Postoperative Hemoglobin Research Articles

Goal-directed fluid therapy guided by Plethysmographic Variability Index (PVI) versus conventional liberal fluid administration in children during elective abdominal surgery: A randomized controlled trial

BackgroundPVI has been shown to be an accurate predictor of fluid responsiveness in paediatric patients. Evidence regarding the role of PVI to guide intraoperative fluid therapy in paediatric abdominal surgery is lacking. We aimed to assess the effect of PVI-guided fluid therapy on the volume of intraoperative fluids administered and post-operative biochemical and recovery profile in children undergoing elective abdominal surgery. Methods42 children, 6 months-3 years scheduled for elective open bowel surgery were randomised to receive either ‘conventional liberal intraoperative fluids’ (liberal group) or ‘goal-directed intraoperative fluids’ (GDT group). PVI <13 was targeted in the GDT group. The primary outcome was the volume of intraoperative fluids administered. Postoperative serum lactate, base excess, hematocrit, recovery of bowel function and duration of postoperative hospital stay were the secondary outcomes. ResultsThe mean fluid administered intra-operatively was significantly lower in the GDT group as compared to the liberal group (24.1 ± 9.6 mL/kg vs 37.0 ± 8.9 mL/kg, p < 0.001). The postoperative hemoglobin concentration (g%) was significantly lower in the liberal group as compared to the GDT group (8.1 ± 1.3 vs 9.2 ± 1.4, p = 0.008). Recovery of bowel function (hours) was significantly delayed in the liberal group as compared to the GDT group (58.2 ± 17.9 vs 36.5 ± 14.1, p < 0.001). ConclusionIntraoperative PVI-guided fluid therapy significantly reduces the volume of intravenous crystalloids administered to children undergoing open bowel surgery. These children also had faster recovery of bowel function and less hemodilution in the immediate postoperative period, compared to those who received liberal intraoperative fluid therapy.Type of study: Randomized Clinical Trial.Level of evidence: Treatment Study (LEVEL 1).

Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis.

Anemia is one of the most common complications after hip fracture surgery. Tranexamic acid (TXA) has been considered effective in preventing anemia in total hip arthroplasty, but its role in hemiarthroplasty is debated. The aim of this systematic review was to investigate the efficacy and safety of perioperative TXA for hip hemiarthroplasty. A systematic literature search was performed to identify studies comparing adult patients who underwent hemiarthroplasty for a hip fracture with and without perioperative TXA. The primary outcome was transfusion rate. Secondary outcomes included postoperative hemoglobin, length of hospital stay, adverse events (i.e., deep venous thromboses and pulmonary embolism), and 30-day mortality. In total, 13 articles were included, comprising 54,843 patients of whom 14.1% received perioperative TXA. TXA was applied intravenous in ten studies, topical in two studies, one study investigated both. Pooled results showed a significant reduction in transfusion rate (pooled RR: 0.48, 95% CI 0.40-0.58, p < 0.01). Postoperative hemoglobin and length of stay were investigated in nine studies, pooled results showed significant improvement of both outcomes for patients that received TXA. Eleven studies investigated thromboembolic events, and there was no statistical difference in deep venous thromboses (pooled RR: 0.67, 95% CI 0.18-2.56, p = 0.56) or pulmonary embolism (pooled RR: 1.10, 95% CI 0.45-2.68, p = 0.83)among the two groups. There was a significant reduction in 30-day mortality for patients that received TXA. TXA can be considered effective and safe forpatients undergoing hip hemiarthroplasty, with a reduction in transfusion rate and increase in postoperative hemoglobin, without increasing adverse events. Optimal timing, dosage, and type of administration of TXA remain unclear.

Preoperative administration of local infiltration anaesthesia decreases perioperative blood loss during total knee arthroplasty – a randomised controlled trial

PurposeLocal infiltration anaesthesia (LIA) consisting of ropivacaine, epinephrine and ketorolac administered at the end of surgery has become the gold standard for postoperative analgesia as it provides improved postoperative pain relief compared to other methods. The use of LIA has retrospectively been shown to be associated with decreased perioperative blood loss. However, no randomised controlled trials have examined the effect of of preoperative LIA on blood loss. This study aimed to compare pre- vs perioperative LIA during TKA surgery, with a primary outcome of perioperative blood loss.MethodsThe present study was performed as a prospective single-center randomised controlled trial. A total of 100 patients undergoing primary TKA between October 2016 and March 2018 were randomised to receive either pre- or perioperative LIA. Perioperative blood loss was measured, as well as pre- and postoperative haemoglobin levels. Postoperative pain was estimated at intervals approximately 24, 48 and 72 hours after surgery; analgesic drug consumption was recorded for each patient, as well as the total length of stay as an in-patient.ResultsNinety six patients received either pre- or perioperative LIA as part of the intervention and control group respectively. Average blood loss was 39% lower in the intervention group at 130 ml vs 212 ml in the control group (p=0.002). No significant difference in haemoglobin drop, postoperative pain or length of hospital stay was found.ConclusionsPreoperative LIA resulted in a 39% decrease in perioperative blood loss during TKA surgery compared to perioperative administration while providing non-inferior postoperative pain relief.

OGC P09 Optimising the management of perioperative anaemia in patients with oesophagogastric cancer

Abstract Background Patients with oesophagogastric malignancy are predisposed to anaemia due to iron deficiency from chronic luminal blood loss. In the pre and post-operative periods, anaemia is associated with increased morbidity and mortality, principally through an increased blood transfusion (BTF) requirement. Anaemia of iron deficiency can be treated with oral or parenteral iron therapy. Newer preparations of parenteral iron therapy have lower rates of complications and are increasingly available. This study explored the effects of an anaemia management pathway on the detection and treatment of perioperative anaemia, as well as the post-operative course of patients undergoing staging and surgical resection of oesophagogastric malignancy. The impact of different forms of iron therapy was also examined. Methods A retrospective analysis was performed of patients undergoing resection of oesophageal, oesophagogastric or gastric malignancies between 12/11/2014 and 31/12/2021 at a tertiary oesophagogastric malignancy centre. A structured pathway for the management of perioperative anaemia was introduced on 1/4/2019 and patients were split into those receiving treatment on the anaemia management pathway compared to historical controls receiving standard treatment before this point. Clinicopathological variables were recorded from the hospital system tracking the haemoglobin (Hb) from diagnosis, through to the day of surgery and in the postoperative period. Other variables identified included iron therapy in the pre or postoperative period, blood transfusion rates, length of stay data and survival as of 01/03/2022. Anaemia was defined using both strict anaemia (Hb &amp;lt; 100g/L) and WHO anaemia (Hb &amp;lt; 120g/L for females and Hb &amp;lt; 130g/L for males) criteria. All analyses and statistical tests were conducted using R software. Results There were 171 patients treated under the new anaemia management pathway, and 343 historical controls receiving standard management. The overall prevalence of anaemia at the point of diagnosis was 33.7% using WHO criteria. Anaemia was more prevalent in patients with gastric malignancies (49%) than those with oesophageal malignancies (19%, p= 0.008) or OGJ malignancies (32%, p=0.017). Following the introduction of the anaemia management pathway, the blood transfusion (BTF) rates and the average length of stay did not change. The proportion of patients with WHO defined anaemia receiving IV iron therapy increased from 0.3% to 18% in the pre-operative period (p &amp;lt; 0.001), and from 2% to 39% in the post-operative period (p &amp;lt; 0.001). In the postoperative period, in-patient IV iron was more effective than oral (p &amp;lt; 0.001) or no iron treatment (p &amp;lt; 0.001) in improving haemoglobin post-operatively at a 6-week follow-up. Conclusions Anaemia is common in patients with oesophagogastric malignancy and patients with gastric cancer were more likely to be anaemic than other patient groups. The introduction of a perioperative anaemia management pathway can improve the use of iron therapy for anaemic patients, but we did not detect a difference in postoperative blood transfusions. IV iron treatment is significantly better than oral or no iron treatment in improving postoperative haemoglobin. IV iron should therefore be incorporated into post-operative management guidelines for post-operative anaemia and used preferentially to oral iron. Further studies should look to prospectively characterise the impacts of iron treatment and explore further variables such as quality of life in the postoperative period.

S61 Postoperative Ustekinumab Drug Levels and Disease Activity in Patients With Crohn’s Disease

Background: Ustekinumab is a biologic that targets and blocks the IL-12 and IL-23 receptors and effectively reduces clinical and endoscopic activity of Crohn’s Disease (CD) (1-3). Despite advances in CD treatment, including novel biologic therapies, surgical intervention is still common (4). Preventing postoperative recurrence of disease is critical to avoid subsequent procedures as these operations are expensive and invasive with risk for complications. Studies have previously evaluated for the association of postoperative drug levels, specifically of tumor necrosis factor inhibitors in relation to endoscopic disease recurrence (5-6). However, no study has been conducted to explore the association between postoperative ustekinumab levels and both endoscopic and clinical CD activity. Methods: This was a retrospective study of CD patients from a tertiary referral center that had an ustekinumab level taken postoperatively. Thirty-two total patients were identified. Ustekinumab drug levels were taken within 2 years postoperatively. Harvey-bradshaw index (HBI) was used to evaluate clinical disease activity and a combination of Rutgeerts’ and simple endoscopic score (SES) for Crohn’s Disease was used for endoscopic activity. Values for labs, clinical scores, and endoscopic scores were taken closest to surgery preoperatively with at least a one-month delay after surgery for postoperative values. Delta was the numeric difference between pre and postoperative measurements. Surgical procedures included small or large bowel resection, proctectomy, and fistulectomy. Patients were separated into groups depending on if their ustekinumab level was adequate, defined as greater than or equal to 4 μg/mL, or suboptimal, defined as below 4 μg/mL. All statistics were completed using built-in Excel functions for linear regression, linear correlation, and one-tailed t-test for unequal variance. P values of <0.05 and correlations above 0.8 were considered significant. Results: Average time drug levels taken postoperatively was 257 days. Postoperative hemoglobin levels were significantly higher in the adequate level group, 13.3 g/dL compared to 12.0 g/dL (P = 0.028). Hematocrit levels were also higher in the adequate ustekinumab level group, 40.5 versus 37.1 (P = 0.027). Clinically, patients with adequate ustekinumab levels had a greater change of their HBI score compared to preoperatively, delta HBI of -3 compared to 0.4 (P = 0.046). Only the suboptimal group showed a significant average decrease in endoscopic disease activity preoperatively to postoperatively, 85.7% to 37.5% (P = 0.029). No significant linear correlations were observed when comparing ustekinumab level to postoperative lab values, clinical scores, and endoscopic scores or their deltas. Conclusion(s): Adequate levels of ustekinumab yielded higher postoperative hemoglobin and hematocrit levels in addition to a greater reduction in HBI score. Only the suboptimal ustekinumab level group showed a significant reduction in average endoscopic disease activity compared to preoperative scores, which is consistent with findings that HBI does not necessarily correlate to endoscopic disease activity. The data suggests that adequate ustekinumab levels following CD surgery reduces the risk of anemia postoperatively and results in better clinical CD remission (HBI < 5) and response (delta HBI >=3). Future studies are needed to find the optimal ustekinumab levels both pre and postoperatively in order to maintain CD remission.

The use of an ultrasonic curettage device in orthognathic surgery decreases surgery-related blood loss

ObjectiveThis study aimed to compare the use of a powered instrument (PI) and ultrasonic curettage device (ULCD) with intraoperative blood loss (IOBL), drain volume (DV), calculated blood loss (CBL), and hidden blood loss (HBL) in orthognathic surgery. MethodsWe included 163 patients who underwent bimaxillary surgery in our department. CBL was calculated from the preoperative and postoperative hemoglobin levels using the “hemoglobin balance method.” CBL is an indicator of the amount of perioperative blood loss. HBL was calculated by subtracting IOBL and DV from CBL. ResultsThe PI group consisted of 61 patients (17 males and 44 females, age: 24.9 ± 9.5 years), and the ULCD group consisted of 102 patients (40 males and 62 females, age: 23.1 ± 7.8 years). In the PI group, the median IOBL, DV, CBL, and HBL were 540.0 (interquartile range [IQR] 380.0–670.0), 113.0 (IQR 77.0–147.0), 1000.0 (IQR 751.4–1248.6), and 285.8 (IQR 151.0–476.4) ml, respectively. In the ULCD group, the median IOBL, DV, CBL, and HBL were 327.5 (IQR 200.0–455.0), 105.5 (IQR 75.3–136.0), 759.5 (IQR 594.9–944.2), and 294.2 (IQR 120.8–456.9) ml, respectively. IOBL and CBL were significantly reduced with ULCD use, but no significant differences were observed in DV and HBL. ConclusionsThis study showed that IOBL decreased with ULCD use, resulting in a decrease in CBL. Conversely, bleeding parameters (DV and HBL), which reflect the amount of bleeding that occurs after wound closure, did not show a decrease with ULCD use.

Benign Over Tümörlerinde Laparoskopi ve Laparotomi Sonuçlarının Karşılaştırılması

Abstract&#x0D; Objectives: To present the data generated at our hospital by comparing the operative characteristics and surgical results of patients who applied to the clinic and emergency room due to ovarian cyst and underwent laparoscopy or laparotomy.&#x0D; Materials and Methods: In this retrospective study, patients who underwent cystectomy, oophorectomy, and hysterectomy salpingo-oophorectomy due to ovarian cysts were compared in two groups, comprising laparoscopy and laparotomy. Evaluated retrospectively in this study were 443 patients operated on due to benign ovarian cyst diagnosis. Data in the patient files were analyzed in terms of age, cyst size, postoperative hemoglobin, postoperative white blood cell count, operating time, hospital stay, and surgical site infection.&#x0D; Results: Postoperative surgical site infection was significantly higher in the laparotomy group. The risk of surgical site infection was RR= 4. 5 (1.74–11.67) times higher in those who underwent laparotomy when compared to laparoscopy. The duration of hospital stay was lower in the laparoscopy group for all operation types (oophorectomy, cystectomy, and hysterectomy salpingo-oophorectomy). The cyst sizes of the patients who underwent hysterectomy salpingo-oophorectomy were significantly more significant in the laparotomy group. The duration of hospital stay in the patients who underwent hysterectomy salpingo-oophorectomy was significantly longer when compared to the laparoscopy group, while no significant difference was found in the oophorectomy and cystectomy patients. The need for blood transfusion was significantly lower in the laparoscopy group for all operation types.&#x0D; Conclusions: It was concluded that the duration of hospital stay, surgical site infection, need for blood transfusion, and operating time was less in patients who underwent laparoscopy. Laparoscopic surgery methods can be safely recommended for rapid and effective treatment of benign ovarian cysts with cystectomy, oophorectomy, and laparoscopic hysterectomy about hospital stay and complications.

The impact of early mobility on functional recovery after hip fracture surgery

Purpose To examine the effect of early mobility (EM) on functional recovery after hip fracture surgery, and to investigate the potential factors that delay mobility. Methods In this retrospective observational study, 110 hip fracture patients were divided into two groups according to the days between surgery and mobility referred to as the EM and the delayed mobility groups. Demographic data, perioperative data, functional outcomes, and discharge destination were compared statistically between the groups using univariate analysis and logistic regression analysis. As a sensitivity analysis, the factors associated with the timing of physiotherapy were also assessed. Results The EM group had significantly better walking ability and Barthel index (p < 0.05), and home discharge rate (p = 0.004). The factors associated with delayed mobility (odds ratio; 95% confidence interval) were delayed postoperative physiotherapy initiation (3.59; 1.76–7.33), days from admission to surgery (1.23; 1.04–1.46), and postoperative CRP (1.14; 1.01–1.29) and hemoglobin level (0.72; 0.54–0.96). Furthermore, patients who received surgery on the day before any holiday were significantly delayed in physiotherapy intervention (p = 0.006). Conclusions This study demonstrated that EM after hip fracture surgery was associated with improving functional recovery and home discharge rate, and early physiotherapy intervention was associated with EM.

Safety and efficacy of two ilioiliac tension band plates osteosynthesis of fragility fractures of the pelvis

The study retrospectively determined the efficacy and safety of fixation of the pelvis (FFP) fragility fractures type IV using two tension band ilioiliac locking compression plates. Forty-one patients with FFP were treated in 2017–2020. 16 patients with FFP type IV, unable to walk weight-bearing, were treated by fixation using two tension band ilioiliac locking compression plates without fixing the anterior ring. Preoperatively and one year postoperatively, the functional outcome and performance were assessed using Pelvic Discomfort Index (PDI) and Timed Up and Go (TUG) test. Pre- and postoperative hemoglobin level was evaluated. Operation time and intra-and postoperative complications were documented. One year postoperatively, an X-ray was taken. The arithmetic mean (x) and standard deviations (±) of quantitative variables were calculated. T-test for dependent samples was used for pre-and postoperative results comparison. The PDI improved (p < 0.001) from x = 81.42 ± 4.04 to x = 36.19 ± 15.58. Preoperatively none of the patients was able to perform the TUG test. Postoperatively, the result exceeded x = 13.13 ± 3.99 s. The operation lasted x = 42.80 ± 8.90 min. Hemoglobin decreased (p < 0.001) from 11.63 ± 1.11 to 9.07 ± 1.21 g/dL. No complications nor fixation loosening were noted. The study support fixation using two tension band ilioiliac locking compression plates as an efficient and safe treatment of the FFP type IV.

Safety and Efficacy of Tranexamic Acid in Hip Hemiarthroplasty for Fracture Neck Femur: a Systematic Review and Meta-analysis.

Although numerous systematic reviews and meta-analyses have established the efficacy of tranexamic acid (TXA) in hip fracture surgeries, the included studies in those reviews have included all types of surgical interventions ranging from fixation to arthroplasty. Hip hemiarthroplasty is usually indicated in the elderly patients with femoral neck fracture and these patients have associated severe comorbidities and cognitive impairment. These subsets of patients with femoral neck fracture needs appropriate perioperative care and judicious use of antifibrinolytics. There is no meta-analysis evaluating the safety and efficacy of intravenous TXA in these patients. Searches of PubMed, Embase and Cochrane Central Register of Controlled Trials databases revealed 102 studies on TXA in hip fracture surgeries. After screening, eight studies were found to be suitable for review. The primary objective of this meta-analysis was to compare blood transfusion rate between TXA vs. control in hip hemiarthroplasty. The secondary objectives were total blood loss, postoperative haemoglobin, surgical duration, length of hospital stay and side effects (VTE, readmission and 30 days mortality). There were one RCT, one prospective cohort study and six retrospective studies. All studies recruited the elderly patients. Intravenous (IV) TXA administration resulted in significant reduction in requirement of blood transfusion (12.7% vs. 31.9%; OR 0.28; 95% CI 0.17-0.46; p < 00,001; I 2 = 73%). The TXA group had significantly decreased total blood loss (MD -100.31; 95% CI -153.79, -46.83; p < 0.0002). The postoperative Hb in the TXA group was significantly higher than the control group (MD 0.53; 95% CI 0.35, 0.71; p < 0.00001). There was no significant difference in the incidences of VTE (0.97% vs. 0.73%, OR 1.27; p = 0.81; I 2 = 64%) and readmission rate (9.2% vs. 9.64%; OR 0.79; p = 0.54), but 30-d mortality rate was significantly lower in the TXA group (3.41% vs. 6.04%; OR 0.66; p = 0.03). Intravenous TXA is efficacious in the reduction of blood loss and transfusion need in hip hemiarthroplasty surgery for hip fracture, without increased risk of VTE. The blood conservation protocol led to decreased 30 days mortality in these fragile elderly patients. III.

Investigation of clinical efficacy and safety of a new herbal “Algan Hemostatic AgentTM” in lumbar disc herniation operations

Aim. ALGAN Hemostatic Agent (AHA) is obtained with a standard mixture of 6 different herbs. It is a polysaccharide based hemostatic agent. The purpose of this study is to determine the clinical efficacy and reliability of AHA as a local hemostatic agent in lumbar disc herniation operations. Materials and Methods. In the study, the hemostatic efficacy of the product was observed on 28 volunteers underwent lumbar disc herniation surgery. In the treatment and control groups (14 patients each), operation times, bleeding stop times, pre- and postoperative hematocrit values (amount of blood loss), duration of hospital stay, and need for cautery use were compared. Traditional methods (cautery, ligation, etc.), which are used as a hemostatic in the operation, were always ready to be used effectively. The AHA application took 120 seconds. Results. While there was no difference between the groups in terms of preoperative hemoglobin and hematocrit values, postoperative hemoglobin and hematocrit values were statistically significant (p=0.033, 0.043). The amount of cautery use decreased significantly in the treatment group and the result was found to be statistically significant (p=.0.001). There was no significant difference in blood transfusion and mean operation times. Conclusions. AHA has been shown to be both effective in controlling bleeding and safe, so it can be used as an auxiliary product in capillary bleeding control in lumbar disc operations.

Short and long-term outcomes after cardiac surgery in Jehovah's Witnesses patients: a case-control study.

Cardiac surgery in Jehovah's Witnesses (JW) patients who refuse blood transfusion is challenging requiring dedicated strategies. We aimed to analyze non-selected JW patients undergoing cardiac surgery and to compare with matched controls both perioperative outcomes and long-term survival. We retrospectively analyzed JW patients undergoing cardiac surgery from January 2016 to March 2021 and compared them with matched controls. The primary outcome was a composite of in-hospital perioperative adverse events and in-hospital mortality. The secondary outcome was all-cause mortality at long-term follow-up. A total of 113 JW patients and 113 controls were included. Baseline clinical characteristics, including laboratory parameters were comparable. Overall, there were no statistical differences between JW vs controls in terms of in-hospital mortality (2.7% vs 1.8%, p = 1.00) but mortality was remarkably high (40%) in JW patients with post-op hemoglobin < 8g/dl. Logistic regression analysis found that the JW group was not associated with a higher occurrence of the composite outcome (adjusted odds ratio 0.91, 95% confidence interval [CI] 0.54-1.57). After a median follow-up of 1397 [IQR 922.7-1723.5] days, JW patients were not associated with a significantly higher all-cause mortality (adjusted hazard ratio 0.77, 95% CI 0.24-2.42). Cardiac surgery can be safely performed in non-anemic JW patients despite the refusal of blood transfusions. Favorable clinical outcomes can be achieved by the use of specific perioperative strategies for bloodless surgery with no differences as compared to control patients except in JW patients with a very low level of post-operative hemoglobin not supported by immediate transfusions.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Maternal bleeding complications and neonatal outcomes following early versus delayed umbilical cord clamping in cesarean deliveries for very low birthweight infants.

Determine effect of at least 60 s delayed cord clamping (DCC) on postpartum hemorrhage and maternal estimated blood loss (EBL) in very low birth weight (VLBW) cesarean deliveries when compared to early cord clamping (ECC). Retrospective study of VLBW infants at birth. Maternal pre- and post-operative hemoglobin, EBL, and neonatal outcomes were collected. In total, 620 VLBW infants (DCC = 166, ECC = 454) born to 545 mothers (DCC = 155, ECC = 390) were included. Maternal PPH between DCC was 8% versus ECC was 10% p = 0.52. There were no differences in estimated blood loss or rate of maternal blood transfusion between groups. The post-operative hemoglobin was lower in infants receiving ECC compared to DCC (10.4 [9.4-11.5] versus 10.8 [10.1-11.9] g/dl, p = 0.01). In comparing pre-operative to post-operative hemoglobin there was no difference between DCC and ECC (-1.2 [-2.0 to -0.3] versus -1.2 [-2.1 to -0.6] g/dl, p = 0.46). DCC of at least 60 s did not increase maternal bleeding complications during VLBW cesarean delivery. To our knowledge, this retrospective study is the largest sample size to date of preterm cesarean deliveries to support maternal safety regarding bleeding complications after delayed cord clamping.

Early Surgical Care of Anticoagulated Hip Fracture Patients Is Feasible-A Retrospective Chart Review of Hip Fracture Patients Treated with Hip Arthroplasty within 24 Hours.

Anticoagulative medication such as antiplatelet drugs (PAI, acetylsalicylic acid and direct platelet aggregation inhibitors), vitamin-K-antagonist Warfarin (VKA) or direct oral anticoagulants (DOAC) are common among hip fracture patients, and the perioperative management of these patients is a rising challenge in orthopaedic trauma. Our objective was to determine the effect of oral anticoagulation in patients receiving early endoprosthetic treatment within 24 h after their admission. For the period from 2016 to 2020, a retrospective chart review of 221 patients (mean age 83 ± 7 years; 161 women and 60 men) who were treated either with hemi- (n = 209) or total hip arthroplasty (n = 12) within 24 h after their admission was performed. We identified 68 patients who took PAI, 34 who took DOAC and 9 who took VKA medications. The primary outcome measures were the transfusion rate and the pre- and postoperative haemoglobin (Hb) difference. The secondary outcome measures were the in-patient mortality and the rate of postoperative haematomas that needed operative treatment. A logistic/ordinal regression was performed considering the related variables to prevent cofounding occurring. The mean time to surgery was significantly longer for the DOAC and VKA groups when they were compared to the controls (none 14.7 ± 7.0 h; PAI 12.9 ± 6.7 h; DOAC 18.6 ± 6.3 h; VKA 19.4 ± 5.5 h; p &lt; 0.05). There was no difference in the preoperative Hb level between the groups. Overall, 62 patients (28%) needed blood transfusions during the in-patient stay with an ASA classification (p = 0.022), but the type of anticoagulative medication was not a significant predictor in the logistic regression. Anticoagulation with DOAC and grouped surgery times were positive predictors for a higher Hb difference in the patients who did not undergo an intraoperative blood transfusion (n = 159). Postoperative haematomas only occurred in patients taking anticoagulative medication (four cases in PAI group, and three cases in DOAC group), but the logistic regression showed that the anticoagulative medication had no effect. The in-patient mortality was significantly influenced by a high ASA grade (p = 0.008), but not by the type of anticoagulative medication in patients who were treated within 24 h. We conclude that the early endoprosthetic treatment of the anticoagulated hip fracture patient is safe, and a delayed surgical treatment is no longer justifiable.

Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis

BACKGROUNDThere is debate on whether uterine gauze packing or intrauterine balloon tamponade is safer and more effective as a surgical management option for treating postpartum hemorrhage. OBJECTIVEThis study aimed to compare intra- and postoperative outcomes of intrauterine balloon tamponade and uterine gauze packing in patients with postpartum hemorrhage. STUDY DESIGNA range of databases such as Cochrane and PubMed were searched using terms including “post-partum haemorrhage,” “uterine balloon tamponade,” and “uterine gauze packing.” All observational studies comparing intrauterine balloon tamponade with uterine gauze packing were included. Five studies were identified enrolling 821 adult patients diagnosed with postpartum hemorrhage. Primary outcomes included blood loss volume, success rates, and maternal mortality. Secondary outcomes comprised requiring additional interventions, postoperative hemoglobin levels, and requiring blood transfusions. Fixed and random models were used for analysis. RESULTSIntrauterine balloon tamponade seemed to be a superior option to uterine gauze packing. Intrauterine balloon tamponade was better in reducing intraoperative blood loss, with a statistically significant improvement (P<.0001). Cases managed with intrauterine balloon tamponade seemed to have statistically significant shorter operative time (P=.023) and hospital length of stay (P=.020) in one study. CONCLUSIONIntrauterine balloon tamponade remains more effective and safer as a first-line surgical management option for postpartum hemorrhage compared with uterine gauze packing.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty.

Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

Jehovah's witness head and neck free flap reconstruction patient outcomes

BackgroundJehovah's Witnesses are members of a Christian religious denomination that rejects the transfusion of whole blood and component blood products. Given new transfusion-free strategies, Jehovah's Witness patients are undergoing free flap reconstructions with increased regularity. However, outcome data remains limited. With this study, we sought to examine post-operative outcomes in Jehovah's Witness patients undergoing free flap reconstruction of the head and neck, compare their outcomes to non-Jehovah's Witness patients, and enumerate strategies to enhance the safety of transfusion-free surgery. MethodsA retrospective chart review was carried out on 10 patients who identified as Jehovah's Witness and 63 patients who did not. Demographic information, pre-operative laboratory values, peri-operative resuscitative interventions, and peri-operative outcome measures were compiled. Descriptive data analysis, Mann-Whitney, Chi-square tests, and multivariate analysis were used. ResultsJehovah's Witness patients were significantly older than non-Jehovah's Witness patients (p = 0.03) and had significantly higher ASA scores (p = 0.009). Head and neck cancer was the primary surgical indication in both groups (p = 0.71). Jehovah's witness patients have significantly less intraoperative blood loss (p = 0.011) and lower post-operative hemoglobin (p = 0.002) compared to non-Jehovah's Witness patients. While Jehovah's Witness patients had significantly higher rates of severe anemia (p = 0.014), there was no significant difference between the two groups in other post-operative complications and readmission rates even in a multivariate analysis accounting for age and ASA score. ConclusionsFree flap microvascular reconstruction can be reliably performed on Jehovah's Witness head and neck patients without an increased risk of complication. Policies such as the use of non-blood volume expanders, albumin, Epogen, perioperative iron supplementation, cell saver and acute normovolemic hemodilution are key to ensuring good outcomes.

Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study.

This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods. This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone. A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05). Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.

The Efficacy and Safety of Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta- Analysis

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Tranexamic acid (TXA) use is increasing in Orthopedic practice specially among arthroplasty surgeons. It was proven to decrease the estimated blood loss and need for blood transfusion in hip, knee and shoulder arthroplasty as well as pelvis and acetabulum surgery. There was no reported increase risk of thromboembolic events with the use of TXA in orthopedic practice. This systematic review and meta analysis aimed on reporting on the available evidence on the use of TXA in foot and ankle surgery. Methods: The current meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic-based search on MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases to November 2021. Clinical studies on tranexamic acid use in foot and ankle surgeries reporting at least one of the desired outcomes; estimated blood loss (EBL), Hemoglobin difference between pre- and post-op, or complications were included. To assess risk of bias, the Joanna Briggs institute critical appraisal tool was used for case series and the Newcastle Ottawa scale for comparetive studies. The level of evidence was assigned according to the Cochrane Book Review Group. Results: A total of 718 foot and ankle procedures were included. Out of those, 491 (68.38%) procedures received tranexamic acid while 221 (31.64%) served as controls and did not receive tranexamic acid. In the TXA group, 34 (6.92%) procedures received local TXA injection in one study, while the remaining majority of 457 (93.08%) procedures received intravenous (IV) TXA. Among the control group, saline was used a placebo in 113 (51.13%) controls in 3 studies, while no placebo was used in the remaining 108 (48.87%) controls. The pooled mean EBL for the TXA group was 57.75 mL [95% CI: 44.80 to 70.70, I2 = 98.31%] while the pooled mean EBL for the control group was 299.26 mL [95% CI: 212.43 to 386.09, I2= 98.96%] with statistical significance Figure 1. No significant difference was found between the two groups in terms of change of hemoglobin and risk of thromboembolic events and other complications. Figure 2,3 Conclusion: This systematic review and metaanalysis showed that the use of TXA in foot and ankle surgery was safe with no increased risk in thromboembolic events. The lower risk of bleeding using TXA despite being stastically significant, did not reach clinical significance and did not affect the post operative hemoglobin level. TXA can be considered in foot and ankle surgery in special cases with higher risk of bleeding or in cases where the use of tourniquet is contraindicated.