Preoperative Hematocrit Values Research Articles

Early complications in scoliosis surgery and relation to preoperative factors: A single-center retrospective study.

In this study, we aimed to investigate the perioperative complications of the patients who underwent scoliosis surgery in our hospital and the factors that may affect the outcome. Between 2014 and 2018, scoliosis patients recorded data was examined retrospectively. Age, gender, height, body weight, comorbidity, Cobb index, scoliosis etiology, operation time, preoperative and postoperative hemoglobin, hematocrit, leukocyte, blood urea nitrogen, creatinine, coagulation value, operation time, level of instrumentation, intraoperative and postoperative blood loss, blood transfusion, intraoperative fluid administration, preoperative pulmonary function test values, blood gas values, urine outputs, hospital (LOS) and post anesthesia care unit stays, complications and mortality rates were examined. The files of 77 patients (48 female, 29 male) were retrospectively analyzed. The average age was 19.54 ± 16.32 years and 98.7% were elective surgery. The mean of LOS was 13.55 ± 9.13 days. As the preoperative hematocrit value decreases, LOS increases significantly. In patients with chronic obstructive pulmonary disease, smokers and high ASA scores, LOS is prolonged in patients with previous operations. As intraoperative colloid administration increased, crystalloid and blood products increased, it was also observed that the amount of crystalloid increased LOS. As the amount of intraoperative colloid or red blood cell administration increases, the duration of surgery and anesthesia increases, also increases the duration of post anesthesia care unit. Compared to patients with complications (n = 29) to the patients without complications (n = 47), it was found that they had longer anesthesia, and surgery times, also longer LOS times (P < .05). Our study showed that chronic obstructive pulmonary disease in the preoperative period, smoking, high ASA score, excessive use of colloid, prolonged duration of surgery and anesthesia, and long intubation durations increase the length of hospital stay. Preoperative comorbidity is directly related to postoperative complications and causes longer hospitalization after reconstructive scoliosis surgery.

Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study

Uterine fibroids are the most common benign tumors affecting females. Laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of myomectomy is excessive bleeding. However, risk factors for hemorrhage in laparoscopic myomectomy are not well studied and no risk stratification tool specific to the need for blood transfusion in laparoscopic myomectomy currently exists in the literature. To identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool for the risk of blood transfusion. Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. Women who underwent laparoscopic (conventional or robotic) myomectomy were included. Women who received ≥1 blood transfusion within 72 hours after laparoscopic myomectomy start time were compared with those who did not require blood transfusion. Multivariable analysis was performed to identify risk factors independently associated with the risk of transfusion. Two risk stratification tools for the need for blood transfusion were developed based on multivariable results: 1. based on preoperative factors, 2. based on preoperative and intraoperative factors. During the study period 11,498 women underwent laparoscopic myomectomy. Of these 331(2.9%) required transfusion. In multivariable regression analysis of preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, ASA III/IV and preoperative hematocrit value ≤35.0% were independently associated with risk of transfusion. Identified intraoperative factors included specimen weight >250 grams or ≥5 intramural myomas and operation time ≥197 minutes. A risk stratification tool was developed, assigning points based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of points. We identified preoperative and intraoperative independent risk factors for blood transfusion among women undergoing laparoscopic myomectomy. A risk stratification tool for the risk of blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool.

Increasing severity of preoperative anemia is associated with higher postoperative medical and surgical complications after primary shoulder arthroplasty

Anemia is a major cause of morbidity worldwide and compounds numerous medical conditions. Studies have found associations between anemia and both medical and surgical complications after shoulder arthroplasty (SA); however, most of these studies have used commercially available national databases with limited information on outcomes and typically short-term follow-up. Our study sought to evaluate the midterm outcomes of primary SA at a single institution when stratified by the degree of preoperative anemia. Between 2000 and 2020, 5231 primary SA (477 hemiarthroplasties, 2091 anatomic total SA, and 2335 reverse SA) with preoperative hematocrit values available and a minimum follow-up of 2 years were collected from a single-institution joint registry database. The severity of anemia was subclassified as no anemia (hematocrit >39% for males, >36% for females; n=4194 [80.2%]), mild anemia (hematocrit 33%-39% for males, 33%-36% for females; n=742 [14.2%]), and moderate-to-severe anemia (hematocrit <33% for both males and females; n=295 [5.6%]). The mean follow-up time for the entire cohort was 5.9 years (range, 2-22 years). Medical and surgical complications, reoperations, revisions, and implant survivorship were assessed. SA with moderate-to-severe anemia had the highest rate of nonfatal and nontransfusion medical complications (5.1%) relative to the nonanemic (1.2%; P<.001) and mild anemic groups (1.5%; P<.001). Similarly, SA with moderate-to-severe anemia had the highest rate of surgical complications (19.3%) compared with mild anemia (14.3%; P=.044) and no anemia (11.6%; P<.001). Postoperative transfusion was most frequent in the moderate-to-severe anemia cohort (40.3%) compared with the mild anemia (14.2%; P<.001) and nonanemic groups (2.5%; P<.001). Furthermore, SA who received postoperative transfusions had a higher risk of nonfatal medical complications (8.2% vs. 1.0%; P<.001), 90-day mortality (1.5% vs. 0.03%; P=.001), and surgical complications (19.5% vs. 12.0%; P<.001) when compared with those without transfusion. Moderate-to-severe anemia (hematocrit <33% for both males and females) was identified in approximately 5.6% of patients who underwent SA at a single institution and was associated with increased medical and surgical complications. Patients who received postoperative transfusions presented elevated rates of medical complications, 90-day mortality, and surgical complications. Health care teams should be aware of these risks in order to provide more individualized medical optimization and postoperative monitoring.

Preoperative hematocrit levels and postoperative mortality in patients undergoing craniotomy for brain tumors.

Abnormal hematocrit values, including anemia and polycythemia, are common in patients undergoing craniotomy, but the extent to which preoperative anemia or polycythemia independently increases the risk of mortality is unclear. This retrospective cohort study aimed to examine the association between preoperative anemia and polycythemia and postoperative mortality in patients who underwent craniotomy for brain tumor resection. We retrospectively analyzed data from 12,170 patients diagnosed with a brain tumor who underwent cranial surgery at West China Hospital between January 2011 and March 2021. The preoperative hematocrit value was defined as the last hematocrit value within 7 days before the operation, and patients were grouped according to the severity of their anemia or polycythemia. We assessed the primary outcome of 30-day postoperative mortality using logistic regression analysis adjusted for potential confounding factors. Multivariable logistic regression analysis reported that the 30-day mortality risk was raised with increasing severity of both anemia and polycythemia. Odds ratios for mild, moderate, and severe anemia were 1.12 (95% CI: 0.79-1.60), 1.66 (95% CI: 1.06-2.58), and 2.24 (95% CI: 0.99-5.06), respectively. Odds ratios for mild, moderate, and severe polycythemia were 1.40 (95% CI: 0.95-2.07), 2.81 (95% CI: 1.32-5.99), and 14.32 (95% CI: 3.84-53.44), respectively. This study demonstrated that moderate to severe anemia and polycythemia are independently associated with increased postoperative mortality in patients undergoing craniotomy for brain tumor resection. These findings underscore the importance of identifying and managing abnormal hematocrit values before craniotomy surgery.

Effectiveness of Combined Preoperative Sublingual Misoprostol and Intravenous Tranexamic Acid on Intraoperative Blood Loss During Elective Caesarean Section: A Randomised, Blinded, Placebo-Controlled Trial.

The objective of this study was to evaluate the effect of preoperative administration of sublingual misoprostol and intravenous tranexamic acid (TXA) on intraoperative blood loss during elective caesarean sections. This was a double-blinded, randomised, placebo-controlled study involving 116 women scheduled for elective caesarean sections. The treatment arm, group 1 (n=58), received 1000 mg of intravenous tranexamic acid 10-15 minutes before skin incision and 600 mcg of sublingual misoprostol after sub-arachnoid anaesthesia and before skin incision. Group 2 (n=58) received placebos; both groups had oxytocin injections at the delivery of the placenta. The data were analyzed using IBM® Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY). The primary outcome was the intraoperative blood loss and the difference between preoperative and postoperative hematocrit values in both groups. The mean intraoperative blood loss was significantly lower in the study group than in the control group (308.552 ± 42.991 mL versus 736.414 ± 171.889 mL, p<0.001). The differences between the preoperative and post-operative hematocrit values were also significantly lower in the study group than in the control group (2.212% ± 0.805% versus 5.660% ± 2.496%, p<0.001). Preoperative administration of 1000 mg of intravenous tranexamic acid and 600 mcg of sublingual misoprostol significantly reduced blood loss related to elective caesarean delivery.

How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?

Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality. The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data. Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference. Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient's recovery and increase the cost of treatment.

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.

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.

Comparison of Maternal and Fetal Complications in Relation to General Anaesthesia vs Spinal Anaesthesia During Caesarean Section

Background: Anesthesia is needed to ensure both maternal and fetal safety during cesarean sections. General anesthesia can be used for the rapid procedure in obstetric emergencies while regional anesthesia can be used for cesarean section due to its effectiveness.Objective: The objective of this study was to compare intra-operative and postoperative maternal and fetal complications with general and spinal anesthesia during cesarean section.Material and Methods: A total of 100 patients admitted for cesarean sections were included in this study and categorized into two groups (50 each) based on the anesthesia used either general or spinal anesthesia. All the demographic data, type of anesthesia, and post-anesthesia complications were determined. Results: A total of hundred patients were included and categorized into two (GA and SA) equal groups of 50 patients each. The mean age of the General anesthesia group was 29.9±3.8 while the spinal anesthesia group's mean age was 29.8±3.0. Parity was 1.6±0.7 and 1.9±0.7 in the general anesthesia and spinal anesthesia group respectively. The preoperative hemoglobin and hematocrit values were insignificant with p=0.257 and p=0.165 respectively. 24 hours after the operation were significantly lower in the general anesthesia group than in the spinal anesthesia group (P &lt;0.001 and P=0.004, respectively). The proportion of newborns with 5th-min Apgar scores &lt; 7 was not significantly different between the two groups, although the general anesthesia group had a significantly larger proportion of newborns with 1-min Apgar scores &lt;7 than the spinal anesthesia group P=&lt;0.001). Keywords: General anesthesia, Spinal anesthesia, Caesarean section, Apgar score.

Association of platelet and hematocrit value with arteriovenous fistula (AVF) failure in hemodialysis patient at Bali Husada Cipta Canti, Bali, Indonesia

Introduction: Hemodialysis is one of the renal replacement therapies used for end-stage renal disease (ESRD) patients. Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, around 31-61% of AVF fail to mature. An early AVF failure may be due to a lack of maturation or thrombosis, and late failure defines as a failure after successful use. Some factors that make AVF fail are injury of the endothelial wall or hypercoagulation. This study aimed to determine the association between pre-operative platelet and hematocrit value with AVF failure in BHCC Clinic Denpasar. Method: This is an analytic cross-sectional study. The data were collected from medical records from all dialytic patients from January 2020-December 2020. Patients with inclusion criteria were collected. Patient with incomplete data was excluded. Data were analyzed using Chi-square analysis. Results: Our study involved 34 patients, 21(61.8%) of them were male, and the mean age was 52.62 years (±10.77 SD). The AVF failure prevalence was 32.4% (n=11). We found no association between platelet value with AVF failure, with a p-value=0.411. There was an association between hematocrit value and AVF failure in hemodialysis patients with a p-value=0.032. Most of the patient was male and aged 45-60 with ESRD from the characteristic found. Conclusion: There was an association between pre-operative hematocrit value and AVF failure in hemodialysis patients. There was no association between pre-operative platelet value with AVF failure.

The effect of tranexamic acid on hidden blood loss in total hip arthroplasty.

Objectives In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients.Patients and methods Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared.Results There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946).Conclusion The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication.

Risk factors associated with 30-day postoperative complications following contemporary pelvic exenterations for gynecologic cancer

Objectives: Pelvic exenteration (PE) is an uncommon radical procedure associated with high perioperative morbidity due to the nature and extent of surgery. Due to surgical innovation and perioperative care advances, postoperative outcomes may have improved for PE. The purpose of this study is to evaluate rates of 30-day postoperative complications (POC) and risk factors associated with POC following PE for gynecologic malignancies. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients who underwent PE for a gynecologic cancer from 2012-2018 were identified using appropriate CPT, ICD-9 and ICD-10 codes. Comparative analyses were performed and stratified by admission status to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: Between 2012-2018, 473 patients who had undergone a PE for a gynecologic malignancy were identified. The median age at time of surgery was 59 years (range, 22-90 years) and median body mass index (BMI) was 26.1 kg/m2 (range, 15.5-65.7 kg/m2). The median operative time was 385 minutes (range, 55-1090 minutes). At the time of their PE, 21.2% of patients underwent a concurrent myocutaneous flap and 12.3% a urinary conduit. The median length of hospital stay was 10 days (range, 0-114 days). At time of discharge, 79.2% were discharged home, 20.4% were transferred to an acute care or rehab facility, and 0.4% expired. The overall POC rate was 75.9%, but when urinary tract infections and blood transfusions were excluded, the POC rate was 37.6%. The 30-day readmission rate was 20.3% and re-operation rate was 10.4%. Lower preoperative albumin and hematocrit values, longer operative times, higher American Society of Anesthesiology (ASA) class, concurrent flap, and urinary conduit procedures were associated with higher POC rates (Table 1). When adjusting for these factors on multivariate analysis, preoperative albumin levels, and longer operative times remained independent risk factors for higher POC rates. Download : Download high-res image (123KB) Download : Download full-size image Conclusions: There remains a high rate of 30-day POC following PE; although a significant proportion of the POC are driven by the development of urinary tract infections and administration of blood transfusions. The contemporary mortality rate appears to be lower than previously reported historical rates. Preoperative albumin levels and longer operative times may be modifiable risk factors that can reduce POC rates.

A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy

We sought to identify the variables independently associated with intra/postoperative blood transfusion at the time of myomectomy. We further hoped to develop an accurate prediction model using preoperative variables to categorize an individual's risk of blood transfusion during myomectomy. Case-control study. Not applicable to this study, which used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Women who underwent an open/abdominal or laparoscopic (robotic or conventional) myomectomy between 2014 and 2017 at participating ACS-NSQIP sites. The primary dependent variable was occurrence of intra/postoperative bleeding requiring blood transfusion. Patient demographics, clinical characteristics, preoperative comorbidities, intraoperative variables, and additional 30-day postoperative outcomes were compared at the bivariable level. For the prediction-model development, only variables that can be reasonably known before surgery were included. Variables associated with intra/postoperative bleeding were entered into 2 separate multivariable logistic regression models. Validation of our prediction model was performed internally using 250 bootstrapped iterations of 50% subsamples drawn from the overall population of myomectomy cases from the ACS-NSQIP database. We identified 6387 myomectomies performed during the defined study period. The most common race in our population was black/African American (45.7%), and most of the patients (57.5%) received an open/abdominal route of myomectomy. A total of 623 patients who underwent myomectomy (9.8%) experienced intraoperative/postoperative bleeding with a need for blood transfusion. At the bivariable level, we identified several variables independently associated with the need for blood transfusion at the time of myomectomy. In using only those variables that can be reasonably known before surgery to develop our prediction model, additional multivariable logistic regression elucidated black race, need for preoperative blood transfusion, planned abdominal/open route of surgery, and preoperative hematocrit value as independently associated with blood transfusion. We identified a number of perioperative variables associated with intraoperative or postoperative bleeding requiring blood transfusion at the time of myomectomy. We subsequently created a model that accurately predicts individual bleeding risk from myomectomy, using variables that are reasonably apparent preoperatively. Making this prediction model clinically available to gynecologic surgeons will serve to improve the care of women undergoing myomectomy.

Prophylactic Use of Tranexamic Acid in Reducing Blood Loss during Elective Cesarean Section

Background: Primary postpartum hemorrhage (PPH) plays a major role in maternal mortality and morbidity like severe anemia, blood transfusion requirement, hospital stay and infection. Tranexamic acid is now recommended in treatment of PPH, yet its prophylactic use before delivery is still not recommended. Objective: To assess the efficacy of preoperative administration of Tranexamic acid in decreasing blood loss during elective cesarean section. Patients and Methods: The study was conducted at Department of Obstetrics and Gynecology of Menoufia University Hospitals. It included 100 pregnant females who went through elective cesarean section with age >18 and < 35 years and singleton alive fetus. They were randomly allocated to two groups: the study group of which women received 1 gm of tranexamic acid 20 minutes before skin incision and the control group who did not receive tranexamic acid. The assessment included the following: measurement of blood loss amount and estimation of postoperative 1st day hemoglobin and hematocrit value. Results: There was highly statistically significant difference between both groups regarding the amount of blood loss during cesarean delivery and blood loss 2 hours from end of CS (p ≤ 0.001). This was reflected in the percentage of difference of preoperative and postoperative hemoglobin and hematocrit values, which showed highly significant statistical difference (p ≤ 0.001). Conclusion: Tranexamic acid administration before elective cesarean section was effective in decreasing intraoperative and postoperative bleeding. And in turn reduces the incidence of PPH with no immediate maternal or neonatal side effects.

Is tranexamic acid effective on hidden blood loss in patients during total knee arthroplasty?

Objectives This study aims to investigate if tranexamic acid (TXA) reduces both visible and hidden blood loss in patients undergoing total knee arthroplasty (TKA).Patients and methods A total of 128 female patients (mean age 68.9±5.8 years; range, 55 to 80 years) who underwent TKA and were admitted between January 2010 and January 2020 were included in this retrospective study. Only patients who had primary unilateral knee arthroplasty with a cemented posterior cruciate ligament substituting implant were included. Patients were divided into two groups according to TXA administration in the perioperative period. Group 1 consisted of patients who did not receive TXA (n=69), while Group 2 consisted of patients who received TXA (n=59). The effect of TXA on visible and hidden blood loss, amount of erythrocyte suspension transfusions, postoperative early wound complications, and the relationship between the volume of hidden blood loss and drainage volume were detected.Results There was no statistically significant difference between the groups in terms of age, body mass index, operation side, preoperative hematocrit (HCT) values, and total blood volume. Postoperative HCT values were statistically higher in Group 2. Fifty-four units of erythrocyte suspension transfusion were required in Group 1, while six units were required in Group 2 (p<0.001). Early wound complication was determined in 10 patients in Group 1 and only in one patient in Group 2 (p=0.011). Intraoperative blood loss, postoperative drainage volume, hidden blood loss, and total blood loss values were significantly lower in Group 2 (p=0.001). In all patients, there was a significant positive correlation between the postoperative drainage volume and the hidden blood loss volume (r=0.532, p=0.001).ConclusionThe use of TXA in patients undergoing TKA reduces postoperative bleeding (visible and hidden blood loss), blood transfusion needs, and early wound complications. In addition, drainage volume in postoperative 24 hours can be used to estimate the amount of hidden blood loss in early postoperative period.

MIS THR using anterolateral approach – the game changer in Indian scenario, early functional and radiological outcomes

Background:Minimally invasive surgery has become a trend in the last decade in all aspects of Orthopaedic surgery, including Total Hip Replacement. The debates and the interest generated in MIS THR is considerable and several approaches have been advocated. The potential benefits include lower surgical morbidity, less pain and peri-operative blood loss, quicker rehabilitation, shorter in-patient stay and improved cosmesis. On the other hand, deficient peer-reviewed literature, a steep learning curve, increased rate of complications due to inadequate visualization, component mal-position, neurovascular injuries, dislocation and intra-operative fractures have drawn criticism.Objectives:To present the various surgical tips and tricks and early functional and radiological results of MIS THR by anterolateral approach.Study designs & Methods:The retrospective analysis of the records of patients undergoing Anterolateral MIS THR between January 2013 and January 2019 was the basis of this study. 72 hips of 70 patients were included in the study. The length of incision , duration of surgery, peri-operative blood loss, were studied. Functional assessment by Harris Hip Score, pain assessment by VAS score and radiological assessment for acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, number of blood transfusions,time to ambulate as well as duration of hospital stay was studied.Results:We had no major complications in the form of mortality, fatal Pulmonary embolism , temporary femoral nerve neuropraxia was seen in 1 case, component mal-position in 3 cases , superficial infection 1 case and a non displaced proximal femoral fracture line was evident on the early postoperative X-ray of 1 case. Functional assessment by Harris Hip Score (HHS )improved from pre-operative 42 (range:26-46) to postoperative 95 (range:72-98) at 1 yr. Radiologic analysis was carried out at post-operative 6weeks, 3months,6months and 1year. Femoral stem varus alignment was seen in 3 cases, Average Acetabular cup abduction angle was 43degrees (range: 40-55 degrees). Average acetabular cup ante-version angle was 17 degrees (range: 12-25 degrees). Of the 72hips, 64 were within the Lewinnek safe zone. The average postoperative hemoglobin value was 9.7 g/dl ( range: 8.5-12.3g/dl) and the average postoperative hematocrit value was 29.8% (range: 28.1-30.6%).Conclusions:The MIS anterolateral approach allows adequate exposure for component placement, less perioperative blood loss and pain in immediate post-op period , earlier discharge from hospital along with early return to function , good cosmesis with better patient satisfaction.

The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Autologous priming (AP) of the extracorporeal circuit has been used as a technique to reduce iatrogenic anemia in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to review the results of standardizing AP techniques to reduce variation among clinicians and its effect on clinical outcomes. Standardized goal-directed protocols for AP were established by the cardiac team and applied to all adult cardiac surgical patients where CPB was used. Following Institutional Review Board approval, data were analyzed for two sequential groups of patients: Non-standardized AP (NST-AP) and standardized AP (ST-AP). Exclusion criteria included pre-CPB hemodynamic instability and preoperative hematocrit (Hct) values less than 30%. The primary end point was the transfusion of red blood cells (RBCs), whereas secondary end points included Hct change and other perioperative allogeneic blood product transfusions. Data are presented as mean and SD. Of the 192 patients evaluated, 82 were in the NST-AP group and 110 in the ST-AP group. There were no preoperative demographic differences across groups. Total AP volume was lower in the NST-AP group than in the ST-AP patients (486.8 ± 259.6 mL vs. 1,048.2 ± 218.7 mL,p&lt; .001). Whereas pre-CPB Hct values were identical between the groups, the first on-CPB (25.7% ± 4.5% vs. 27.9% ± 4.2%,p&lt; .001), high CPB (27.7% ± 3.5% vs. 29.1% ± 3.6%,p&lt; .008), and first postoperative (32.5% ± 4.0% vs. 34.3% ± 3.9%,p&lt; .003) were all significantly higher in ST-AP patients. Perioperative transfusion rate was higher in NST-AP patients (63.6%) vs. ST-AP (44.6%),p&lt; .01. There was no difference in intraoperative RBC transfusion, but postoperatively, more patients in the NST-AP group received RBCs than those in the ST-AP group (51.2% vs. 28.2%,p&lt; .01). The application of an ST-AP protocol was effective in reducing hemodilution, which was associated within higher Hcts and lower postoperative transfusion rates.

The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass.

Autologous priming (AP) of the extracorporeal circuit has been used as a technique to reduce iatrogenic anemia in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to review the results of standardizing AP techniques to reduce variation among clinicians and its effect on clinical outcomes. Standardized goal-directed protocols for AP were established by the cardiac team and applied to all adult cardiac surgical patients where CPB was used. Following Institutional Review Board approval, data were analyzed for two sequential groups of patients: Non-standardized AP (NST-AP) and standardized AP (ST-AP). Exclusion criteria included pre-CPB hemodynamic instability and preoperative hematocrit (Hct) values less than 30%. The primary end point was the transfusion of red blood cells (RBCs), whereas secondary end points included Hct change and other perioperative allogeneic blood product transfusions. Data are presented as mean and SD. Of the 192 patients evaluated, 82 were in the NST-AP group and 110 in the ST-AP group. There were no preoperative demographic differences across groups. Total AP volume was lower in the NST-AP group than in the ST-AP patients (486.8 ± 259.6 mL vs. 1,048.2 ± 218.7 mL, p < .001). Whereas pre-CPB Hct values were identical between the groups, the first on-CPB (25.7% ± 4.5% vs. 27.9% ± 4.2%, p < .001), high CPB (27.7% ± 3.5% vs. 29.1% ± 3.6%, p < .008), and first postoperative (32.5% ± 4.0% vs. 34.3% ± 3.9%, p < .003) were all significantly higher in ST-AP patients. Perioperative transfusion rate was higher in NST-AP patients (63.6%) vs. ST-AP (44.6%), p < .01. There was no difference in intraoperative RBC transfusion, but postoperatively, more patients in the NST-AP group received RBCs than those in the ST-AP group (51.2% vs. 28.2%, p < .01). The application of an ST-AP protocol was effective in reducing hemodilution, which was associated within higher Hcts and lower postoperative transfusion rates.

The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder

Objective This study aimed to evaluate the parameters affecting the treatment success of conservative surgery in cases with placental invasion anomaly. Methods Archive files and digital image records of 67 patients with placental invasion anomaly were studied. The patients were divided into two groups, a conservative surgery group and a cesarean hysterectomy group. Demographic data, cervical length, placental localization, placental surface area adhering to previous cesarean section line, preoperative and postoperative hematocrit values, transfused blood products, and surgical complications were compared between the two groups. Results In the conservative surgery group, the cervical length was longer (p < .001) and the surface area of the placenta in the previous cesarean scar line was smaller (p < .001). For cervical length, the sensitivity and specificity values were 97 and 81%, respectively, when the cut-off value was 35.5 mm. When the cut-off value for the placental surface area in the previous cesarean scar line was 85.5 cm2, the sensitivity and specificity values were 68 and 72%, respectively. In the caesarean hysterectomy group, the preoperative and postoperative hematocrit values were lower (p < .001, p = .003, respectively), and the amount of transfused erythrocyte suspension and fresh frozen plasma were higher (p < .001, p = .001, respectively). Conclusion In this study, it was concluded that the presence of the nondestructive intact cervical tissue, in the cases with placental invasion anomaly and/or the small size of the placental surface area adhering to the previous cesarean scar line, increase the feasibility of conservative surgery.

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial.

Introduction and Aim:Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared.Materials and Methods:After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717.Results:Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien–Dindo classification) which were not statistically significant.Conclusion:Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.