Preoperative Hemoglobin Research Articles

ACUTE MYOCARDIAL INJURY AFTER SURGICAL LUNG RESECTION: INCIDENCE, CLINICAL FEATURES, PREDICTORS

HighlightsAcute perioperative myocardial injury develops in 38.5% of patients with non – small cell lung cancer and is associated with the ThRCRI major cardiac events risk index, preoperative hemoglobin level and postoperative heart rate. Aim. To determine the incidence and predictors of acute myocardial injury after surgical treatment of patients with non – small cell lung cancer (NSCLC).Methods. The study included 104 men aged 63.0 [58–67] years who underwent lung resection for NSCLC. Blood levels of cardiac troponin I (cTnI) were determined before and 24 and 48 hours after surgery. Myocardial injury after noncardiac surgery (MINS) was diagnosed when postoperative cTnI increased > 99th percentile of the upper reference limit. Two patients with elevated cTnI of non-ischemic origin were excluded from the analysis. In groups with and without MINS, clinical parameters were compared and their relationships with the MINS development were assessed using univariate regression. Multivariate logistic regression analysis was performed to identify independent MINS predictors. ROC curves were constructed and threshold values of quantitative variables associated with the study outcome were determined.Results. MINS was diagnosed in 40 patients (38.5%). In 36 of them, the cTnI increase was asymptomatic. Among patients with MINS, in contrast to the group without MINS, the share of pneumonectomy, heart rate (HR) after surgery and the cardiac events risk index ThRCRI were higher, as well as hemoglobin level before surgery was lower. Using multiple logistic regression, a combination of factors that provides the greatest accuracy in predicting MINS was identified: ThRCRI index ≥ 1 (adjusted odds ratio (OR) 5.85, 95% confidence interval [1.41–24.28]), hemoglobin before surgery (OR 0.68 [0.5–0.91] for every 10 g/L), HR after surgery (OR 1.99 [1.26–3.13] for every 10 min–1). Threshold levels were established for hemoglobin before surgery (135 g/L), below which the OR for MINS was 2.54 [1.12–5.75], and postoperative HR (88 min–1), above which the OR for MINS was 2.64 [1.16–5.99].Conclusion. The incidence of acute myocardial injury after NSCLC surgery is 38.5%. In 90% of cases the MINS was asymptomatic. A mathematical model was created and following independent predictors of MINS were established: ThRCRI index ≥ 1, hemoglobin level before and heart rate after the surgery. At a threshold hemoglobin value < 135 g/L and HR>88 min–1, the risk of MINS increases significantly.

Analysis of influencing factors for complications of anterior thoracolumbar tuberculosis surgery in adults.

This study analyzes the risk factors related to the complications of anterior thoracolumbar tuberculosis in adults and to provide clinical reference. A total of 98 adult patients with thoracolumbar tuberculosis undergoing anterior surgery in our hospital from February 2020 to December 2023 were selected, and the clinical data and postoperative complications were collected. The clinical characteristics were analyzed, and the risk factors related to surgical complications were analyzed by univariate analysis and multi-factor logistic regression model. A total of 54 patients had 75 postoperative complications of different degrees. Univariate analysis showed that patient age, preoperative hemoglobin (Hb) level, bone graft fusion method, intraoperative blood loss, and postoperative neurological function [Asian neurological function classification] were correlated with the occurrence of postoperative complications (P < .05). Multivariate Logistic regression analysis showed that age over 60 years old, preoperative Hb < 100 g/L, blood loss ≥ 800 mL, bone graft fusion method were independent risk factors for anterior postoperative complications of thoracolumbar tuberculosis (P < .05). The independent risk factors for surgical complications of anterior thoracolumbar tuberculosis were age over 60 years old, preoperative Hb < 100 g/L, blood loss ≥ 800 mL, titanium cage by bone graft fusion. Controlling these variable factors before operation can reduce the incidence of postoperative complications.

Preoperative hemoglobin to albumin ratio as a prognostic predictor for patients with colorectal cancer surgery.

The purpose of this study was to identify whether the preoperative hemoglobin to albumin ratio (HAR) could predict the prognosis of patients who underwent colorectal cancer (CRC) radical resection. This study enrolled 4018 consecutive CRC patients, calculating HAR as the hemoglobin count divided by albumin count. Patients were divided into the high and low HAR groups based on a cut-off value (0.36). Baseline information and short-term outcomes were compared between the two groups. Logistic and Cox regression analyses were conducted to determine whether HAR was an independent risk factor for CRC. A total of 4018 patients were divided into the high HAR group (3295) and the low HAR group (723). It was found that the high HAR group had more females (P < 0.01), less BMI (P = 0.027), less smoking (P < 0.01), less drinking (P < 0.01), less T2DM (P = 0.027), lower albumin (P < 0.01), higher hemoglobin (P < 0.01) and more rectal cancer (P = 0.026). We found that HAR was an independent risk factor for overall complications (P = 0.012, OR = 1.279, 95% CI 1.055-1.550). Moreover, we found that HAR was an independent risk factor for overall survival (OS) (P = 0.012, HR = 1.300, 95% CI 1.059-1.597) and disease-free survival (DFS) (P = 0.030, HR = 1.231, 95% CI 1.021-1.484). We found that the low HAR group had worse OS in stage III (P = 0.012) CRC than the high HAR group. In terms of DFS, the low HAR group also had worse DFS in stage III (P = 0.01) CRC than the high HAR group. HAR was an independent predictive factor for the prognosis of CRC. Therefore, surgeons should pay attention to hemoglobin and albumin values before surgery.

Characterization of trends in preoperative hemoglobin A1c testing prior to metabolic and bariatric surgery: a retrospective, observational study

BackgroundIrrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.MethodsWe queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.ResultsWe identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).ConclusionDespite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.

Preoperative anemia is associated with prolonged hospital stay and increased facility discharges after glioblastoma resection

BackgroundDespite numerous operative and non-operative treatment modalities, patients with glioblastoma (GBM) have a dismal prognosis. Identifying predictors of survival and recurrence is an essential strategy for guiding treatment decisions, and existing literature demonstrates associations between hematologic data and clinical outcomes in cancer patients. As such, we provide a novel analysis that examines associations between preoperative hematologic data and postoperative outcomes following GBM resection.MethodsWe performed a retrospective analysis of patients who underwent GBM resection from January 2016 to December 2020. Standard demographic and clinical variables were collected, including pre-operative complete blood count (CBC), and inferential analyses were performed to analyze associations between CBC parameters and postoperative outcomes.ResultsOne hundred and eighty nine (189) patients met inclusion criteria, with a mean age of 60.7 years. On multivariate regression analysis, controlling for age, gender, and performance status, we observed trends suggesting anemic patients may have longer lengths of stay (t statistic = 3.23, p = 0.0015) and higher rates of discharge to inpatient facilities [OR 3.01 (1.09–8.13), p = 0.029], though these associations did not reach statistical significance after correction for multiple comparisons (Bonferroni-corrected significance threshold p &amp;lt; 0.01).ConclusionPreoperative anemia may be a useful pre-operative predictor of postsurgical GBM outcomes. Further study is required to determine whether pre-operative hemoglobin optimization can improve postoperative clinical outcomes, and whether other hematologic and inflammatory markers are predictive of postoperative recovery and functional status.

A systematic review and meta-analysis of randomized trials comparing carbetocin to oxytocin in prevention of postpartum hemorrhage after cesarean delivery in low-risk women.

To evaluate the efficacy and safety of Carbetocin compared to oxytocin in prevention of postpartum hemorrhage (PPH) after low-risk cesarean delivery (CD). Screening of Medline, Web Of Science, Scopus, Google scholar, and clinical trials registry till January 2024 using the key words related to carbetocin, blood loss, PPH, Cesarean section and their MeSH terms was done. This study included all RCTs conducted on women with low risk for developing PPH after CD and compared the administration of carbetocin to oxytocin without any language limitation. These studies compared carbetocin to oxytocin alone or oxytocin combined with misoprostol. The review included all doses and routes of carbetocin and oxytocin administration. The extracted data included study settings, the participants' size and characteristics, intervention details of both the study and control groups especially data about the dose route and timing of drug administration, the outcome parameters and trial registration details The reported outcomes included the requirement of additional uterotonic agents or blood transfusion, the difference between preoperative and postoperative hemoglobin, the occurrence of PPH, blood loss and drug adverse effects. Seventeen studies including 3667 participants were included. The need for additional uterotonic agents was evaluated in 14 studies with 3154 participants and revealed an OR of 0.53 with 95% CI of 0.39 and 0.72 (p < 0.001, I2 41%). The incidence of PPH was reported in 11 studies with 2228 participants and revealed an Odd ratio of 1.08 with 95%CI of [0.81, 1.44] (p = 0.61, I2 0%). The hemoglobin drop after the operation was evaluated in 3 studies with 1240 participants and revealed an MD of -0.08 with 95% CI of -0.10 and - 0.06 (p < 0.001, I2 0%). The need for blood transfusion was evaluated in 9 studies with 1936 participants and revealed an OR of 0.57 with 95% CI of 0.34 and 0.97 (p = 0.04, I2 0%). Carbetocin administration during CD in women with low risk for PPH is associated with less need for additional uterotonic agents (moderate evidence), less need for blood transfusion (high evidence) and lower hemoglobin drop (high evidence) when compared to those who underwent oxytocin administration without an increase in adverse effects.

Predictive value of the nutritional risk index for postoperative complications in individuals with pancreatic cancer undergoing pancreaticoduodenectomy.

To explore the predictive value of the geriatric nutritional risk index (GNRI) for postoperative complications and their severity in older adults with pancreatic cancer undergoing pancreaticoduodenectomy (PD). This study conducted a retrospective analysis of 109 older adults with pancreatic cancer undergoing PD at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Quzhou Medical University, between May 2019 and May 2022. Statistical analysis of clinical data was performed to assess the predictive value of the GNRI for postoperative complications and their severity in older adults with pancreatic cancer undergoing PD. Among the 109 individuals in this study, a total of 41 older adults undergoing PD experienced postoperative complications. The outcomes of the regression analysis showed that preoperative GNRI (OR = 0.184, 95 % CI = 0.023-0.457, P < 0.001), albumin levels (OR = 0.897, 95 % CI = 0.812-0.912, P < 0.001) and haemoglobin levels (OR = 1.231, 95 % CI = 1.043-1.451, P = 0.034) significantly influence the incidence of postoperative complications in older adults with pancreatic cancer. The prognostic value of the GNRI in predicting overall postoperative complications boasts a sensitivity of 83.2 %, specificity of 71.2 %, positive predictive value of 81.1 %, negative predictive value of 65.9 %, accuracy rate of 73.1 %, area under the curve (AUC) of 0.756 (P < 0.001) and a discriminative threshold of 97.0. Furthermore, the predictive efficacy of the GNRI in gauging the severity of postoperative complications demonstrates a sensitivity of 85.32 % and specificity of 79.54 %. The GNRI can offer a faster, simpler and more effective method for evaluating nutritional risk in individuals with pancreatic tumours. Moreover, for older adults undergoing PD, it can serve as a convenient and efficient nutritional predictive indicator for postoperative complications and their severity.

Investigating an appropriate indicator of acute kidney injury for patient prognosis following lung transplantation

Objective The purpose of this study was to investigate the correlation between different subtypes of acute kidney injury (AKI) and clinical outcomes following lung transplantation (LTx) and to identify a reliable indicator for predicting poor prognosis in the LTx population. Methods We retrospectively analyzed the clinical data of 279 LTx patients from August 2016 to March 2023. The AKI subtypes included AKI, persistent AKI on Day 7 (P7-AKI) and Day 14 (P14-AKI) after LTx, and AKI stages. The correlations of these factors with respiratory outcomes, mortality at 90 days, mortality at 1 year and data finalization were assessed, and the risk factors for the selected AKI subtypes were evaluated. Results AKI occurred in 215 patients (77.1%), with 129 (46.2%) experiencing P7-AKI and 95 (34.1%) experiencing P14-AKI. P7-AKI was associated with more respiratory and mortality outcomes than were AKI and AKI stages, and P7-AKI surpassed P14-AKI in terms of a shorter diagnostic time. After adjusting for age, sex, BMI, type of transplant, transplant diagnosis and comorbidities, P7-AKI independently correlated with increased mortality risk at 90 days [HR 12.312 (95% CI: 2.839–53.402)], 1 year [HR 3.847 (95% CI: 1.840–8.044)], and data finalization [HR 2.010 (95% CI: 1.331–3.033)]. Five variables were identified as independent predictors for P7-AKI, including preoperative body mass index, prothrombin activity, hemoglobin and serum creatinine, and intraoperative colloid administration. Conclusion P7-AKI has been identified as a reliable indicator for predicting adverse outcomes in LTx patients, which may assist healthcare professionals in identifying high-risk individuals.

Retrospective Analysis of the Efficacy and Safety of Benign Gynecological Laparoscopic Surgery in Patients with a History of Open Abdominal Surgery

Objective : In our clinic, we aim to analyze the operative characteristics and complications of patients who have undergone abdomen surgery prior to total laparoscopic hysterectomy, in comparison to those who have not. Materials and Methods: The study analyzed a total of 2012 cases of laparoscopic hysterectomy conducted at the Women's Diseases and Birth Clinic in Tepecik Training and Research Hospital from January 2021 to December 235. The cases were categorized based on whether the patients had previous abdominal surgery or not. Various demographic characteristics, surgical treatment methods, operation durations, indications for hysterectomy, and postoperative findings were documented. Statistical analysis was performed using the SPSS program, with a significance level set at P &lt; 0.05. Findings :No significant differences were found between the two groups in terms of age, body mass index (BMI), preoperative and postoperative hemoglobin (Hb) values and values. In contrast, the difference between preop and post op Hb value measurements ; the level of statistically significant is higher in the group without obdomen surgery (p=0,001). There is no statistically significant difference between indications in both groups as surgical indication (p=0,043). In the group without western surgery, adhesion was observed to be statistically significantly lower (p=0,001). In the group with abdomen surgery, the presence of adhesions sufficient to require adezyolisis is statistically significant (p

Preoperative coagulopathy and blood transfusion requirements in children with intraventricular lesions undergoing neurosurgery: a retrospective cohort study.

Pediatric patients undergoing neurosurgery pose risk of perioperative hemorrhage and clotting dysfunction which is increased in tumors with high vascularity, endothelial exposure, and necrosis. Lesions affecting the ventricular system may arise from several etiologies, including rare tumors. The present study aimed to study the preoperative coagulation and transfusion profile of pediatric patients undergoing neurosurgery for intraventricular lesions. A retrospective study of all paediatric patients who underwent surgery for intraventricular lesion was included from June 2014 to June 2022. Demographic data, preoperative and postoperative investigations, intraoperative blood loss, blood product transfusion, and duration of surgery were noted. Postoperative outcomes were also assessed. A total of 98 patients underwent surgery, the median age was 11.1years (1.0 to 17.0), with a male predominance (50.9%). The median blood loss during surgery was 500mL (300-812.5). The incidence of preoperative coagulopathy was 30.7%. The intraoperative packed blood cell and fresh frozen plasma transfusion requirement was noted in 50.9% and 5%, respectively. The median ICU stay and hospital stay was 6days (3-10) and 14days (4-77), respectively. The mortality rate in the study population was 7.7%. This study highlights the multifactorial nature of perioperative blood loss and transfusion requirements in pediatric patients undergoing surgery for intraventricular lesions. Factors such as tumor histopathology, preoperative hemoglobin levels, and surgical duration play a crucial role in determining transfusion needs.

Comprehensive assessment of risk factors and development of novel predictive tools for perioperative hidden blood loss in intertrochanteric femoral fractures: a multivariate retrospective analysis

ObjectivesTo identify independent risk factors for perioperative hidden blood loss (HBL) in intertrochanteric femoral fractures (ITFs) and to develop a predictive model.MethodsWe enrolled 231 patients with ITFs who underwent proximal femoral nail antirotation (PFNA) surgery at the Orthopedics Department of Northern Jiangsu People’s Hospital, Jiangsu Province, China, from January 2021 to December 2023. Hidden blood loss was calculated using the OSTEO formula, and independent risk factors were screened using the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression. A nomogram prediction model was subsequently constructed based on multivariate logistic regression.ResultsThe LASSO regression identified eight key predictive factors: sex, body mass index (BMI), Admission serum calcium (mmol/L), American Society of Anesthesiologists (ASA) physical status classification, fracture type (Evans), hypertension, preoperative blood transfusion, and preoperative hemoglobin (HGB, g/L). The nomogram model demonstrated excellent predictive performance in both the training and validation sets, with area under the curve (AUC) values of 0.947 and 0.902, respectively. Calibration curves and decision curve analyses further confirmed the strong agreement between model predictions and actual observations, as well as the net clinical benefit.ConclusionsThe nomogram model facilitates an intuitive and quantitative assessment of the risk of perioperative hidden blood loss in patients with ITFs, providing robust support for clinical decision-making.

Re-evaluating the Need of Postoperative Blood Testing in Low-Risk Patients After Primary Elective Arthroplasty: A Single-Centre Retrospective Analysis.

Introduction Increasing demand and financial burdens are placing significant strain on current health resources. To help ease pressures, there has been increased emphasis on improving patient flow and saving costs within the health service. Routine postoperative blood tests in otherwise healthy patients may add to delays and healthcare costs without influencing subsequent management. Recent studies suggest that routine postoperative blood tests may be unnecessary in fit and healthy patients undergoing elective arthroplasty. We aimed to assess this practice at our institution in the American Society of Anaesthesiologists (ASA) grade 1 and 2 patients undergoing elective hip and knee arthroplasty. Methods We conducted a retrospective review of 1595 consecutive elective hip and knee replacements in ASA 1 and ASA 2 patients at our institution over a one-year period from 2021 to 2022. Operation notes and electronic databases were analyzed to collect data regarding demographics, co-morbidities, treatment, preand postoperative blood tests, and any documented interventions in these patients. Binomial logistic regression was employed to identify risk factors associated with postoperative abnormalities and the need for clinical intervention. Results Postoperative blood abnormalities were identified in 75.4% of patients, primarily anaemia (69.2%) and hyponatremia(29.9%). Anaemia was similarly prevalent in both total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients, with 70.2% affected in each group, although the majority of cases were mild (83.8% in THA and 90.5% in TKA). Hyponatremiawas significantly more common in TKA patients (40.3%) compared to THA patients (19.3%), although most cases were mild in severity. Only 5% of cases required any intervention, with higher rates observed in the TKA group compared to the THA group (p=0.008). Blood transfusion rates were low, occurring in 0.6% of cases. Factors associated with postoperative anaemia included higher BMI, preoperative antiplatelet use, and lower preoperative haemoglobin levels, while postoperative hyponatremia was linked to preoperative sodium levels, loop diuretic use, and PPI use. Acute Kidney Injury (AKI) was identified in 2.2% of patients and was predominantly mild. Potassium abnormalities were infrequent, with hypokalemiaoccurring in 1.5% of patients and no cases of hyperkalemiain our series. Conclusions Although postoperative blood test abnormalities were common, the majority were mild and rarely influenced management in this low-risk cohort of patients, with overall low postoperative intervention rates. Selective blood testing may allow safetargeted testing in this low-risk cohort of patients,minimizing costs and saving valuable resources.

The optimal surgical time after stent placement in obstructive colorectal cancer: impact on long-term survival of patients.

To investigate the optimal interval between self-expanding metal stent (SEMS) placement and radical surgery in patients with obstructive colorectal cancer. In this study, a retrospective research design was used to select 125 patients with obstructive colorectal cancer who underwent colonoscopic SEMS placement with subsequent radical surgery between February 2011 and November 2022 at Shanghai Changhai Hospital. In addition, their clinical data and therapeutic efficacy were examined. Grouping: grouping on the basis of the interval of bridge to surgery (BTS). Group A: interval of BTS ≤ 14days; group B: 14days < interval of BTS ≤ 21days; group C1: interval of BTS > 21days; group C2: interval of BTS > 21days, excluding patients who received neoadjuvant therapy; group D: patients who received neoadjuvant therapy. Patients were grouped according to their different surgical methods, group E: patients who received open surgery and group F: patients undergoing laparoscopic surgery. A total of 125 patients were included in this study, the mean age of the patients was 61.34 ± 13.99years, with the median follow-up time was 39 (25-61) months. Of these, 84 cases (67.2%) underwent open surgery, while 41 cases (32.8%) underwent laparoscopic surgery. Among the cohort, 15 patients received neoadjuvant radiotherapy and chemotherapy after placement of SEMS. There was a significant difference in preoperative hemoglobin levels between group A and both group B and group C1. The laparoscopic surgery rate was significantly higher in group B than in the other two groups (48.57% versus 3.33% and 22.81%, P = 0.038). The 5-year disease-free survival (DFS) of group C1 patients was lower than that in group A and group B (32.4% versus 56.3%, 62.3%, P = 0.038; P = 0.043), whereas there was no statistical difference in the 5-year overall survival (OS) (60.7% versus 62.1%, 69.6%, P = 0.365, P = 0.339). group D showed a higher proportion of open surgery and a higher T-stage (P < 0.05), resulting in a 5-year DFS that was inferior to group A and group B (17.7% versus 56.3%, 62.3%, P = 0.045; P = 0.047). However, there was no significant difference compared with group C2 (17.7% versus 36.9%, P > 0.05). The 5-year OS of group D was not statistically significantly different from that of group A, group B, and group C2 (28.4% versus 62.1%, 69.6%, 73.4%, P = 0.089, P = 0.090, P = 0.183). In addition, no statistically significant differences were identified in 5-year DFS (49.9% versus 37.0%, P = 0.555) or 5-year OS (66.2% versus 62.6%, P = 0.062) between group E and group F CONCLUSIONS: Radical surgery performed 14-21days apart after SEMS placement has been shown to improve minimally invasive rates and 5-year DFS rates. The addition of neoadjuvant radiotherapy and chemotherapy during the interval does not appear to improve long-term survival, although this conclusion is based on the results of only 15 patients.

Forty-eight-hour cold-stored whole blood in paediatric cardiac surgery: Implications for haemostasis and blood donor exposures.

Cold-stored whole blood (CS-WB) in paediatric cardiac surgery is making a resurgence, given its identified benefits compared to conventional blood component therapy (CT). A single-centre retrospective study was conducted from January 2018 to October 2018 by including children <18 years of age undergoing cardiac surgery requiring cardiopulmonary bypass. ABO-compatible CS-WB from non-directed random donors was leukoreduced with platelet-sparing filters and compared with CT. Fifty-seven patients (30, 53% CS-WB; 27, 47% CT) were studied. Patient demographics were similar, although CT patients were cooled to a lower intra-operative temperature. Blood product requirements 24 h post operation were less in the CS-WB group (11.1 vs. 26.7 mL/kg, p = 0.048). Twelve (40%) patients in the CS-WB cohort had more than one donor exposure versus 25 (93%) in the CT group (p < 0.001). CT patients compared to CS-WB patients had a greater decrease in pre-operative versus 48-h post-operative haemoglobin, platelets and prothrombin time. Patients who received CT compared to CS-WB had a trend towards higher median (interquartile range [IQR]) chest-tube output (mL/kg/h) in the first 4 h post cardiac intensive care unit (ICU) admission (2.1 [0.8, 3] vs. 1.6 [0.8, 2.2], p = 0.197). There was no difference in antifibrinolytic use, length of stay, sepsis, acute kidney injury or wound infection. Survival to discharge was similar. CS-WB in paediatric cardiac surgery may reduce donor exposure and improve haemostatic balance. Future multi-centre prospective studies are needed to validate these findings and identify patients who would benefit from CS-WB in paediatric cardiac surgery.

Lipedema: Complications in High-Volume Liposuction Are Linked to Preoperative Anemia.

Background: Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus, we examined the effect of high-volume liposuctions on lipedema patients and the incidence of associated complications. Methods: We analyzed perioperative differences in lipedema patients undergoing low- or high-volume liposuctions. Statistical analyses were performed, investigating postoperative complications and the correlation of patients' BMI, total amount of aspiration, duration of surgery, hospital stay and hemoglobin alterations. Complications were investigated according to the Clavien-Dindo Classification. Patients were divided in two groups based on the volume aspirated at liposuction (low-volume vs. high-volume liposuction). Results: Overall, 121 sessions were investigated. Mean total volume of aspiration was 8227.851 mL ± 3643.891. Mean preoperative hemoglobin levels were 13.646 g/dL ± 1.075 g/dL. Preoperatively, 7.44% of patients were anemic (Hb < 12 g/dL). Mean postoperative hemoglobin was 10.563 g/dL ± 1.230 g/dL. Postoperatively, 90.10% of patients showed Hb levels below 12 g/dL. Hemoglobin loss differed significantly between the two groups (p = 0.001). Significant correlations between pre- (p = 0.015) and postoperative (p < 0.001) hemoglobin levels and pre- (p < 0.001) and postoperative (p < 0.001) anemia with Class II complications were also seen. The total volume of aspiration did not correlate with complication rates (p = 0.176). Conclusions: Complication rates in high-volume liposuctions are hemoglobin-dependent rather than volume-associated. Preoperative anemia was the most influential for the occurrence of postoperative complications. To safely conduct high-volume liposuctions in lipedema patients, adequate patient selection and preoperative patient preparation are imperative.

Preoperative hemoglobin level and anemia frequency among patients admitted for diabetic lower extremity amputation.

Anemia is known to be prevalent in patients with diabetic foot ulcers, but such was not documented in those who required lower extremity amputations (LEAs). In this high-risk population, preoperative anemia could be an additional risk factor for postoperative morbidity and mortality. This study attempts to address the knowledge gap related to the preoperative hemoglobin (Hg) level and anemia prevalence in patients admitted for diabetic LEA. Using a cross-sectional design, the primary outcomes were defined as the mean preoperative Hg level and anemia frequency. Mean differences and sex-based results were calculated and compared between three categories: major, midfoot, and forefoot amputation groups. Correlation between Hg level and serum creatinine was set as a secondary outcome. A total of 141 patients comprising 192 amputation cases were included. The mean Hg value for the whole sample was 10.6 ± 1.8g/dl. Only 18 patients (9.7%) had a normal Hg level and 174 (90.3%) were anemic: 90 cases (46.8%) with mild anemia, 76 (40.8%) with moderate anemia, and 8 cases (4.3%) with severe anemia. No significance was found between mean Hg values of the three groups or between sex groups. A significant negative correlation between the levels of serum creatinine and Hg was found (p = .037). An overwhelming majority of patients admitted for diabetic LEA were anemic. Since anemia could impede limb perfusion and induce higher postoperative mortality rate, adjusting this confounder could be justified. Future research should aim to evaluate the impact of preoperative blood component transfusion on postoperative complications following diabetic LEA.

Clinical outcomes after emergency transarterial renal embolization: a retrospective study

BackgroundStudies on emergency transarterial embolization (TAE) of renal arterial injuries are rare. The aim of this retrospective study was to evaluate clinical outcomes after emergency transarterial renal embolization.Material and methodsBetween January 1st, 2013 and January 1st, 2024, all consecutive patients treated for renal arterial injuries by TAE in emergency settings were retrospectively reviewed. Demographic, biological and angiographic data were recorded. The inclusion criteria were all patients ≥ 18-years-old treated by emergency TAE for renal vascular injury. Clinical success was defined as the resolution of bleeding signs without the need for repeat TAE, surgery, death related to massive blood loss during this period, without functional impairment (> 50% of parenchyma volume or onset of chronic kidney disease) following TAE.ResultsDuring the inclusion period, 79 procedures were performed. The median age was 60[39–73] years old. On preoperative CT, ≥ 1 pseudoaneurysm was detected in 36(45.6%) patients, and active bleeding in 47(65.8%) patients. The preoperative median haemoglobin rate was 8.9[7.6–11] g/dl, and 37(46.8%) patients required red blood cell transfusions. The main aetiologies of arterial injury were blunt trauma (n = 19) and renal biopsy (n = 17). No severe adverse events were reported. Clinical success was reported in 74(93.7%) of the procedures. Three (3.8%) repeat embolizations were required, and were clinically successful. During the median follow-up of 7[1.5–35.5] months, 9(11.4%) patients died, of which 5(6.3%) occurred within 30 days.ConclusionThe present study reports high clinical success, low complications and low rebleeding rates of emergency renal TAE.

Serum hemoglobin and albumin levels serve as prognostic predictors after adrenal metastasectomy

PurposeAdrenal metastasectomy is a common local treatment for adrenal metastases, with a lack of serum prognostic factors. Here, we identified the prognostic significance of preoperative hemoglobin and albumin levels in patients undergoing adrenal metastasectomy.Materials and MethodsData from 93 patients who underwent adrenal metastasectomy were assessed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values of hemoglobin and albumin for survival. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan–Meier method, thereafter Cox regression models and subgroup analyses were applied to adjust confounding factors. A risk stratification developed by joint use of serum hemoglobin and albumin levels was also tested.ResultsOptimal cut-off points were 130.5 g/L and 44.8 g/L for hemoglobin and albumin, respectively. Multivariate Cox regression analysis identified decreased hemoglobin (HR [95% CI]: 0.41 [0.18—0.91], P = 0.029) and albumin (HR [95% CI]: 0.12 [0.02—0.88], P = 0.038) levels as independent factors for poorer OS. Patient with both decreased hemoglobin and albumin levels had the worst OS (P = 0.001) and DFS (P = 0.001) than other risk groups. Subgroup analyses proved decreased hemoglobin and albumin levels predicted poorer OS independent of cancer types.ConclusionsPreoperative hemoglobin and albumin levels may serve as prognostic predictors after adrenal metastasectomy. A prognostic model that combines hemoglobin and albumin can improve accuracy in predicting patient outcomes and be easily implemented in clinical practice.

Relationship between Fibrinogen Values and Sensitivity and Specificity of STS Score, Euroscore for Patients Undergoing Open Heart Surgery

Background/Aim: Cardiovascular diseases are a leading cause of mortality worldwide, with surgical interventions playing a crucial role in outcomes. Despite technological advancements and improved operator experience, perioperative and postoperative risks remain significant, particularly for high-risk patients. Fibrinogen, an acute-phase reactant, increases during inflammation and plays a role in coagulation. This study investigates the prognostic impact of fibrinogen levels on the outcomes of cardiac surgery and evaluates its relationship with established risk classification systems. Materials and Methods: This observational cohort study included 105 patients who underwent cardiac surgery between May 2018 and December 2023. Patients with coronary bypass grafting and valve surgery were included, while those with transplantation, congenital heart surgery, or other significant conditions were excluded. Patient data, including demographic information, comorbidities, laboratory parameters, and surgical details, were collected. The fibrinogen cutoff value was determined using the Youden index. Statistical analyses were performed using SPSS 23.0, with p-values &lt; 0.05 considered significant. Results: Of the 116 individuals screened, 105 were included in the study. The HighFib group (&gt;3.8 g/dL) showed higher rates of complications, such as low cardiac output, prolonged mechanical ventilation, and atrial fibrillation, compared to the LowFib group (&lt;3.8 g/dL). The HighFib group also had lower preoperative hemoglobin levels and higher Euroscore values. Logistic regression analysis demonstrated that both fibrinogen levels and established risk scores were significant predictors of postoperative complications. Conclusion: Elevated fibrinogen levels are associated with increased postoperative complications in cardiac surgery patients. Fibrinogen, alongside traditional risk scores, can be a valuable predictor of adverse outcomes. Prospective studies are needed to further validate these findings and establish optimal fibrinogen management strategies in cardiac surgery.

The effect of intravenous vitamin C administration on postoperative pain and intraoperative blood loss in older patients after intramedullary nailing of trochanteric fractures.

The purpose of this study was to determine the effects of peri and postoperative intravenous vitamin C administration on severity of postoperative pain and intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing. A prospective, single-blinded, controlled, randomised clinical study was conducted. It included 60 patients who were randomly divided into the Vitamin C and Control groups. Baseline characteristics, haemoglobin levels, number of Red Blood Cell (RBC) units transfusion, and metamizole consumption were noted in each group. Visual Analogue Scale (VAS) score was evaluated at 24 and 48h postoperatively. There were no differences between the groups concerning age, gender, length of hospitalisation, fracture type distribution, preoperative and postoperative haemoglobin levels. Postoperative metamizole consumption was higher in the Control group than in the Vitamin C group, with statistically significant difference (p = 0.003). The median VAS scores were higher in the Control group compared to the Vitamin C group at 24 and 48h postoperatively with significant differences (p = 0.001 and p < 0.0005, respectively). Multivariate logistic regression analysis revealed two independent predictors of postoperative blood transfusion: unstable fracture pattern (OR = 0.065, 95% CI 0.007-0.571, p = 0.014), and preoperative haemoglobin level (OR = 903, 95% CI 0.846-0.965, p = 0.003). The results showed significant reduction of subjective pain levels and lower analgesic consumption in patients who received intravenous vitamin C, suggesting that it could be considered as an adjuvant agent for analgesia in older patients with hip fracture. Unstable fracture pattern and preoperative haemoglobin levels significantly contributed to postoperative blood transfusion requirement.