Preoperative Hb Research Articles

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation.

IntroductionThe loss of blood is a significant problem in Total Knee Arthroplasty (TKA). Anemia often occurs after such surgeries, leading to serious consequences, such as higher postoperative infection rates and longer hospital stays. Tools for predicting possible anemia can provide additional guidance in realizing better blood management of patients.Methods2,165 patients who underwent TKA from 2015 to 2019 in the same medical center were divided into training and validation cohorts. Both univariate and multivariate logistic regression analyses were performed to identify independent preoperative risk factors for anemia. Based on these predictors, a nomogram was established using the area under the curve (AUC), calibration curve (AUC), and the area under the curve (AUC). The model was then applied to the validation cohort, and decision curve analyses (DCA) were also plotted.ResultsThrough analysis of both univariate and multivariate logistic regression, five independent predictors were found in the training cohort: female, relatively low BMI, low levels of preoperative hemoglobin, abnormally high levels of ESR, and simultaneously two sides of TKA in the same surgery. The AUCs of the nomogram were 74.6% (95% CI, 71.35%–77.89%) and 68.8% (95% CI, 63.37%–74.14%) of training and the validation cohorts separately. Furthermore, the calibration curves of both cohorts illustrated the consistency of the nomogram with the actual condition of anemia of patients after TKA. The DCA curve was higher for both treat-none and treat-all, further indicating the relatively high practicality of the model.ConclusionFemale, lower BMI, lower levels of preoperative Hb, simultaneous bilateral TKA, and high levels of preoperative ESR were figured out as five independent risk factors for postoperative anemia (<9.0 g/dL) in patients undergoing TKA. Based on the findings, a practical nomogram was constructed to predict risk of postoperative anemia. The evidence level should be level 4 according to guideline.

The impact of timing of intravenous iron supplementation on preoperative haemoglobin in patients scheduled for major surgery.

Anaemia is frequent and an independent risk factor for morbidity and mortality in patients undergoing surgery. Iron deficiency (ID) is the main cause for anaemia and can be corrected by intravenous (IV) iron. The aim of this study was to investigate the timing of preoperative IV iron supplementation on preoperative haemoglobin (Hb) level. Surgical patients were screened for the presence of anaemia and ID from November 2015 to January 2020. In case of ID or iron deficiency anaemia (IDA), patients received IV iron supplementation. The timing of IV iron supplementation on preoperative Hb level was analysed by days and time frames clustered by 5 days before surgery. In total, 404 patients with IV iron supplementation were analysed. In all patients, IV iron was administered with a median (interquartile range [IQR]) of 3.0 (1.0; 9.0) days before surgery. Preoperative Hb level increased steadily starting from 6 days (0.13 [±1.2] g/dL) until 16 days before surgery (1.75 [±1.1] g/dL). Group comparison revealed a median preoperative Hb change of -0.2 (-0.5; 0.2) g/dL for days 1-5, 0.2 (0.0; 0.7) g/dL for days 6-10, 0.7 (0.2; 1.1) g/dL for days 11-15, 0.7 (0.2; 1.8) g/dL for days 16-20, 0.9 (0.3; 1.7) g/dL for days 21-25, 1.5 (0.4; 2.6) g/dL for days 26-30, and 0.6 (0.0; 1.7) g/dL for >31 days. Three patients received multiple administrations of IV iron which resulted in an increase in Hb of >4 g/dL. Supplementation of IV iron to increase Hb concentration preoperatively may be most effective if administered at least ten days before surgery.

MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS

You have accessJournal of UrologyCME1 May 2022MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS Rocco Simone Flammia, Umberto Anceschi, Antonio Tufano, Gabriele Tuderti, Alexander Kutikov, Robert G. Uzzo, Francesco Porpiglia, Cristian Fiori, Andrea Minervini, Umberto Capitanio, Riccardo Autorino, Michele Gallucci, Costantino Leonardo, and Giuseppe Simone Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Antonio TufanoAntonio Tufano More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert G. UzzoRobert G. Uzzo More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The CLOCK trial found no differences between on clamp vs off-clamp RAPN. However, investigators relied mostly on cT1 patients with RENAL score ≤ 10. In consequence, their results are not applicable to more complex and larger renal masses. To address this void we tested the association of off-clamp vs on-clamp RAPN with perioperative and functional outcome within a selective cohort of kidney tumor with high-risk RENAL score. METHODS: Within a multi-institutional database (2012-2019), we identified 116 patients treated with RAPN for kidney tumor harboring RENAL score ≥ 10. Multivariable logistic regression models addressing trifecta achievement, linear regression model addressing postoperative eGFR and Cox regression models and Kaplan-Meier plots addressing any upstaging to CKD ≥ 3a (CKD-upstaging) were applied according to off-clamp vs on-clamp RAPN. Covariates were preoperative eGFR, ASA, age, clinical tumor size and preoperative Hb. Trifecta was defined as the absence of any major complication plus negative surgical margin plus absence of postoperative AKI. RESULTS: Baseline characteristic are reported in Table 1. Overall 55 vs 66 patients were treated with off-clamp vs on-clamp RAPN, respectively. Off-clamp RAPN patients exhibited higher rate of trifecta achievement, that translated into a multivariable OR of 2.78 (1.25-6.46, p=0.014). Moreover, off-clamp RAPN were associated with higher postoperative eGFR at last follow up (linear coefficient +9.8, 95%CI 3.2-16.3, p=0.004). Kaplan-Meier plots depicted 3-years CKD-upstaging-free survival rates of 91% for off-clamp RAPN vs 60% for on-clamp RAPN, which translated in a protective multivariable HR of 0.23 (95%CI 0.08-0.63, p=0.005) in favor of off-clamp RAPN. CONCLUSIONS: In patients treated for high-risk RENAL score kidney tumors, off-clamp RAPN is associated with better perioperative and mid-term functional outcome than their on-clamp counterparts. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e869 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia More articles by this author Umberto Anceschi More articles by this author Antonio Tufano More articles by this author Gabriele Tuderti More articles by this author Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Francesco Porpiglia More articles by this author Cristian Fiori More articles by this author Andrea Minervini More articles by this author Umberto Capitanio More articles by this author Riccardo Autorino More articles by this author Michele Gallucci More articles by this author Costantino Leonardo More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

Outcomes and Effects of 250-cm Biliopancreatic Limb One Anastomosis Gastric Bypass in Patients with BMI > 50 kg/m2 with Total Bowel Length > 6 m: a 2-Year Follow-up

BackgroundThere is a controversy on the suitable bariatric procedure for patients with BMI > 50 kg/m2. Many surgeons prefer the Roux en-Y gastric bypass (RYGB) while others resort to long biliopancreatic limb (BPL) one anastomosis gastric bypass (OAGB).MethodsThis study included patients with BMI > 50 kg/m2 who underwent 250-cm BPL OAGB with total bowel length (TBL) > 6 m and completed 24-month follow-up from July 2015 to November 2021. Demographic data with preoperative weight, BMI, hypertension (HTN), DM (HbA1C), Hb, iron, calcium, albumin, vitamin D, and parathormone levels (PTH) were recorded. Operative time, total bowel length (TBL), residual length (RBL), complications and postoperative weight, BMI, % of total weight loss (%TWL), HTN, DM, and alkaline reflux as well as Hb, iron, calcium, albumin, vitamin D, and PTH levels were recorded at 6, 12, 18, and 24 months.ResultsOAGB had a significant decrease in weight, BMI (25.6 ± 3.4 kg/m2 at 24 months) with %TWL of 48 ± 5% at 24 months. TBL and RBL were 6.7 ± 0.65 and 4.2 ± 0.65 m respectively. %BL (RBL/TBL*100) was 62.4 ± 3.3%. The HbA1C, HTN, and alkaline reflux incidence were 5.5 ± 0.29 gm%, 1.4%, and 3.7% respectively at 24 months. Hb, iron, calcium, albumin, and vitamin D showed a significant decrease but still within normal range, and PTH showed a significant increase at 24 months.ConclusionLong BP (250 cm) OAGB in patients with BMI > 50 kg/m2 with TWL > 6 m had good results in the achievement of weight loss and weight maintenance goals with remission of associated comorbidities as HTN and DM.Graphical abstract

Intravenous Ferric Carboxymaltose Improves Response to Postoperative Anemia Following Total Knee Arthroplasty: A Prospective Randomized Controlled Trial in Asian Cohort.

Background: Ferric carboxymaltose (FCM) is an intravenous (IV) high-dose iron that is effective in the treatment of iron deficiency anemia. This study was performed to determine whether postoperative FCM infusion is effective at improving hemoglobin (Hb) responders, Hb and iron profiles, and the patient’s quality of life (QOL). Methods: A total of 110 patients with postoperative anemia, defined by a Hb < 10 g/dL within 3 days of unilateral primary TKA, between June 2018 and February 2020 were randomized into either the FCM or Control group. On postoperative day 3, the FCM group (55 patients) received IV FCM while the Control group (55 patients) did not. The Hb responders (Hb increase ≥ 2 g/dL compared to baseline), Hb level, iron profiles (ferritin, total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and EQ-5D scores were compared at weeks 2, 4, and 8. Results: The FCM group demonstrated a significantly greater number of Hb responders (p < 0.001) and a higher Hb level (p = 0.008) at 2 weeks postoperative than did the Control group. The FCM group recovered its preoperative Hb level between 4 and 8 weeks. In contrast, the Control group did not recover its preoperative level until 8 weeks. The FCM infusion group also had higher serum ferritin, iron and TSAT, and lower TIBC levels than those of the Control group between 2 and 8 weeks (all p < 0.001). However, there was no significant difference in the postoperative transfusion rate (p = 0.741) or EQ-5D score between the two groups (all p > 0.05). Discussion: In postoperative anemia following TKA, IV FCM increases the Hb response and improves Hb and iron metabolism variables, however, it does not affect the transfusion rate or QOL.

Prediction and Evaluation of Machine Learning Algorithm for Prediction of Blood Transfusion during Cesarean Section and Analysis of Risk Factors of Hypothermia during Anesthesia Recovery.

Prediction and Evaluation of Machine Learning Algorithm for Prediction of Blood Transfusion during Cesarean Section and Analysis of Risk Factors of Hypothermia during Anesthesia Recovery.

Impact of Preoperative Anemia Severity on Primary Total Hip Arthroplasty Outcomes.

Preoperative anemia (POA) is a significant predictor for adverse outcomes in primary total hip arthroplasty (THA). Current literature has studied POA stratified by severity. This study aims to find a threshold preoperative hemoglobin (Hb) value for increased risk of adverse outcomes in THA. This is a retrospective analysis of primary THA patients with preoperative Hb values from 2014 to 2021 from an academic orthopedic specialty hospital. Demographics, surgical data, and postoperative outcomes were collected. Patients without preoperative Hb values within the electronic health record system or values acquired >30 days preoperatively were excluded. Patients were grouped based on POA severity using World Health Organization criteria. Secondary analysis using discrete preoperative Hb values was performed. P-values were calculated using analysis of variance/Kruskal-Wallis and chi-squared/Fisher's exact testing with P < .05 considered significant. A total of 1347 patients were included: 771 (57.2%) patients with POA and 576 (42.8%) with normal preoperative Hb. In the POA group, 292 (37.9%) were mild, 445 (57.7%) moderate, and 34 (4.4%) severe. Increased length of stay was seen in moderate (3.9±4.3 vs 2.4±2.1, P < .001) and severe (5.0±3.4 vs 2.4±2.1, P < .0001) groups compared to control. The severe group had higher 90-day readmission and revision rates compared to control. Analysis by discrete Hb values showed increased length of stay in Hb values <11 g/dL and a greater proportion of patients with Hb values <12 g/dL were discharged to skilled nursing facilities. Patients with preoperative Hb <12 g/dL should be assessed for other risk factors that may predispose them to postoperative complications. Further investigation is warranted to develop more robust perioperative management strategies for POA patients undergoing THA. Retrospective Cohort Study.

Clinical Utility and Cost of Postoperative Hemoglobin Level Testing Following Robotic-assisted Hysterectomy for Endometrial Cancer.

Our aim was to assess the clinical utility of postoperative hemoglobin testing following hysterectomy. We carried out a retrospective cohort study of patients who underwent robotic surgery at an academic center during a 44-month study period. Data included demographics and perioperative outcomes. The mean postoperative decrease in hemoglobin level was evaluated using numerical and categorical variables. A total of 201 women were included. A total of 45 (22.4%) developed symptoms suggestive of hemodynamic compromise. When compared to asymptomatic patients, these patients were no different in operative time, estimated blood loss, pre- or post-operative hemoglobin levels, or the change in hemoglobin levels. Symptomatic patients did receive less fluid intraoperatively (1.2 vs. 1.5 l; p<0.0001). Perioperative outcomes were not associated with a greater postoperative decrease in hemoglobin (Hb). Postoperative anemia was associated with preoperative anemia (0% vs. 45%; p<0.0001). Patients with postoperative anemia were also more likely to be re-admitted within 30 days after surgery (7% vs. 23%; p=0.025). Of the three patients who received blood transfusions postoperatively, all three had preoperative Hb<9.5 g/dl, compared to 2.5% of those who were not transfused (p<0.0001). Using Institutional charges and Medicare reimbursement rates for blood hemoglobin testing, savings were estimated to be $3,629 and $1,236, respectively, during the study period. Postoperative Hb testing may be safely avoided unless starting Hb is less <10 g/dl. Clinical practice change can reduce healthcare costs without hindering patient care.

Effect of severity and cause of preoperative anemia on the transfusion rate after total knee arthroplasty

This study aimed to (1) evaluate the preoperative Hb cut-off value for transfusion after unilateral and bilateral staged (1 week apart) TKAs, respectively, and (2) determine whether cause of preoperative anemia can affect transfusion rate after TKA. A total of 951 patients who underwent TKA (unilateral: 605, bilateral staged: 346) from 2016 to 2019 were reviewed retrospectively. Patient demographics, comorbidities, preoperative Hb level, surgery types, and cause of anemia were evaluated as possible risk factors. The cut-off values for preoperative Hb level to reduce transfusion after TKA were evaluated in each surgery type. Preoperative Hb level, surgery type, and cardiac disease were identified as the risk factors for transfusion after TKA, and preoperative Hb levels of 11.8 (AUC 0.88) and 12.8 (AUC 0.76) were the cut-off values for transfusion after unilateral and staged bilateral TKAs, respectively. Although transfusion rate was higher in anemia with iron deficiency (ID) group than anemia without ID group, preoperative Hb level was also lower in anemia with ID group than anemia without ID group. Single use of preoperative Hb level with different cut-offs depending on the surgery types can be useful indicator for preoperative optimization regardless of cause of anemia.

An observational study on post-operative hemoglobin level in patients undergoing total hip replacement with fracture neck of the femur with and without drain

Background: The neck of femur fracture is a major public health problem due to ever increasing aging population. Its incidence has drastically increased forthe past few decades. Total hip replacement (THR) is the most common treatment option for displaced fracture neck of femur in high demanding patients who is cognitively intact, independently mobile, and active. Drains have been used with varying success in orthopedic surgery for many years. There are several studies done regarding the utility of drain with conflicting results. Aims and Objectives: To observe the pattern of fall in hemoglobin (Hb) in post-operative patients of fractured neck of the femur with and without drain undergoing THR. Materials and Methods: Observational study was conducted in admitted patients with Fracture Neck of Femur who will be undergoing THR with (cases) and without drain(controls). Pre-operative Hb, Post-operative Hb from day 1 to 5, Length of Hospital Stay, mobilization were taken into consideration for both arms. Results: Among 35 cases studied in each arm,45 were male and 25 were female with male: female ratio of 1.8:1.Maximum number of patients allocated in our study falls in the 60–65 years group (68.58%) followed by the age group of 66–70 years(11.42%) with least number in the age group of 80 years or more (2.84%).Average pre-operative Hb of patients with drain group was 10.6 gm% and non-drain group was 10.2 gm %.Post-operative Hb fall was observed up to first three POD.Mean hospital stay of patients in CSD was 10.9 days as compared to no CSD which was 8.4 days P=0.000*. Mean day of mobilization of patients in CSD was 1.9 days s compared to no CSD which was 1.8 days P=0.291. Conclusion: This study showed keeping drain has more blood less as compared to non drained group.Similarly, CSD had more hospital stay as compared to no CSD but there was no any association with day of mobilization in both arms.

Simultaneous Bilateral Total Hip Arthroplasty With Contemporary Blood Management is Associated With a Low Risk of Allogeneic Blood Transfusion.

There is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion. We identified 191 patients who underwent SBTHA at a single institution from 2016 to 2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis. Twenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female gender as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the nontransfusion group (100% vs 43.5%, respectively, P < .001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hb <12 had an elevated risk of transfusion at 37.5% (15/40 patients). With contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hb (<12 g/dL) had the highest risk of transfusion at 37.5%.

Preoperative Hemoglobin Level, Oxygen Saturation and Postoperative Outcomes in Children With Cyanotic Congenital Heart Disease: A Propensity-Score Matching Analysis.

BackgroundThe optimal preoperative hemoglobin (Hb) level is difficult to define in children with cyanotic congenital heart disease (CHD) due to hypoxemia-induced secondary erythrocytosis. This retrospective study integrated preoperative Hb and pulse oxygen saturation (SpO2) using the product of Hb × SpO2 to predict postoperative outcomes in children with cyanotic CHD.Patients and MethodsChildren aged <18 years undergoing cardiac surgery with cyanotic CHD were included. The cutoff value of Hb × SpO2 was the age-adjusted lower limit of normal Hb (aaHb) in healthy children. The main outcomes were in-hospital death and the composite outcome of severe postoperative events. Multivariate logistic regression analysis and propensity score matching analysis were used to adjust for important confounders.ResultsThe presence of preoperative Hb × SpO2 < aaHb was observed in 21.6% of cyanotic children (n = 777). Children with Hb × SpO2 < aaHb had higher in-hospital mortality (12.5% vs. 4.6%, P < 0.001) and composite outcome incidence (69.6% vs. 32.3%, P < 0.001) than those with Hb × SpO2 ≥ aaHb. After propensity score matching, 141 pairs of children were successfully matched. Multivariate analysis showed that preoperative Hb × SpO2 < aaHb was significantly associated with the composite outcome in the entire population (odds ratio = 4.092, 95% confidence interval = 2.748–6.095, P < 0.001) and the matched cohorts (odds ratio = 2.277, 95% confidence interval = 1.366–3.795, P = 0.002).ConclusionOur results suggest that a preoperative Hb × SpO2 value below the lower limit of normal hemoglobin is a prognostic factor in cyanotic children undergoing cardiac surgery and is a potential criterion to evaluate preoperative anemia in this population.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUNDBilateral one-stage total knee arthroplasty (BTKA) is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy. However, postoperative pain and disablement during convalescence from BTKA, and procedure-related complications have been concerning issues for patients and surgeons. Although some studies reported that BTKA in selected patients is as safe as the staged procedure, well-defined guidelines for patient screening, and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIMTo compare the perioperative outcomes including perioperative blood loss (PBL), cardiac biomarkers, pain intensity, functional recovery, and complications between unilateral total knee arthroplasty (UTKA) and BTKA performed with a similar perioperative protocol. METHODSWe conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols. The exclusion criteria of this study included patients with an American Society of Anesthesiologists score > 3, and known cardiopulmonary comorbidity or high-sensitivity Troponin-T (hs-TnT) > 14 ng/L. Outcome measures included visual analogue scale (VAS) score of postoperative pain, morphine consumption, range of knee motion, straight leg raise (SLR), length of stay (LOS), and serum hemoglobin (Hb) and hs-TnT monitored during hospitalization. RESULTSOf 210 UTKA and 137 BTKA patients, those in the BTKA group were younger and more predominately female. The PBL of the UTKA vs BTKA group was 646.45 ± 272.26 mL vs 1012.40 ± 391.95 mL (P < 0.01), and blood transfusion rates were 10.48% and 40.88% (P < 0.01), respectively. Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA, whereas preoperative Hb was only a determinant in UTKA patients. The BTKA group had significantly higher VAS scores than the UTKA group at 48, 72, and 96 h after surgery, and also had a significantly lower degree of SLR at 72 h. The BTKA group also had a significantly longer LOS than the UTKA group. Of the patients who had undergone the procedure, 5.71% of the UTKA patients and 12.41% of the BTKA patients (P = 0.04) had hs-TnT > 14 ng/L during the first 72 h postoperatively. However, there was no difference in other outcome measures and complications. CONCLUSIONFollowing similar perioperative management, the blood transfusion rate in BTKA is 4-fold that required in UTKA. Also, BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA. Hence, BTKA patients may require more extensive perioperative management for blood loss and pain, even if having no higher risk of complications than UTKA.

Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery.

This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

Perioperative anemia predicts kidney injury after partial nephrectomy.

PurposePartial nephrectomy (PN) induced kidney injury is still a challenging clinical matter that has not been completely conquered. This study aimed to explore the influences of perioperative anemia on renal function after PN.Materials and MethodsA total of 114 patients undergoing PN were retrospectively studied. Serum creatinine was tested preoperatively and 24 hours and 3 days after PN to evaluate the occurrence of acute kidney injury (AKI). Perioperative anemia was evaluated on the basis of the hemoglobin (Hb) value at 24 hours and 3 days postoperation. Patients were then followed up for the development of chronic kidney disease (CKD). Associations between perioperative anemia and postoperative AKI and CKD were determined.ResultsThe cumulative incidence of perioperative anemia was 33.33% in the study. A total of 32.46% of patients suffered from postoperative AKI, and 16.67% of patients progressed to CKD. The incidences of AKI and CKD in perioperative anemia patients were dramatically exceeded in those without anemia. Further statistical analyses indicated that perioperative anemia was a relevant factor for postoperative kidney injury, presenting the highest odds ratio of 31.272 for postoperative AKI and 17.179 for postoperative CKD. Receiver operating characteristic curve analysis showed that ΔHb=(preoperative Hb)-(postoperative Hb nadir) was a meaningful predictor of postoperative kidney injury, with an area under the curve of 0.784 for predicting postoperative AKI and 0.805 for postoperative CKD.ConclusionsPerioperative anemia can predict kidney injury after PN, and ΔHb shows a meaningful predictive value for postoperative AKI and CKD.

Modifiable Risk Factors associated with Post-Operative Bleeding and transfusion requirements in Cardiac Surgery

Objectives:In this study we determine the modifiable factors related to bleeding and transfusion in post-cardiac surgery patients who underwent open heart surgery.Methods:This is a retrospective study that include two hundred patients who had undergone open heart surgery (OHS) at Northwest General Hospital and Research Center from December 2018 to July 2021. Platelet count and hemoglobin level were measured in the pre-operative period.Results:This study included both male and female patients. Postoperative platelets were counted as follow: 50-100 x109 L in 3.0% cases, 101-150 x109 L seen in 27.5% cases, and >150 x 109 L in 69.5% cases which required transfusion. We have also reported the increased requirement of transfusion of blood and blood products in patients with pre-operative hemoglobin (Hb) < 10 g/dl.Conclusion:Correction of pre-op Hb, post-op platelet count and total bypass time are the significant and preventable parameters in patients undergoing cardiac surgery if proper pre-op assessment of the patient is performed.

Is Type and Crossmatch Really Necessary for Transurethral Resection of Prostate? A Retrospective Study from a Tertiary Care Center in Northern India

Background and Objectives: Rate of blood transfusion is considerably low in transurethral resection of the prostate (TURP). We follow type and crossmatch (TC) policy in TURP. The objective was to assess the suitability of TC policy along with the impact of preoperative (preop) prostate weight and hemoglobin (Hb) on the pattern of blood ordering (whether demand for TC was sent or not). Methods: Retrospective analysis of TURP patients was done from 2014 to 2017. Patients were divided into 2 groups on the basis of whether the demand for TC was sent or not. The age, preop prostate weight and preop Hb of patients where demand for TC sent was compared with patients where TC demand was not sent. Crossmatch to transfusion ratio (Crossmatch to transfusion ratio C/T ratio), Transfusion probability (%T) and Transfusion index (TI) were calculated. Results: Among the total 92 TURP patients, 42.4% (39/92) had TC samples sent preoperatively. Only three patients (3.2%, 3/92) required transfusion intraoperatively. CT ratio was 23.6, %T was 7.6% and TI was 0.07. Preop prostate weight and Hb were significantly higher and lower, respectively, for the group where request for TC was sent. Transfusion probability was also higher for this group. Conclusion: The blood utilization indices show the inadequate utilization of blood and that TC policy is unnecessary. Type and screen policy can be used for patients with large prostate and/or low Hb while type and hold would be appropriate for rest of the patients. Change in pretransfusion policy would reduce workforce and reagent wastage along with efficient inventory management.

Can C-reactive protein-based biomarkers be used as predictive of 30-day mortality in elderly hip fractures?A retrospective study.

C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein/albumin (CRP/ALB), and CRP are prognostic factors for outcome and survival in oncology and digestive surgery. CLR has not been studied for the prediction of mortality in hip fracture. The aim of this study is to investigate whether there is an association between pre-operative CLR, CRP/ALB, and CRP levels in patients with hip fracture and patient survival. The medical reports of the patients who underwent surgery with a diagnosis of hip fracture in our hospital between January 2016 and December 2019 were retrospectively reviewed. The patients were divided into two groups (Group E: Those who died within 1 month and Group S: Those who died after the 1st month or those who survived). A total of 19 parameters, namely, included ' blood parameters including hemoglobin, C-reactive protein, albumin, lymphocytes, neutrophils, monocytes, platelets, PLR, NLR, LMR, CLR CRP/ALB ratios, gender, American Society of Anesthesiologists, Charlson Comorbidity Index, delirium, infections, repeated surgeries, and type of anesthesia were evaluated preoperatively and on the post-operative 2nd and 5th days and 1 month. A total of 165 patients with the mean age of 83.09±8.52 years who met the inclusion criteria were studied. The pre-op-erative means of CRP, neutrophil count, CLR ratio, and CRP/ALB ratio were statistically significantly higher in Group E than in Group S (p=0.016, p=0.023, p=0.035, and p=0.044, respectively). The univariate regression analysis showed that age, pre-operative Hb level, CRP, and CRP/ALB ratio were significant predictors of the 1-month mortality (ß=-0.335, p=0.049; ß=0.411, p=0.028; ß=3.632, p=0.007; and ß=-3.280, p=0.008; respectively). When we performed the ROC curve analysis, the CRP/ALB ratio had the highest AUC, with the highest sensitivity and specificity. The cutoff value of CRP/ALB ratio was found to be 12.42. We found that the pre-operative CRP/ALB ratio is an important parameter for predicting the first 30-day mortality in elderly patients with intertrochanteric femur fractures. For this reason, we recommend that CRP and albumin be checked in prepa-ration for routine pre-operative anesthesia.

Assessment of Intraoperative Blood Transfusion Practices during Elective Surgeries in a Tertiary Care Hospital: A Prospective Cross-sectional Study

Introduction: Blood transfusion remains the cornerstone of managing volume depletion and blood loss during surgeries. There are always patients and situations which clearly benefit from blood transfusion intraoperatively. Crystalloids and colloids cannot replace blood, as a substitute when the patient’s oxygen carrying capacity has been compromised. Anaemia in acute and chronic conditions is associated with increased risk of morbidity and mortality. Thus, blood transfusion has a very important role in the perioperative management of the patient. Aim: To ascertain the common indications for which anaesthesiologists start perioperative blood transfusion, the rates of intraoperative overtransfusion, and to assess the variation in the blood transfusion practices at the study Institution from standard guidelines. Materials and Methods: A prospective cross-sectional study was conducted on 168 patients patients operated at Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India, from February 2017 to July 2017. The patients were adult American Society of Anaesthesiologists Physical Status (ASAPS) I and II, undergoing elective surgeries and required transfused blood intraoperatively. Operating room anaesthesiologists completed a record form for each of the patient. The form included details of the patient like age, gender, weight, type and duration of surgery, preoperative haemoglobin (done within 48 hours preoperatively), intraoperative blood loss, fluids and blood, and blood products transfused intraoperatively. The postoperative Haemoglobin (Hb) levels (done between 6 hours24 hours postoperatively) were also recorded. Results: The study showed that, 76 out of the 168 (45.2%) patients, who were transfused blood intraoperatively had been overtransfused, i.e., their postoperative Hb values were more than 10 g/dL. Blood loss was the sole indication for transfusion in 41 out of 168 (24.4%) patients. Blood was transfused in patients with low preoperative Hb in 21/168 (12.5%) patients, while it was done on surgeon’s request in 13/168 (7.7%) cases. Pallor, hypovolaemia and haemodynamic instability as sole indications included only 4.8%, 2.4% and 1.2% cases, respectively. Conclusion: The present study revealed that a significant number (45.2%) of patients were overtransfused. A wide variation exists from the standard guidelines among anaesthesiologists. Implementation of restrictive transfusion strategies and a protocol-based intraoperative transfusion is required to optimise patient outcome.

High-dose intravenous iron supplementation after preoperative autologous blood donation is useful to prevent post-donation/preoperative anemia

To estimate the effectiveness of high-dose intravenous (IV) iron supplementation for iron deficiency anemia after preoperative autologous blood donation (PAD), 155 donors who visited the donation office of the University of Tokyo Hospital from December 2020 to June 2021 and showed suspected post-donation anemia were analyzed. The participants were treated with high-dose intravenous (IV) iron supplementation (high-dose group, n = 30) or a combination of low-dose IV iron and oral iron supplementation (low-dose group, n = 125). The preoperative hemoglobin (Hb) and Hb decreasing ratios during PAD (ΔHb) were compared between the two groups. Multivariate linear regression analyses were also performed to identify the confounding factors associated with preoperative Hb and ΔHb as well as high-dose IV iron supplementation. Preoperative Hb level was slightly higher in the high-dose group than in the low-dose group (12.1 ± 1.1 vs. 11.9 ± 1.1 g/dL, p = 0.27). ΔHb was significantly higher in the high-dose group than in the low-dose group (3.7 % ± 8.8 % vs. 7.7 % ± 6.5 %, p = 0.011). On the multivariate linear regression analyses, high-dose IV iron supplementation was significantly associated with higher preoperative Hb and lower ΔHb levels (p = 0.021 and 0.017, respectively) as well as the donation available period (period from the first visit to the donation office to the operation) and administration of erythropoiesis-stimulating agents. High-dose IV iron supplementation after PAD will be useful in the treatment of post-donation anemia.