Preoperative Hematocrit Levels Research Articles

Comprehensive evaluation of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in obese patients based on efficacy and nutrition

Objective: To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients. Methods: This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m2 regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m2. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18-61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m2. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. Results: (1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all P < 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all P < 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically significant (all P < 0.05). The incidence of anemia was 6.1% (4/66), hypoalbuminemia was 4.5% (3/66), and ferritin deficiency was 4.5% (3/66), all of which were improved or normalized through conservative treatment. Twelve months after surgery, 30 (45.5%) patients had vitamin A deficiency, 17 (25.8%) had vitamin E deficiency, 11 (16.7%) had folic acid deficiency, 2 had potassium deficiency (3.0%), 3 (4.5%) had calcium deficiency, 2 (3.0%) had magnesium deficiency, 9 (13.6%) had iron deficiency, and 16 (24.2%) had zinc deficiency. However, no relevant clinical symptoms occurred. Conclusions: SADI-S has a very significant effect on weight loss and alleviation of metabolic diseases. Nutrient deficiencies after SADI-S mainly involve vitamin A, vitamin E, zinc, and folic acid. The long-term efficacy and safety of SADI-S still need further follow-up observation.

Intraoperative cell salvage reduces postoperative allogeneic blood transfusion and shortens off-bed time in simultaneous bilateral total hip arthroplasty: a single-center retrospective study

BackgroundSimultaneous bilateral total hip arthroplasty (SI-THA) results in more blood loss and a greater need for postoperative allogeneic blood transfusion (ABT). Previous studies have reported that multimodal patient blood management (PBM) strategies were associated with a smaller effect of intraoperative cell salvage (ICS) in unilateral total hip arthroplasty. However, there are few studies on the role of ICS in SI-THA. This study aims to explore the effect of ICS with multimodal PBM strategies on SI-THA and to identify risk factors associated with ABT.MethodsThis retrospective matched cohort study included 72 patients in the ICS group and 72 patients in the control group who were matched according to age, sex, and year of hospitalization. Demographic data, hematological indicators, blood loss, and ABT were compared between the two groups. Logistic regression analysis was performed to identify independent risk factors for postoperative ABT. Postoperative outcomes were also recorded.ResultsIn the cohort of 144 patients, 27 patients (37.5%) in the ICS group while 45 patients (62.5%) in the control group received postoperative ABT after SI-THA. Compared with the control group, the ICS group showed significant differences in terms of blood loss, postoperative hemoglobin and hematocrit. The transfused volume of allogeneic red blood cells per ABT patient was also lower in the ICS group. Multivariate logistic regression analysis indicated that sex, the utilization of ICS, and preoperative hematocrit level were identified as independent factors associated with postoperative ABT. The utilization of ICS significantly shortened off-bed time and length of hospital stay, but had no effect on early pain and functional outcomes.ConclusionThe utilization of ICS can significantly affect postoperative ABT in SI-THA patients with multimodal PBM strategies. Sex, the utilization of ICS and preoperative hematocrit level were identified as independent factors associated with postoperative ABT. The utilization of ICS promoted weight-bearing functional exercises, but had no effect on early outcomes.

Low preoperative hematocrit adversely affects short-term outcomes after arthroscopic rotator cuff repair

The purpose of this study was to investigate preoperative anemia as a risk factor for postoperative complications after arthroscopic rotator cuff repair (ARCR). Adult patients who underwent ARCR from 2015-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were grouped according to the following preoperative hematocrit levels: normal (male >39%, female >36%), mild anemia (male 33%-39%, female 33%-36%), and moderate to severe anemia (male and female ≤33%). Multivariable logistic regression analyses were performed to identify significant differences in 30-day postoperative complication rates. Of the 21,836 patients identified, 19,726 (90.3%) patients had normal preoperative hematocrit, 1731 (7.9%) were mildly anemic, and 379 (1.7%) were moderate to severely anemic. After adjusting for significantly associated demographics and comorbidities, mild anemia was a significant predictor of any complication (odds ratio [OR] 1.436, P= .007), cardiac complications (OR 4.891, P= .002) sepsis-related complications (OR 4.760, P= .004), readmission (OR 1.585, P= .014), and nonhome discharge (OR 1.839, P= .006). Moderate to severe anemia was a significant predictor of any complication (OR 2.471, P < .001), readmission (OR 3.002, P < .001), and nonhome discharge (OR 3.211, P < .001). Preoperative anemia is a significant risk factor for postoperative complications within 30 days of ARCR.

Hidden blood loss and its risk factors after hip reconstruction in children

ObjectiveThere were few reports in the literature regarding hidden blood loss following surgery for developmental dysplasia of the hip in children. This study aimed to evaluate the volume of hidden blood loss and its risk factors among children undergoing hip reconstruction for developmental dysplasia of the hip.MethodsA retrospective analysis of clinical data from 42 patients (58 hips), who underwent Pemberton and femoral osteotomies between March 2020 and March 2023, was conducted. Serial complete blood count assays were conducted on the day of admission and four days post-surgery. Preoperative and postoperative hematocrit levels were documented to calculate hidden blood loss utilizing the Gross formula. Pearson and Spearman correlation analyses, along with multivariable linear regression, were employed to ascertain associations between patient characteristics and hidden blood loss.ResultsThe mean hidden blood loss was recorded as 283.06 ± 271.05 mL, constituting 70.22% of the total blood loss. Multiple linear regression analysis identified weight and surgical duration as independent risk factors contributing to hidden blood loss.ConclusionsA relevant amount of postoperative hidden blood loss occurs after Pemberton osteotomy and femoral osteotomy for developmental dysplasia of the hip. Surgeons should be aware that patients who require blood transfusions and have longer surgical durations are at a higher risk of developing more hidden blood loss. Therefore, attention should be given to hidden blood loss to ensure patient safety during the perioperative period for those undergoing Pemberton and femoral osteotomies.Level of evidenceIV.

PP01.129 Effects of Preoperative Hematocrit Level on Perioperative Outcomes and Survival After Robotic-Assisted Video-Thoracoscopic Pulmonary Lobectomy

PP01.129 Effects of Preoperative Hematocrit Level on Perioperative Outcomes and Survival After Robotic-Assisted Video-Thoracoscopic Pulmonary Lobectomy

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

Overestimated the cross-match of preoperative PRC preparation for elective primary lumbar spinal fusion needs revision for cost-effectiveness. We aimed to develop a novel preoperative predictive model for appropriate PRC preparation. This clinical prediction model in a retrospective cohort was studied between January 2015 and September 2022. Multivariate logistic regression models were used to assess predictive variables. The logistic coefficient of each predictor generated scores to establish a predictive model. The area under the receiver operating characteristic curve (AuROC) was used to evaluate the model. The predictive performance was validated using bootstrapping techniques and externally validated in 102 independent cases. Among 416 patients, 178 (43%) required transfusion. Four final predictors: preoperative hematocrit level, laminectomy level, transforaminal lumbar interbody fusion level, and sacral fusion. When categorized into two risk groups, the positive predictive values for the low-risk score (≤ 4) were 18.4 (95% Cl 13.9, 23.6) and 83.9 (95% CI 77.1, 89.3) for the high-risk score (> 4). AuROC was 0.90. Internal validation (bootstrap shrinkage = 0.993) and external validation (AuROC: 0.91). A new model demonstrated exemplary performance and discrimination in predicting the appropriate preparation for PRC. This study should be corroborated by rigorous external validation in other hospitals and by prospective assessments.

Assessment of the Prevalence and Factors Associated with Post-Caesarean Surgical Site Infections among Patients in Fort Portal Regional Referral Hospital

The global incidence of cesarean section deliveries has significantly increased, resulting in a rise in post cesarean surgical site infections (SSIs). These infections pose a notable threat to maternal health, often leading to prolonged hospital stays, elevated costs, and direct health consequences, particularly in populations facing low socioeconomic status, limited resources, and conditions involving forced internal displacement due to conflict. Fort Portal Regional Referral Hospital lacked prior studies on SSIs, prompting the initiation of this research to ascertain the prevalence and specific factors linked to post-caesarean SSIs within the Maternity Ward at FPRRH. The study adopted a retrospective cross-sectional approach, utilizing a pretested checklist to gather information from 110 patient files admitted and operated in Maternity Ward during the six months preceding the investigation. The collected data underwent entry and analysis using IBM SPSS version 25, incorporating the chi-square test to establish relationships between SSIs and associated risk factors. Results were presented through tables and charts. The mean age of study participants was 27.67 years, with a standard deviation of 6 and an age range of 16 to 45 years. A majority (64.3%) were over 30 years old, over 50% hailed from rural areas, and the majority identified as Christians and were married. The overall prevalence of post-caesarean SSIs stood at 12.7%. Statistically significant factors influencing SSIs included gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH. In conclusion, this study revealed a 12.7% prevalence of post-caesarean SSIs, with gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH identified as significant contributing factors. Recognizing and addressing these factors early on could guide obstetricians in enhancing their daily practices, ultimately improving the outcomes of cesarean sections and diminishing the risk of post-caesarean SSIs. Keywords: Cesarean section, SSI, Patients, Post caesarean, FPRRH.

Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis.

In the absence of timely treatment, the risk of rupture in patients with ectopic pregnancy (EP) increases, which is associated with extensive bleeding, complicated surgery, and maternal death. This study aimed to investigate the prevalence of rupture and its related factors among EP cases. A comprehensive, systematic search was conducted in electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Ectopic pregnancies", "Extrauterine pregnancies", and "Ruptured ectopic pregnancy" from the earliest to the 13th of December 2022. The CMA program, version 3, was utilized for analysis. The overall effect size was calculated using the sample size and the frequency of rupturein each of the studies. Heterogeneity was measured using the I2 statistics. A total of 5,269 women with EP participated in 17 studies. The pooled prevalence of rupture was 56.4% (95%CI: 44.9% to 67.2%; I2=98.09%; P<0.001). Factors such as number of parties, amount of β-hCG, age, history of ectopic pregnancy, cornual and isthmic pregnancies, gestational age, number of gravidities, history of tubal ligation, tubal diameters, periods of infertility, history of infertility, pregnancy by ovulation induction, extensive hemoperitoneum, ampullar and isthmic pregnancies, ampullar pregnancies, preoperative heart rate (HR), triage, triage shock index (SI), abdominal pain, single marital status, preoperative hemoglobin levels, preoperative hematocrit levels, history of pelvic inflammatory disease (PID), and use of contraceptives were associated with the prevalence of rupture in EP cases. Based on the findings, 56.4% of EP cases experienced rupture and various factors influence its prevalence. As a result, health managers and policymakers can address and mitigate modifiable factors contributing to rupture in EP cases by implementing regular consultations and screenings.

Risk of deep vein thrombosis (DVT) in lower extremity after total knee arthroplasty (TKA) in patients over 60 years old

PurposeThere is a significant risk of DVT after TKA. We aim to evaluate the potential risk factors for postoperative DVT in the lower extremities in TKA patients over 60 years of age and provide a reference for the effective prevention of DVT.MethodsThis retrospective study included patients older than 60 who underwent TKA surgery in our hospital from May 2015 to May 2022 and compared and analyzed patients' personal characteristics and clinical data with or without postoperative DVT. Logistic regression analysis was performed to determine the potential risk factors for DVT after TKA. The sensitivity and specificity of each risk factor in the diagnosis of DVT were compared by the ROC curve, and the value of this model in the diagnosis of DVT was further investigated using a multivariable combined diagnosis ROC curve model.ResultsA total of 661 patients over 60 who underwent TKA were included. Preoperative Hematocrit (HCT), platelet count, anesthesia mode, postoperative D-dimer, ESR, diabetes mellitus, and other aspects of the DVT group and non-DVT group were statistically significant after TKA (P < 0.05). Multivariate logistics regression analysis showed that preoperative HCT, anesthesia mode, and diabetes were independent risk factors for DVT in patients over 60 years old after TKA. Compared with the univariate ROC model, the multivariable combined ROC curve analysis model has a higher diagnostic value for the diagnosis of DVT.ConclusionDVT is common in patients over 60 years of age after TKA, and there is a multivariable influence on its pathogenesis. For patients over 60 with diabetes, neuraxial anesthesia is recommended for patients with high preoperative HCT levels, which may reduce the incidence of postoperative DVT.

Postoperative Outcomes for Spinal Fusion Procedures in Pediatric Patients with Anemia: A Retrospective and Multivariate Analysis

BackgroundPre-operative anemia is known to be associated with perioperative complications in many surgical interventions. Here, we examine the effects of pre-operative anemia on peri-operative complications and post-operative outcomes in pediatric patients undergoing spinal fusion. MethodsRetrospective analysis was conducted using the American College of Surgeons Pediatric National Surgery Quality Improvement Program Database between 2012-2020. Current Procedural Terminology codes 22800, 22802, 22804, 22840, 22842, 22843, and 22844 were included to represent all primary spinal fusion procedures performed. Patients without pre-operative hematocrit (HCT) levels were excluded. Classification of anemia was determined via age- and sex-adjusted HCT levels. Patient demographics, pre-operative comorbidities and risk factors, and 30-day post-operative outcomes were compared between the two cohorts using univariate analysis. Multivariate logistic regressions were performed to determine if anemia severity was independently associated with worse post-operative outcomes. ResultsA total of 30,243 pediatric patients were included in this study, with 26,621 not having pre-operative anemia and 3,622 having pre-operative anemia. Pediatric patients with anemia have increased length of stay (6.7 ± 9.6 vs. 5 ± 6, P < 0.001), 30-day unplanned reoperation rate (4% vs 2.8%, P <0.001), and total blood transfused (489.9 ± 497.8 vs. 423.4 ± 452.6, P <0.001). Multivariate analysis supported anemia and degree of its severity as an independent predictor of increased length of stay, reoperation rate, and post-operative complications. ConclusionPreoperative anemia leads to worse outcomes in pediatric spinal fusion procedures. Utilizing HCT recordings could be factored into the equation for optimal patient selection and prevention of post-operative complications.

Utility of postoperative laboratory testing after posterior spinal fusion for adolescent idiopathic scoliosis.

With advancements to blood management strategies, risk of perioperative transfusion following surgical treatment of adolescent idiopathic scoliosis (AIS) has diminished. We hypothesize that routine laboratory testing on postoperative-day 1 (POD1) and beyond is unnecessary. The purpose of this study is to determine necessity of POD1 labs, particularly hematocrit and hemoglobin levels, following surgical management of AIS. We performed a retrospective cohort study of consecutive AIS patients aged 11-19 who underwent posterior spinal fusion (PSF) at a single institution. Univariable logistic regression was utilized to determine factors associated with hematocrit ≤ 22% on POD1 or a postoperative transfusion. Firth's penalized logistic regression was used for any separation in data. Youden's index was utilized to determine the optimal point on the ROC curve that maximizes both sensitivity and specificity. 527 patients qualified for this study. Among the eight total patients with POD1 hematocrit ≤ 22, none underwent transfusion. These patients had lower last intraoperative hematocrit levels compared to patients with POD1 hematocrit > 22% (24.1% vs 31.5%, p < 0.001), and these groups showed no difference in preoperative hematocrit levels (38.2% vs 39.8%, p = 0.11). Four patients underwent postoperative transfusion. Both preoperative hematocrit levels (34.0% vs 39.9%, p = 0.001) and last intraoperative hematocrit levels (25.1% vs 31.4%, p = 0.002) were lower compared to patients without transfusion. Intraoperative hematocrit < 26.2%, operative time of more than 35.8min per level fused, or cell salvage > 241cc were significant risk factors for postoperative transfusion. Transfusion after PSF for AIS is exceedingly rare. POD1 labs should be considered when last intraoperative hematocrit < 26%, operative time per level fused > 35min, or cell salvage amount > 241cc. Otherwise, unless symptomatic, patients do not benefit from postoperative laboratory screening.

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.

Concurrent Cholecystectomy Does Not Increase Splenectomy Morbidity in Patients With Hemolytic Anemia: A Pediatric NSQIP Analysis

PurposeChildren undergoing splenectomy for hemolytic anemia often have cholelithiasis, which may or may not be symptomatic. It is unclear whether concurrent cholecystectomy increases length of stay or morbidity after splenectomy. The purpose of this study was to compare morbidity among children undergoing laparoscopic splenectomy alone versus splenectomy with concurrent cholecystectomy in patients with hemolytic anemia. MethodsWe retrospectively evaluated children with hemolytic anemia undergoing non-traumatic laparoscopic splenectomy in the National Surgical Quality Improvement Program-Pediatric database (2012–2020). Outcomes were compared for patients undergoing splenectomy alone (n = 1010) versus splenectomy with cholecystectomy (n = 371). Pearson's Chi-square and Student's t-tests were utilized as appropriate. Propensity score-matching was completed, controlling for eight demographic and clinical variables. Results1381 patients were identified, 73.1% undergoing splenectomy alone and 26.9% splenectomy with cholecystectomy. Splenectomy with cholecystectomy patients were older (10.9 years vs. 8.4 years, p < 0.01), more likely to have hereditary spherocytosis (56.1% vs. 40.8%, p < 0.01), less likely to have sickle cell disease (12.1% vs. 33.5%, p < 0.01), more likely ASA class 1 or 2 (49.3% vs. 42.1%, p < 0.01), and had similar preoperative hematocrit levels (29.6 vs. 29.3, p = 0.33). The splenectomy with cholecystectomy group was less likely to receive preoperative blood transfusions (13.5% vs. 25.4%, p < 0.01). There were 360 pairs selected on propensity score-matching, and splenectomy with cholecystectomy was associated with increased operative time (182 min vs. 145 min, p < 0.01) and decreased occurrences of a postoperative transfusion (4.2% vs. 8.9%, p = 0.01). Length of stay after surgery (2.5 days vs. 2.3 days, p = 0.13), composite morbidity (3.9% vs. 3.4%, p = 0.69), and 30-day readmission rates (3.3% vs. 7.4%, p = 0.08) were all similar. ConclusionsSplenectomy with cholecystectomy is associated with similar postoperative morbidity, length of stay and readmission rates compared to splenectomy alone. These data support the safety of concurrent cholecystectomy with splenectomy for children with cholelithiasis in the setting of hemolytic anemia. Type of StudyRetrospective Cohort Study. Level of EvidenceLevel III.

Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip?

In this study, we aimed to investigate whether the use of epinephrine solution-impregnated gauzes and irrigation fluid with epinephrine could reduce perioperative blood loss during the combined surgical treatment of developmental dysplasia of the hip (DDH) patients. Between January 2018 and June 2023, a total of 68 pediatric patients (8 males, 60 females; mean age: 32.4±13.2 months; range, 18 to 98 months) who underwent combined surgery for DDH were retrospectively analyzed. The patients were divided into two groups as those who used topical epinephrine in the surgical sites during combined surgical treatment (n=34) and those who did not (n=34). Demographic and clinical characteristics and pre-, intra-, and postoperative data were recorded. To avoid transfusion complications, blood transfusion was performed in only symptomatic patients in the postoperative period. Age, sex, weight, and surgical duration were similar between the two groups (p>0.05). No statistically significant difference was found between the groups in terms of preoperative hemoglobin and hematocrit levels (p>0.05) There were statistically significantly differences between the groups in terms of postoperative hemoglobin and hematocrit levels, perioperative amount of blood loss, and postoperative length of hospital stay (p<0.001). No significant difference was found between the groups in terms of intraoperative hemodynamic parameters (p>0.05). The differences in perioperative and estimated intraoperative blood loss amounts and length of hospital stay were statistically significant between the groups (p<0.001). There was a significant relationship between the groups in terms of perioperative and estimated intraoperative blood loss, and transfusion of blood products (p<0.01). Blood transfusion was administered to five patients in the no epinephrine group. No local complications were observed in any group; however, one patient had transfusion-related fever and one patient had allergic skin lesions in the no epinephrine group. The intraoperative topical use of epinephrine irrigation solution and epinephrine solution-impregnated gauze dressings is effective and safe in reducing blood loss in DDH patients.

Perioperative Haemorrhage in Transurethral Resection of Prostate: Impact of 5 Alpha Reductase Inhibitors in the Reduction of Perioperative Blood Loss

Introduction: Benign prostatic hyperplasia (BPH) is an age dependent disorder characterized by hyperplasic changes in the tissue resulting in enlargement of the prostate that may lead to difficultly in micturition or impairment in the flow of urine from the bladder. Medical treatment is the primary option for the patient with mild to moderate voiding symptoms which consists of alpha blockers and 5-alpha reductase inhibitors either as mono-therapy or in combination therapy. Materials and Methods: A observational cross-sectional study was conducted in a teaching hospital. Total sixty-four patients were selected from hospital records. Group-A received Alpha blocker along with Dutasteride while group-B received Alpha blockers only as a primary medical treatment two weeks prior to transurethral resection of prostate for benign prostatic hyperplasia. Patients were followed up after 24 hours of surgery in which hematocrit levels were estimated. Blood loss was calculated by recording pre-operative and post-operative (after 24 hours) hematocrit level. Data were tabulated and analyzed by SPSS v25. Comparison of two groups’ Group A Alpha-blocker with Dutasteride and Group B with Alpha-blocker only was done by applying independent sample t-test. A p-value ≤0.05 was taken as significant. Results: A total of 64 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (TURP with Alpha-blocker &amp;Dutasteride) and Group-B (TURP with Alpha-blocker). Mean age of group-A patients was 66.4±7.5 years and 66.5±7.2 years in group-B. Mean blood loss of group-A patients was 158.3±131.1 ml and 311.5±150.7 ml in group-B with a p-value of 0.000054, which is statistically significant. Conclusion: Patients on Dutasteride have less perioperative bleeding during transurethral resection of prostate for benign prostatic hyperplasia.

Do preoperative hemoglobin and hematocrit levels predict postoperative nausea and vomiting in orthognathic surgery patients? A retrospective case-control study

Do preoperative hemoglobin and hematocrit levels predict postoperative nausea and vomiting in orthognathic surgery patients? A retrospective case-control study

Preoperative Hematocrit Level and Associated Risk of Transfusion for Myomectomy Based on Myoma Burden and Surgical Route

To determine the association between preoperative hematocrit level and risk of blood transfusion for laparotomic and laparoscopic myomectomy based on myoma burden and surgical route. A cohort study of prospectively collected data. American College of Surgeons National Surgical Quality Improvement Program participating institutions. A total of 26229 women who underwent a laparotomic or laparoscopic myomectomy from 2010 to 2020. The primary outcome assessed was the risk of transfusion based on preoperative hematocrit level. This was evaluated with respect to myoma burden and surgical route. There were 26229 women who underwent a myomectomy during the study interval, 2345 women (9%) of whom required a blood transfusion. Compared with patients who did not require transfusion, those who did had lower median preoperative hematocrit levels (34.7 vs 38.2). Patients were stratified by surgical approach (laparotomic vs laparoscopic) and myoma burden (1-4 myomas/weight ≤250 g or ≥5 myomas/weight >250 g) using Current Procedural Terminology codes (58140, 58146, 58545, 58546). In all categories, there was an inverse relationship between blood transfusion and preoperative hematocrit level with increasing risk depending on preoperative hematocrit range. The odds ratios comparing hematocrit level of 29% with 39% were 6.16 (95% confidence interval [CI], 5.15-7.36), 4.92 (95% CI, 4.19-5.78), 4.85 (95% CI, 3.72-6.33), and 5.2 (95% CI, 3.63-7.43) for patients with laparotomic (1-4 myomas/≤250 g, ≥5 myomas/>250 g) and laparoscopic myomectomy (1-4 myomas/≤250 g, 5 myomas/>250 g), respectively. Incremental increases in hematocrit result in a significantly decreased risk of blood transfusion at the time of myomectomy.

7413 Preoperative Hematocrit and Transfusion Risk for Myomectomy Based on Surgical Route and Fibroid Burden

<h3>Study Objective</h3> To determine the association between preoperative hematocrit and rate of transfusion for abdominal and laparoscopic myomectomy based on fibroid burden. <h3>Design</h3> Retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database. <h3>Setting</h3> NSQIP participating institutions. <h3>Patients or Participants</h3> 26,229 women who underwent a myomectomy from 2010 - 2020. <h3>Interventions</h3> Abdominal or laparoscopic myomectomy. <h3>Measurements and Main Results</h3> 2,345/26,229 (9%) patients received a blood transfusion intra or postoperatively. Compared with patients who did not require transfusion, those who required transfusion had lower median preoperative hematocrit levels (34.7 vs. 38.2, p<0.01). The preoperative hematocrit levels were inversely associated with the rate of transfusion both overall (53%, 42%, 32%, 20%, 11%, 6%, 5% 4% for preoperative hematocrit level categories <24, 24-27, 27-30, 30-33, 33-36, 36-39, 39-42, >42, respectively) and stratified by surgical approach and fibroid burden (abdominal/1-4 myomas/weight ≤250g: 63%, 30%, 34%, 19%, 9%, 6%, 5%, 3%; laparoscopic/1-4 myomas/weight ≤250g: 30%, 19%, 11%, 5%, 2%, 1%, 2%, 1%; abdominal/≥5 myomas/weight >250g: 61%, 68%, 52%, 35%, 22%, 15%, 12%, 8%; and laparoscopic/≥5 myomas/weight >250g: 25%, 52%, 17%, 7%, 6%, 4%, 3%; all p<0.01). In addition, compared with abdominal, laparoscopic myomectomy is associated with a lower risk of transfusion both overall (3% vs. 13%, odds ratio: 0.20, 95% confidence interval: 0.18 - 0.22, p<0.01) and stratified by fibroid burden (1-4 myomas/weight ≤250g: 2% vs 9%, p<0.01; and ≥5 myomas/weight >250g: 5% vs. 19%, p<0.01). <h3>Conclusion</h3> A laparoscopic approach and higher preoperative hematocrit were associated with a lower risk of transfusion for myomectomy. This study provides valuable data to optimize anemia prior to myomectomy to decrease the risk of transfusion, perform patient counseling regarding risk of transfusion for myomectomy, and select the optimal surgical route for myomectomy.

Incidence and risk factors for acute kidney injury after total joint arthroplasty

BackgroundAcute kidney injury (AKI) is one of the most common medical causes for readmission following total joint arthroplasty (TJA). This study aimed to (1) examine whether the incidence of AKI has changed over the past decade with the adoption of modern perioperative care pathways and (2) identify the risk factors and concomitant adverse events (AEs) associated with AKI.Methods535,291 primary TJA procedures from the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2018 were retrospectively reviewed. The annual incidence of AKI was analyzed for significant changes over time. Matched cohort analyses were performed to identify the risk factors and AEs associated with AKI using multivariate logistic regression.ResultsThe mean incidence of AKI was 0.051%, which remained unchanged during the study period (P = 0.121). Factors associated with AKI were diabetes (OR 1.96, P = 0.009), bilateral procedure (OR 6.93, P = 0.030), lower preoperative hematocrit level (OR 1.09, P = 0.015), body mass index (OR 1.04, P = 0.025), and higher preoperative BUN (OR 1.03, P = 0.043). AKI was associated with length of stay (LOS) > 2 days (OR 4.73, P < 0.001), non-home discharge (OR 0.25, P < 0.001), 30-day readmission (OR 12.29, P < 0.001), and mortality (OR 130.7, P < 0.001).ConclusionsThe incidence of AKI has not changed over the past decade, and it remains a major bundle buster resulting in greater LOS, non-home discharge, readmissions, and mortality. Avoidance of bilateral TJA in patients with DM and high BMI as well as preoperative optimization of anemia and BUN levels are advised.

Haematocrit Patterns following Transurethral Resection of Prostate for Benign Prostatic Hyperplasia among Jehovah’s Witnesses

Background: Transurethral resection of the prostate (TURP) is a gold standard surgical intervention for managing symptomatic benign prostatic hyperplasia (BPH) due to its minimal blood loss benefit, especially when dealing with patients that do not consent to blood transfusion. However, there is still a dilemma on the efficacy of this procedure as a preferable choice in minimising blood loss. This study aimed to highlight the pattern of haematocrit levels of Jehovah’s Witnesses’ subjects with BPH following TURP. Methodology: This is a retrospective study of sixty-seven Jehovah’s Witnesses patients with BPH who underwent TURP at the University of Port Harcourt Teaching Hospital and a private hospital from January 2009 to January 2021. Their venous pre-operative haematocrit levels were measured a day before TURP and on a postoperative day 3. Overall blood loss was estimated by subtracting the post-operative packed cell volume (post-ops PCV) from Pre-operative Packed cell volume (Pre-ops PCV) [Overall Blood Loss (%)= post-ops PCV – Pre-ops PCV]. Estimated Blood Loss (ml) = Overall Blood Loss (%) divided by 3% multiplied by 450 ml. Results: Mean age of the study population who underwent TURP was 68.05±8.4 years, while the mean pre-and post-operative haematocrit levels were 35.65±6.5% and 31.44±4.3 %, respectively. There was an age-independent significant association between the pre-and post-operative haematocrit levels (P=0.0004). The pre-operative haematocrit levels significantly reduced with age and increased in the younger age group, while the post-operative haematocrit level did not change significantly with age (P=0.019 and P=0.19 respectively). The net blood loss of BPH patients below their sixties was considerably higher than the amount lost in their BPH counterparts above their sixties (P=0.014). Conclusion: Although TURP is a preferable choice in the surgical management of clinical BPH, bleeding is still one of the possible complications. The younger age group (those below their sixties) are more prone to blood loss using this intervention. Hence, it is a more preferable choice for managing BPH in the elderly. A subsequent study will provide a more robust population size and working variables for validation and generalization of the results.