patients within the EA group (2.53%) to 0 (0%) in the No EA group. The active engagement of the surgeon in mobilising patients led to a substantial reduction in LOS, decreasingit from 5.81 ± 2.18 days to 2.2 ± 0.77 days (p < 0.001). Multivariable analysis revealed five independent factors influencing the LOS following PAO which included absence of EA, surgeon-led mobilisation within 24h after surgery, postoperative hemoglobin levels, BMI, and prior experience with PAO surgery on the contralateral side. Opting against the use of EA in patients undergoing PAO is advisable, as it will result in extended postoperative immobility and the associated risks. Additionally, the active participation of the surgeon in the mobilisation process is strongly recommended.

A comparative retrospective analysis on robot-assisted laparoscopic surgery compared to conventional laparoscopy in case of myomectomy: experience in a third-level hospital of Southern Italy.

Uterine myomas are the most common gynecological disease in reproductive-aged women, present several symptoms, and require effective medical and/or surgical strategies. This study aimed to compare robotic-assisted laparoscopic myomectomy (RALM) with laparoscopic myomectomy (LM) in terms of operative times, intraoperative estimated blood loss, pre- and post-hemoglobin levels drop, and length of hospital stay. Data from 50 clinical records (25 RALM in Group A and 25 LM in Group B) of patients with uterine fibroids were collected from December 2022 to December 2023 at Gynecological Unit of DAI Materno-Infantile Federico II in Naples, Italy. Patients aged 30-49years with symptomatic fibroids were included. Data on peri-operative outcomes, including operative time for myomectomy (OTM), overall operative time (OOT), intraoperative estimated blood loss (EBL), pre- and post-operative hemoglobin levels, and length of hospital stay were analyzed. The OTM in the presence of > 5 myomas was 59 [52-65] vs 69min [61-96] (p < 0.001) for RALM and LM groups, respectively. Moreover, also in presence of ≤ 5 myomas, a difference was observed in the RALM group 48[43-55] compared to the LM group 53[50-61] min (p = 0.07). The OOT was also statistically significant for Group A compared to Group B (83[65-93] vs 72[56-110] min, p < 0.001). There were no significant differences between the two groups in terms of pre- and post-operative hemoglobin levels and EBL (p = 0.178). Group A demonstrated a notably shorter hospital stay 1.2 [1-2] days compared to Group B 2.9[3-3.75] days (p = 0.007). Our study suggests potential advantages of RALM over LM in terms of reduced operative times and shorter hospital stays. The standardized approach and extensive surgical experience likely contributed to the favorable outcomes of RALM.

The Efficacy of Tranexamic Acid in Reducing Perioperative Drainage in Cardiac Surgery with Cardiopulmonary Bypass.

Although cardiopulmonary bypass procedures remain a critical treatment option for heart disease, they come with risks, including hemorrhage. Tranexamic acid is known to reduce morbidity and mortality in surgical hemorrhage. This study aimed to evaluate the efficacy of tranexamic acid, which is routinely used to treat hemorrhage, in decreasing the amount of intraoperative and postoperative drainage. A total of 80 patients who underwent cardiac surgery with cardiopulmonary bypass were included in this retrospective study. Forty patients who received tranexamic acid during the operation were assigned to Group 1, while 40 patients who did not receive tranexamic acid were assigned to Group 2. Patient data were collected from the hospital computer system and/or archive records after applying exclusion criteria, and the data were recorded. Statistical analyses were then performed to compare the data. Age, sex, height, weight, body surface area, flow, and ejection fraction percentages, preoperative hematological parameters, and intraoperative variables (except tranexamic acid) were similar between the groups (P>0.05). However, there were statistically significant differences between the groups in terms of intraoperative (through the heart-lung machine) and postoperative red blood cell transfusion rates, intraoperative and postoperative bleeding drainage amounts, as well as postoperative hematocrit, hemoglobin, platelet, and red blood cell levels (P<0.05). We concluded that intraoperative and postoperative use of tranexamic acid in patients who underwent coronary artery bypass grafting with cardiopulmonary bypass has positive effects on hematological parameters, reducing blood product use, and bleeding drainage amount.

Intra- and post-operative outcomes of the Enhanced Recovery after Surgery (ERAS) Program in laparoscopic hysterectomy.

To investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on perioperative and post-operative outcomes in laparoscopic hysterectomies (LHs) performed for benign gynecological diseases. This prospective study was conducted with randomized 100 participants who underwent LH between 1 January and 31 December, 2022. A standard care protocol was applied to 50 participants (Group 1, control) and the ERAS protocol to the other 50 (Group 2, study). Length of hospitalization was compared between the groups as the primary outcome, and the duration of the operation, the amount of bleeding, post-operative nausea-vomiting, gas discharge time, visual analog scale (VAS) pain scores, and complications as the secondary outcomes. No statistically significant difference was seen between the groups in terms of sociodemographic characteristics, medical history, operation indications, surgical procedures applied in addition to hysterectomy, operative time, pre-operative and post-operative hemoglobin levels, amount of bleeding, or drain use (p > 0.05). However, a statistically significant difference was observed in terms of nausea (60% vs. 26%, p = 0.001), vomiting (28% vs. 10%, p = 0.040), duration of gassing (17.74 ± 6.77 vs. 14.20 ± 7.05h, p = 0.012), length of hospitalization (41.78 ± 12.17 vs. 34.12 ± 10.90h, p = 0.001), analgesic requirements (4.62 ± 1.36 vs. 3.34 ± 1.27h, p < 0.001), or VAS scores at the 1st (5.86 ± 1.21 vs. 4.58 ± 1.31, p < 0.001), 6th (5.16 ± 1.12 vs. 4.04 ± 1.08, p < 0.001), 12th (4.72 ± 1.12 vs. 3.48 ± 1.12, p < 0.001), 18th (4.48 ± 1.21 vs. 3.24 ± 1.34, p < 0.001), and 24th (4.08 ± 1.29 vs. 3.01 ± 1.30, p < 0.001) hours. The findings of this study show that the ERAS protocol has a positive effect on peri- and post-operative outcomes in LH. Further prospective studies are now needed to confirm the validity of the results.

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Although major bleeding is among the most common and prognostically important perioperative complications, the relative timing of bleeding events is not well established. This information is critical for preventing bleeding complications and for informing the timing of pharmacologic thromboprophylaxis. To determine the timing of postoperative bleeding among patients undergoing surgery for up to 30 days after surgery. This is a secondary analysis of a prospective cohort study. Patients aged 45 years or older who underwent inpatient noncardiac surgery were recruited in 14 countries between 2007 and 2013, with follow-up until December 2014. Data analysis was performed from June to July 2023. Noncardiac surgery requiring overnight hospital admission. The primary outcome (postoperative major bleeding) was a composite of the timing of the following bleeding outcomes: (1) bleeding leading to transfusion, (2) bleeding leading to a postoperative hemoglobin level less than 7 g/dL, (3) bleeding leading to death, and (4) bleeding associated with reintervention. Each of the components of the composite primary outcome (1-4) and bleeding independently associated with mortality after noncardiac surgery, which was defined as a composite of outcomes 1 to 3, were secondary outcomes. Among 39 813 patients (median [IQR] age, 63.0 [54.8-72.5] years; 19 793 women [49.7%]), there were 5340 major bleeding events (primary outcome) in 4638 patients (11.6%) within the first 30 days after surgery. Of these events, 42.7% (95% CI, 40.9%-44.6%) occurred within 24 hours after surgery, 77.7% (95% CI, 75.8%-79.5%) by postoperative day 7, 88.3% (95% CI, 86.5%-90.2%) by postoperative day 14, and 94.6% (95% CI, 92.7%-96.5%) by postoperative day 21. Within 48 hours of surgery, 56.2% of major bleeding events, 56.2% of bleeding leading to transfusion, 56.1% of bleeding independently associated with mortality after noncardiac surgery, 51.8% of bleeding associated with hemoglobin less than 7 g/dL, and 51.8% of bleeding associated with reintervention had occurred. In this cohort study, of the major postoperative bleeding events in the first 30 days, more than three-quarters occurred during the first postoperative week. These findings are useful for researchers for the planning future clinical research and for clinicians in prevention of bleeding-related surgical complications and in decision-making regarding starting of pharmacologic thromboprophylaxis after surgery.

Postoperative haemoglobin and anaemia-associated ischaemic events after major noncardiac surgery: A sex-stratified cohort study

Study objectiveTo determine the sex-specific associations between postoperative haemoglobin and mortality or complications reflecting ischaemia or inadequate oxygen supply after major noncardiac surgery. DesignA retrospective cohort study with prospective validation. SettingA large university hospital health system in China. PatientsMen and women undergoing elective major noncardiac surgery. Interventions and measurementsThe primary exposure was nadir haemoglobin within 48 h after surgery. The outcome of interest was a composite of postoperative mortality or ischaemic events including myocardial injury, acute kidney injury and stroke within hospitalisation. Main resultsThe study included 26,049 patients (15,757 men and 10,292 women). Low postoperative haemoglobin was a strong predictor of the composite outcome in both sexes, with the risk progressively increasing as the nadir haemoglobin concentration dropped below 130 g l−1 in men and 120 g l−1 in women (adjusted odds ratio [OR] 1.43, 95% CI 1.37–1.50 in men, and OR 1.45, 95% CI 1.35–1.55 in women, per 10 g l−1 decrease in postoperative nadir haemoglobin). Above these sex-specific thresholds, the change of nadir haemoglobin was no longer associated with odds of the composite outcome in either men or women. There was no significant interaction between patient sex and the association between postoperative haemoglobin and the composite outcome (Pinteraction = 0.673). Validation in an external prospective cohort (n = 2120) with systematic postoperative troponin and creatinine measurement confirmed our findings. ConclusionsPostoperative haemoglobin levels following major noncardiac surgery were nonlinearly associated with ischaemic complications or mortality, without any clinically important interaction with patient sex.

Effect of Uterine Artery Clamping in Reducing Cesarean Hysterectomy in Pregnancies Complicated by Placenta Accrete Spectrum

Background and objective: The placenta accreta spectrum is a major public health problem. Many interventional measures are used for controlling hemorrhage and preventing emergency caesarean hysterectomy. The aim of this study was to evaluate the role of uterine artery clamping in reducing maternal morbidity and mortality in pregnancies complicated by placenta accrete spectrum. Methods: This is a retrospective case-control study implemented in the Sulaymaniyah Maternity Teaching Hospital in Sulaymaniyah city, Kurdistan region-Iraq through the period of 2 years from 1st of June 2020, to 31st of May, 2022. A sample of sixty pregnant women with placenta accreta spectrum surgically managed by elective cesarean section and divided into two study groups (32 women underwent elective cesarean section with uterine artery clamping [interventional group] and 28 women underwent elective cesarean section without uterine artery clamping [control group]). Results: The postoperative hemoglobin level was significantly higher in women of the interventional group with a mean of (10.1±0.7 gm/dL) compared to (9.3±1 gm/dL) in women of the control group. The mean of units of blood transfused was significantly lower in women of the interventional group with a mean of (1.3±0.6 units) compared to (3.1±1.4 units) in women of the control group. Also, there was a significant reduction in units of fresh frozen plasma in women of the interventional group with a mean of (0.9±0.6 units) compared to (2.9±1.5 units) in women of the control group. Conclusions: The uterine artery clamping before placental separation is helpful in reducing the rate of maternal morbidity and mortality in pregnancies complicated by placenta accreta spectrum.

Does Adenoid Hypertrophy Affect Hemoglobin and Erythropoietin Levels in Children?

Objective: Adenoid hypertrophy restricts the nasal airflow by obstructing the choanae posteriorly and may lead to chronic hypoxia. The present study mainly aims to compare pre- and postoperative erythropoietin (EPO) and hemoglobin (Hgb) levels in children undergoing adenoidectomy.&#x0D; Methods: Between 2021 September and 2022 August, 61 children who performed adenoidectomy in the ENT clinic included in this prospective clinical trial. The pre- and postoperative third months EPO and Hgb values of children were compared.&#x0D; Results: The mean age of the children undergoing adenoidectomy was 5.7±3.4 (range, 3-9 years). Twenty-seven of the subjects were men and 34 were women. The mean EPO values of the adenoid hypertrophy patients preoperatively and at postoperative third months were 13.7±2.4 Mu/mL and 10.8±1.6 Mu/mL, respectively. The decrease in mean EPO value was significant (p = 0.031). The mean Hgb levels of the subjects preoperatively and at postoperative 3rd months were 12.1±2.4 g/dL and 11.9±1.6 g/dL, respectively. When pre- and postoperative 3rd month mean Hgb values compared, the difference was not significant (p = 0.721). &#x0D; Conclusions: According to these outcomes, grade 4 adenoid hypertrophy is associated with significantly increased EPO values compared to post-operative values in children. To validate these results further prospective studies with larger sample sizes are required.

Comparison of blood loss between intra-articular microporous polysaccharide hemospheres powder and tranexamic acid following primary total knee arthroplasty

Total knee arthroplasty (TKA) is associated with substantial blood loss and tranexamic acid (TXA) effectively reduces postoperative bleeding. Although it is known that there is no difference between intravenous or intra-articular (IA) injection, the general interest is directed towards topical hemostatic agents regarding thromboembolic events in high-risk patients. This study aimed to compare the blood conservation effects of IA MPH powder and TXA in patients undergoing primary TKA. We retrospectively analyzed 103 patients who underwent primary TKA between June 2020 and December 2021. MPH powder was applied to the IA space before capsule closure (MPH group, n = 51). TXA (3 g) was injected via the drain after wound closure (TXA group, n = 52). All patients underwent drain clamping for three postoperative hours. The primary outcome was the drain output, and the secondary outcomes were the postoperative hemoglobin (Hb) levels during the hospitalization period and the perioperative blood transfusion rates. An independent Student’s t-test was used to determine differences between the two groups. The drain output in the first 24 h after surgery was significantly higher in the MPH group than in the TXA group. The postoperative Hb levels were significantly lower in the MPH group than in the TXA group. In patients with simultaneous bilateral TKA, there was a significant difference in the blood transfusion volumes and the rates between groups. It is considered that IA MPH powder cannot replace IA TXA because of an inferior efficacy in reducing blood loss and maintaining postoperative Hb levels in the early postoperative period after primary TKA. Moreover, in the case of simultaneous bilateral TKA, we do not recommend the use of IA MPH powder because it was notably less effective in the field of transfusion volume and rate.

MRI-based central sarcopenia negatively impacts the therapeutic effectiveness of single-segment lumbar fusion surgery in the elderly

Central sarcopenia is associated with the prognosis of various orthopedic surgeries in the elderly. This study aims to investigate its impact on the outcomes of single-segment lumbar fusion surgery in elderly patients. Retrospective analysis was conducted on 314 patients aged 60 to 80 who underwent single-segment posterior lumbar fusion surgery due to degenerative lumbar diseases. Patients were categorized into high psoas and L4 vertebral index (PLVI) and low PLVI groups according to the MRI-measured PLVI for central sarcopenia. Basic patient data, surgery-related parameters, functional assessments at preoperative and postoperative 3, 6, and 12 months, and X-ray-based fusion status were compared. The basic data of the two groups showed no significant differences. Parameters including the operative segment, preoperative hemoglobin levels, surgical duration, and intraoperative blood loss exhibited no significant variances. However, notable differences were observed in postoperative initial hemoglobin levels, transfusion requirements, and length of hospital stay between the two groups. During the postoperative follow-ups at 3, 6, and 12 months, the VAS scores for lower back pain and ODI scores in the lower PLVI group were significantly higher compared to the high PLVI group. Additionally, the EuroQoL 5D scores were notably lower in the low PLVI group. There were no significant differences between the groups in terms of leg pain VAS scores at each time point and the fusion status at 12 months postoperatively. MRI-based central sarcopenia has a negative impact on the therapeutic effectiveness following single-segment lumbar fusion surgery in elderly patients.

Surgical Strategies in Placenta Accreta Spectrum; A Quasi-experimental study

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

Oxytocin infusion is a safe uterine bleeding controller alternative to blood transfusion in patients undergoing abdominal myomectomy

Background &amp; objective: Uterine bleeding is a notable complication that can occur after the surgical removal of uterine fibroids, and oxytocin infusion has been a commonly used method to control blood loss in such cases. The objective of this study was to evaluate the effectiveness of oxytocin infusion in managing surgical bleeding following abdominal myomectomy, as an alternative to immediate blood transfusion.&#x0D; Methodology: The study population consisted of 120 patients who experienced acute blood loss following abdominal myomectomy. These patients were divided into two groups: Group A, which included 50 patients who received an oxytocin infusion, and Group B, which included 60 patients who received a placebo. All myomectomies were conducted according to department protocols, and various variables related to the study were recorded. Postoperative hemoglobin levels were checked in every patient.&#x0D; Results: In Group A, the average blood loss was 470.02 ± 81.65 ml, while in Group B, it was 721.42 ml ± 63.55 ml (P &lt; 0.0001). The need for urgent blood transfusion was significantly lower in Group A (3.3%) compared to Group B (20.0%), (P = 0.044). Postoperative hemoglobin levels also showed a significant difference between the two groups, with Group A demonstrating better results than Group B.&#x0D; Conclusion: Oxytocin infusion can be safely used for managing blood loss in patients undergoing abdominal myomectomy. However, in cases where oxytocin is unable to effectively control the bleeding, blood transfusion may be needed as a means to compensate for the blood loss.&#x0D; Key Words: Uterine leiomyomas; Myomectomy; Surgical blood loss; Oxytocin&#x0D; Citation: Nasief H, Hassan A, AlDardeir N, Khadawardi K, Alwazzan AB, Alothmani H, Hammad Z. Oxytocin infusion is a safe uterine bleeding controller alternative to blood transfusion in patients undergoing abdominal myomectomy. Anaesth. pain intensive care 2024;28(1):05−09; DOI: 10.35975/apic.v28i1.2298&#x0D; Received: October 05, 2023; Reviewed: October 17, 2023; Accepted: November 19, 2023

Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures.

Sterile inflammation is a natural response of the organism in the absence of microorganisms, which is triggered in correspondence with the degree of tissue damage sustained after a surgical procedure. The objective of this study was to explore the values of postoperative hematological-derived biomarkers in assessing the sterile inflammatory response magnitude related to the invasiveness of the surgical reduction technique used for subtrochanteric fractures (STFs) treatment. A retrospective, observational cohort research was conducted between January 2021 and October 2023 that included a total of 143 patients diagnosed with acute subtrochanteric fractures who underwent long Gamma Nail (LGN) fixation. According to the surgical reduction technique used, they were divided into two groups: group 1, which consisted of those with a closed reduction and internal fixation (CRIF); and group 2, which consisted of those with an open reduction internal fixation (ORIF). Between groups, statistically significant differences (p < 0.05) were found in relation to days to surgery, length of hospital stay (LOHS), duration of surgery, postoperative hemoglobin (HGB) levels, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The receiver operating characteristics (ROC) curve analysis revealed that all ratios presented a high diagnostic ability (p < 0.0001) with NLR > 6.95 being the most reliable (sensitivity 94.8% and specificity 70.6%). Moreover, the multivariate regression model confirmed that sterile immune response after orthopedic interventions can be assessed in an almost equal and non-dependent manner using these biomarkers. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated to the sterile inflammatory response magnitude, due to the extent of surgical dissection performed during internal fixation procedures of subtrochanteric femur fractures.

Assessment of Blood Loss during Neuroendovascular Procedures

(1) Background: Neuroendovascular procedures have generally been considered to have minor or inconsequential blood loss. No study, however, has investigated this question. The purpose of this study is to quantify the blood loss associated with neuroendovascular procedures and identify predictors of blood loss, using hemoglobin change as a surrogate for blood loss. (2) Methods: A retrospective review of 200 consecutive endovascular procedures (diagnostic and therapeutic) at our institution from January 2020 to October 2020 was performed. Patients had to have pre- and post-operative hematocrit and hemoglobin levels recorded within 48 h of the procedure (with no intervening surgeries) for inclusion. (3) Results: The mean age of our cohort was 60.1 years and the male representation was 52.5%. The mean pre-operative hemoglobin/hematocrit was significantly lower among females compared to males (12.1/36.2 vs. 13.0/38.5, p = 0.003, p = 0.009). The mean hemoglobin decrease was 0.5 g/dL for diagnostic angiograms compared to 1.2 g/dL for endovascular interventions (p &lt; 0.0001), and 1.0 g/dL for all procedures combined. In a multivariate linear regression analysis, pre-operative antiplatelet/anticoagulant use was associated with a statistically significant decrease in hemoglobin. (4) Conclusions: Our data support that blood loss from diagnostic angiograms is marginal. Blood loss in endovascular interventions, however, tends to be higher. Pre-operative blood antiplatelet/anticoagulant use and increasing age appear to increase bleeding risk and may require closer patient monitoring.

Is prophylactic intraoperative transfusion needed in unilateral total knee arthroplasty? Comparison of hematologic data and postoperative transfusion rate between a prophylactic allogenic or autologous transfusion group with a no-transfusion group: A preliminary retrospective cohort study

ObjectivesTo determine whether prophylactic intra-operative allogenic or autologous transfusion could prevent postoperative anemia and additional transfusion comparing to the control group without receiving any prophylactic intervention in unilateral total knee arthroplasty. Materials and methodsThis study included 711 patients who underwent unilateral TKA. They were divided into four groups: allogeneic transfusion group (group AL), autologous transfusion group (group AT), tranexamic acid group (group TA), and control group (group C). The primary outcome was rate of postoperative allogeneic blood transfusions. Secondary outcomes were postoperative hemoglobin and hematocrit levels, postoperative bleeding amount. ResultsGroups AT and AL did not exhibit a significant reduction in postoperative allogenic blood transfusion rate compared to group C (28/108 vs. 20/108, p = 0.21 and 37/159 vs. 34/159, p = 0.78 respectively). However, group TA demonstrated a significantly lower rate of postoperative allogenic blood transfusions than group C (22/125 vs. 3/125, p = 0.0001). Postoperative hemoglobin and hematocrit levels were statistically higher in group TA than in group C. However, those levels in group AT and AL did not differ significantly from those of group C. ConclusionIntra-operative prophylactic transfusions did not decrease postoperative anemia or additional postoperative transfusion compared to the control group in patients undergoing total knee arthroplasty. However, the group receiving tranexamic acid showed lower transfusion rate and higher levels of hemoglobin and hematocrit.

Сравнительный анализ влияния общей и спинальной анестезии на акушерские исходы при плановом кесаревом сечении

Objective. To determine which type of anesthesia, general or spinal, causes less amount of blood loss in elective cesarean section. Patients and methods. An observational randomized controlled study including 300 women was conducted at the Al-Zahraa University Maternity Hospital. Two patient groups were identified: group G (general anesthesia) (n = 150) and group S (spinal anesthesia) (n = 150). All patients underwent elective cesarean section with identical operative steps by the same surgeon. Anesthesia, general or spinal, was standard. Data were collected, including age, parity, pre- and postoperative heart rate and blood pressure, pre- and postoperative complete blood count (on day 3), type of anesthesia, duration of surgery, complications (atonic postpartum hemorrhage, uterine extension), postoperative urinary output, need for blood transfusion, fainting and headache attacks, time to breastfeeding, ambulation, and passing flatus. Data on postoperative analgesia were also obtained, including time to first analgesic request and number of doses taken. The amount of intraoperative blood loss was estimated using the acute normovolemic hemodilution technique. Results. When using changes in hemoglobin levels to estimate blood loss, group S showed statistically significantly less blood loss than group G, with a mean difference of 103.7 mL (p &lt; 0.05). When using hematocrit levels, group S showed statistically significantly less blood loss than group G, with a mean difference of 114 mL (p &lt; 0.05). Headache attacks were more frequent in group S (78) than in group G (19) (p &lt; 0.05). Group S started breastfeeding 5 hours earlier than group G (p &lt; 0.05). Group S started postoperative ambulation 4 hours earlier than group G (p &lt; 0.05). There were no statistically significant differences between both groups regarding time to first analgesic request, heart rate, blood pressure, urinary output, and fainting attacks in the postoperative period. Conclusion. Spinal anesthesia has certain advantages over general anesthesia: higher postoperative hemoglobin and hematocrit levels, less intraoperative blood loss, less postoperative pain, less need for analgesia, earlier ambulation, and earlier initiation of breastfeeding. Key words: spinal anesthesia, general anesthesia, cesarean section

The Impact of Total Synovectomy on Blood Loss and Knee Function. A Prospective Randomized Study

"Synovial proliferation is a common intraoperative finding during total knee arthroplasty (TKA) and many studies have proposed synovectomy for the reduction of postoperative pain. We included 180 patients that were split into two groups, one which received a total synovectomy (TS) and the other with partial synovectomy (PS). We measured the amount of intra- and post-operative bleeding as well as perceived pain (using the Visual Analogue Scale) and knee function (using the Knee Society Knee Score) at 4 and 12 weeks. The blood loss during the surgical procedure was 367.77 ± 115.71 mL for TS, while the other group recorded 295.55 ± 106.17 mL (p &lt; 0.05). Regarding postoperative bleeding, the TS group aspirated 533.77 ± 281.65 mL, which was significantly higher than the PS group (404.44 ± 211.55 mL, p &lt; 0.05). No significant differences were recorded between the TS and PS groups regarding pain and knee function at 12 weeks. Total synovectomy demonstrated significantly higher blood loss and lower postoperative hemoglobin levels, even though knee function and pain level did not show improvements. We consider that the decision of performing synovectomy should rely on the clinical indication and, if conditions allow for it, a limited resection should be attempted."

A Comparison of the Asleep-Awake Technique and Monitored Anesthesia Care During Awake Craniotomy: A 10-Year Analysis.

Background Awake intracranial surgery with direct electrical stimulation (DES)is considered the gold standard for the resection of tumors affecting the eloquent areas of the brain. Awake craniotomy is a challenge for the anesthesiologist, as the patient's active cooperation is required throughout the operation. There are two frequent techniques, one is asleep-awake-asleep (AAA), and the other is called monitored anesthesia care (MAC). The AAA technique is the longer standing of the two and comprises general anesthesia followed by intraoperative awakening, which is necessary for neurological monitoring. In the present study, a comparison was made between the asleep-awake (AA) technique, a variation of the AAA anesthesia technique, and the MAC, which consists of a sedation that makes it possible to control pain and anxiety. Unlike the AA technique, the MAC does not involve the use of invasive airway devices. Objective The main objective was to contrast the two anesthetic management techniques for awake brain surgery used in our hospital. Methods A retrospective observational single-center study was performed consisting of a review of patient clinical records. The study sample comprised all patients above 18 years of age undergoing brain surgery through awake craniotomy between January 2013 and December 2022 at the Miguel Servet University Hospital (HUMS) in Zaragoza (Spain). Results Of the 79 patients included in the study, 39 were operated under AA anesthesia while the remaining 40 were operated under the MAC procedure. The main age of the participants was 52.8 years, the mean height was 169 cm, andthe mean weight was 74.2 kg.No statistically significant differences were observed with respect to the patients' baseline characteristics, except for obesity which was more prevalent in the MAC group.In the MAC group, the airway was managed by means of nasal cannulas in all cases, with conversion to general anesthesia being required in only one instance. In the AA group, thelaryngeal mask (LM) was used in 89.7% of the patients, and the endotracheal tube (ETT) in 10.3%. The surgical and anesthetic procedure duration was 15 and 20 minutes shorter in the MAC group, respectively. A reduction of almost 20 minutes in the anesthetic procedure and 15 minutes in the surgical one was observed.Tachycardia, desaturation, and airway complications were observed in four, five, and four patients respectively in the AA group but in none of the patients in the MAC group. The mean stay in the intensive care unit (ICU) and the mean postoperative hemoglobin levels between both groups were insignificant. Conclusions Both techniques analyzed in this study turned out to be equally safe and effective for brain tumor surgery in awake patients.