Preoperative Hemoglobin Values Research Articles

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

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

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

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

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

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

P46. TXA vs no TXA: tranexamic acid in lumbar fusion, a retrospective study comparison

<h3>BACKGROUND CONTEXT</h3> Tranexamic Acid (TXA) has been proven safe and efficacious in procedures with large volume blood loss (joint replacement and cardiac surgery). Its role as a pharmaceutical agent for blood loss preservation for long-segment spinal fusion (complex spinal fusion, deformity cases) has also shown promising results. However, it remains unclear if the risk of potential thrombogenesis that could lead to venous thrombotic events (VTE) outweighs its benefits in shorter cases less likely to need blood transfusion. TXA is widely available in various forms, (ie, oral, topical, intravenous [IV]); consensus is lacking with regards to the optimal dosing regimen for spinal fusion. <h3>PURPOSE</h3> Our study objective is to evaluate IV TXA use in lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective/single center. <h3>PATIENT SAMPLE</h3> Patients undergoing 2-5 level lumbar fusion with instrumentation. <h3>OUTCOME MEASURES</h3> EBL, POD 1 hemoglobin, blood transfusion requirements, LOS, post-dose incidence of VTE. <h3>METHODS</h3> A total of 251 patients were included in this retrospective case series (2018-2019). Demographics, patient characteristics, estimated blood loss (EBL), postoperative day (POD) 1 hemoglobin, transfusion requirements, VTE, and length of stay (LOS) were compared between a group who received TXA (TXA) and a control group who did not (No TXA). The No TXA group are historical patients 6 months preTXA use, and those with contraindications during the treatment period (ie, history of hypersensitivity, bleeding, clotting, recent trauma or significant kidney disease). Treatment modality was 2 grams infused over 30 minutes perioperatively (1 gram prior to incision and repeated at closure). Data was analyzed with t-test (or Wilcoxon test) and Chi-squared test (or Fisher's exact test). P< 0.05 are to be considered statistically significant. <h3>RESULTS</h3> The two groups were similar in characteristics. There were no differences in age, gender, BMI and ASA score, all p>0.05. Both groups had similar smoking status (p=0711) and preoperative hemoglobin values (No TXA 13.9mg/dL ± 1.3mg/dL vs TXA 14.1± 1.5mg/dL, p=0.305). All patients had degenerative disease, approximately 10% had concurrent scoliotis. Number of levels intrumented: 2 (37%), 3 (23%), 4 (22%) and 5 (18%). No difference in the distribution in terms of primary vs revision surgery (p=0.209). Thirty-six percent (n-91) received 1-2 doses. Of the 91 treated patients, 90% (n-82) received the two doses, at preincision and closure; 99% (n-90) received a dose at preincision and 91% (n-83) at closure. With two doses, the average dose administered was 22mg/kg ±6.1mg/kg. EBL was skewed with outliers, No TXA median (IQR): 300 (150-450) vs TXA median (IQR): 250 (150-300), p=0.078. Cell saver utility by both groups were similar (No TXA 27%, TXA 24%); no difference in amount returned (p=0.739). Although the TXA group had significantly higher hemoglobin level on POD1 (No TXA 10.8±1.5 g/dL vs TXA 11.5±1.5 g/dL, p<0.001), both groups had similar low incidence of severe postoperative anemia requiring blood transfusion (No TXA 7.5% vs TXA 3.3%, p=0.268). A difference in LOS was observed (No TXA 3.5+1.3 days vs TXA 3.2+1.1 days, p=0.02). While hospitalized, one patient in the control group developed deep vein thrombosis on POD4; no VTE was reported in the TXA group. <h3>CONCLUSIONS</h3> With or without TXA, EBL was comparable in 2-5 level lumbar fusion. Patients in the TXA group, however, had a higher POD 1 hemoglobin and had shorter length of hospitalization. No VTE was reported among the TXA treated population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Independent risk factors affecting hemorrhage in percutaneous nephrolithotomy: Retrospective study

IntroductionThe perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL. Material and methodA total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity. ResultsThe mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=0.019), MPV (P=0.000), NLR (P=0.005), stone volume (P=0.041) and HU (P=0.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=0.022). No effects at significant levels were identified for gender (P=0.078), presence of atheroma plaque (P=0.949), obesity (P=0.869), age (P=0.686), urine pH (P=0.746), urine density (P=0.421), and PLR (P=0.855) on Hgb variations. ConclusionIn addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Use of ureteral catheter in uterine-sparing surgery for placenta accreta

Objective: The study aimed to investigate the effect of ureteral catheter use during surgery on the outcomes of obstetric and urinary complications in patients with placenta accreta spectrum (PAS) and placenta previa. Methods: The patients who were followed up at Meram Medical Faculty Hospital of Necmettin Erbakan University between January 2016 and November 2021 and diagnosed with PAS and placenta previa were included. Patients who underwent emergency and planned surgery were grouped as those with or without an intraoperative ureteral catheter. The primary outcome was determined as the rate of urinary system damage among these groups. The number of blood transfusions, preoperative and postoperative hemoglobin values and hemoglobin changes, length of hospitalization, patients who underwent uterine-sparing surgery or hysterectomy, urinary tract injury, and wound infection were compared regarding the use of catheters. Results: A total of 122 patients were included in the study. While an intraoperative ureteral catheter was placed in 56 (45.01%) patients, it was not used in 66 (54.09%) patients. Bladder injuries were determined in 31 (55.4%) patients with a catheter and 13 (19.7%) patients without a catheter, and no other urinary system injuries were found. The incidence of bladder injury was statistically significantly higher in the group with a catheter (p=0.001). The number of transfused erythrocyte suspensions, the hemoglobin change according to the preoperative hemoglobin level, and the mean duration of hospitalization in patients with a catheter were statistically significantly greater than the group without a catheter (p=0.001). Conclusion: Ureteral catheterization did not reduce urinary damage in patients with PAS and placenta previa who underwent uterine-sparing surgery and hysterectomy. However, we believe that the insertion of a catheter increases the possibility of diagnosing intraoperative damage.

Evaluation of Blood Loss in Conventional vs MAKOplasty Total Knee Arthroplasty

BackgroundPrimary total knee arthroplasty (TKA) has been historically associated with considerable blood loss. Allogenic transfusions, the standard of care for blood loss following TKA, carry inherent risks. With the expanding use of robotic technology in TKA, one theoretical advantage is decreased blood loss and postoperative blood transfusions requirements. The purpose of this study was to compare postoperative hemoglobin levels and the percentage of patients requiring a transfusion of allogenic packed red blood cells after conventional TKA (CTKA) vs robot-assisted TKA (RATKA). MethodsThis is a retrospective review of 486 consecutive patients undergoing either CTKA or RATKA between October 30, 2018, and June 25, 2020, by a single fellowship-trained arthroplasty surgeon. Mako SmartRobotics (Stryker, Kalamazoo, MI) was used for RATKA cases. Primary outcomes included preoperative vs postoperative hemoglobin values and postoperative blood transfusion rates between the 2 groups. ResultsThe mean hemoglobin on postoperative day 1 was 10.7 gm/dl (±1.3) in the CTKA group and 10.9 gm/dl (±1.3) in the RATKA group, P = .24. The largest decline in hemoglobin from preoperative to within 2 days postoperatively was 3.1 gm/dl (±1.1) in the CTKA group and 3.1 gm/dl (±1.1) in the RATKA group, P = .92. The percentage of patients requiring a blood transfusion was 1.1% in the CTKA group and 1.3% in the RATKA group, P = .79. ConclusionsRATKA and CTKA groups did not have significant differences in postoperative hemoglobin changes or the need for postoperative blood transfusions.

Factores de riesgo independientes asociados al sangrado en la nefrolitotomía percutánea: estudio retrospectivo

IntroductionThe perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL. Material and methodA total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity. ResultsThe mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=.019), MPV (P=.000), NLR (P=.005), stone volume (P=.041) and HU (P=.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=.022). No effects at significant levels were identified for gender (P=.078), presence of atheroma plaque (P=.949), obesity (P=.869), age (P=.686), urine pH (P=.746), urine density (P=.421), and PLR (P=.855) on Hgb variations. ConclusionIn addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Evaluation of the HemoCue® for blood loss estimation in suction fluid in patients undergoing neurosurgical procedures: A prospective observational study.

Blood loss in neurosurgical procedures can be rapid and tremendous leading to consequential hemodynamic instability. HemoCue is a portable photometer used for the measurement of blood hemoglobin concentration. Using this point of care device, we contemplated this study to assess the reliability of HemoCue for suction hemoglobin determination and calculation of surgical blood loss by comparing with the gold standard laboratory Coulter Counter method in patients undergoing neurosurgical procedures. This prospective observational study was conducted in 233 patients undergoing elective neurosurgical procedures in the age group of 18 to 60 years and having preoperative hemoglobin (Hb) values above 9 g/dL. Values of preoperative hemoglobin, suction hemoglobin, and volume in the suction container were used to obtain the estimated blood loss. The normality of the data was tested using the Kolmogorov Smirnov test. Bland Altman analysis was used to test the reliability of HemoCue in estimating hemoglobin and blood loss with reference to the gold standard laboratory Coulter Counter automated hematology analyzer. Median blood loss calculated in our study using HemoCue was 554.65 mL with an interquartile range of 336.81 mL to 982.39 mL. Laboratory counter method estimated median blood loss was 533.37 mL with an interquartile range of 335.21 mL to 994.73 mL. The majority of the data obtained and analyzed using the Bland and Altman analysis method were within a 95% confidence interval. The HemoCue method is a reliable method and henceforth can be used to estimate blood loss in suction fluid in patients undergoing neurosurgical procedures.

Length of Hospital Stay after Total Knee Arthroplasty: A Correlation Study on 1200 Patients.

In countries with a high average population age, total knee arthroplasty is still carried out in an inpatient setting. The roadmap to performing major surgery on an outpatient basis passes through the understanding of those perioperative features that correlate with higher lengths of hospital stay (LOS). A retrospective database of 1200 patients was reviewed for retrieving preoperative and perioperative factors including anthropometric and demographic data, comorbidities, preoperative laboratory assessment, and surgical time. Considering the LOS as a discrete series, data were analyzed by means of logistic regression with multiple univariate and multivariate models. The results showed a median length of hospital stay of 3 (IQR 3, 4) days. According to multiple univariate analysis, arterial hypertension (p = 0.008), diabetes mellitus (p = 0.028), CCI score (p < 0.001), ASA score (p = 0.006), surgical time (p < 0.001) and intraoperative blood loss (p < 0.001) were significantly associated with the duration of hospital stay in days. Moreover, preoperative hemoglobin value was inversely correlated to the LOS (p = 0.008). Multivariate analysis showed a significant correlation between LOS and surgical time and intraoperative blood loss. Many factors influence the permanence of the inpatient and acting on those variables, by stabilizing comorbidities and optimizing laboratory values, may reduce the overall healthcare burden.

Estimating blood loss during cesarean delivery: A comparison of methods

ObjectivesObstetrical hemorrhage contributes significantly to maternal morbidity and mortality. Assessment of blood loss while undergoing cesarean sections (CS) is essential in lowering the morbidity and mortality, however this amount is commonly underestimated by the surgeon and probably the anesthetist too. MethodsThis study addresses this issue by comparing three separate ways of assessing blood loss during cesarean sections. For each of 97 full-term pregnant women undergoing elective CS, blood loss was measured by the following: visual estimation by both the obstetrician and the anesthetist, weighing surgical pads pre operatively and post operatively and by calculations (multiplying the difference of pre-operative and postoperative hemoglobin values by the patient's estimated blood volume). ResultsThe results of this study indicated that the lowest estimated value for blood loss came from visual estimation, while the highest value came from the mathematical formula. Anesthetists were more accurate in their visual estimation of blood loss than were obstetricians. ConclusionThis study found the amount of blood loss during CS to be overestimated by the mathematical calculation and underestimated by obstetricians. However, the estimate given by anesthetists was close to that obtained by weighing pads. This underscores the need for more accurate methods of blood loss estimation in cesarean sections to be adopted.

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.

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

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

Preoperative nutritional evaluation of prostate cancer patients undergoing laparoscopic radical prostatectomy.

Background and objectiveProstate cancer (PCa) is one of the most common malignant tumors in men. Geriatric Nutritional Risk Index (GNRI) is an objective index for evaluating nutritional status of elderly people over 65 years old. The aim of the current study was to explore the correlation and predictive value between GNRI and postoperative recovery and complications in PCa patients undergoing laparoscopic radical prostatectomy (LRP).MethodsTaking 98 as the GNRI boundary value, 96 PCa patients (aged≥65 y) undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were grouped into malnutrition group (MNg, 34 patients, 35.4%) and normal nutrition group (NNg, 62 patients, 64.6%). Basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were recorded and retrospectively analyzed. Clavien-Dindo Classification System (CDCS) was used to assess postoperative complications. T-test was used to analyze differences between the two groups. ROC curve was generated to determine the predictive value of GNRI for postoperative complications.ResultsPercentage of complications was significantly higher in MNg group compared with that in NNg group (P < 0.01). The average grade based on CDCS was significantly lower in NNg group compared with that in MNg group (P < 0.01). Body weight, Body Mass Index (BMI), preoperative hemoglobin value (HGB), serum albumin (ALB) values of MNg and NNg were significantly positively correlated with GNRI (P<0.01). Incidence and severity of postoperative complications of MNg patients were significantly higher compared with those of NNg patients (P<0.05). Average hospitalization cost of MNg patients was higher in MNg patients compared with that of NNg patients (P<0.05). Duration of post-anesthesia care unit (PACU), duration of antibiotic use and duration of indwelling drainage tube were longer in MNg patients compared with those in NNg patients (P<0.05). Furthermore, volume of indwelling drainage tube was higher in MNg patients compared with that in NNg patients (P<0.05).ConclusionGNRI is an effective and reliable tool for evaluation of preoperative nutritional status of prostate cancer patients. The findings showed that GNRI is correlated with postoperative recovery and complications, and is an effective predictive marker.

Critical Preoperative Hemoglobin Value to Predict Anemia-Related Complications After Cardiac Surgery

Preoperative anemia is frequent in patients undergoing cardiac surgery and is associated with increased postoperative complications. The purpose of this observational study was to estimate the critical preoperative hemoglobin threshold associated with the occurrence of complications after cardiac surgery. A retrospective observational cohort study. A tertiary-care medical center from January 2019 to April 2020. A total of 1,004 patients undergoing elective cardiac surgery were included. None (observational study). The primary study endpoint was to define the hemoglobin threshold that predicted the occurrence of postoperative major complications after elective cardiac surgery. Postoperative complications were a composite criterion, including transient ischemic attack or stroke, myocardial infarction, acute kidney injury, respiratory failure, mediastinitis, or mesenteric ischemia. A discrimination threshold was determined by using receiver operating characteristic curves. The discrimination threshold for hemoglobin concentration with the best sensitivity/specificity ratio for the occurrence of postoperative complications was 13 g/dL for male patients and 11.8 g/dL for female patients. The incidence of postoperative complications was 17.2% in the total population. Independent risks were preoperative hemoglobin concentration, red blood cell transfusion, European System for Cardiac Operative Risk Evaluation II, and the type of surgery. The critical preoperative hemoglobin thresholds associated with the occurrence of postoperative complications with the best sensitivity/specificity ratio were 13 g/dL for men and 11.8 g/dL for women, which were very similar to the World Health Organization criteria defining anemia.

Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers

This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR=2.35; 95% CI, 1.3-4.78), induction of labor (OR=1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10g/dl (OR=2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.

Risk Reduction and Perioperative Complications in Diabetics with Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction

Category:Diabetes; OtherIntroduction/Purpose:Modern Patient Safety Programs focus on medical optimization prior to surgery, regional anesthesia and hospitalist-orthopaedic co-management during the perioperative period.Methods:Eighty-five consecutive diabetic patients with multiple medical co-morbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized perioperative medical optimization program, which included medical optimization prior to surgery, regional anesthesia whenever possible and hospitalist-orthopaedic comanagement during hospitalization. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk.Results:On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (RR = 1.36; P =.01) and congestive heart failure (RR = 1.42; P =.02). There were 22 (27%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), one cardiac event, and one pulmonary embolism. Overall, the accuracy of predicting a complication using the NSQIP risk calculator was 74% (95% CI: 63% - 85%) which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI: 62% - 86%).Conclusion:Medical optimization of diabetic patients with multiple medical co-morbidities prior to elective complex reconstruction orthopaedic surgery leads to improved clinical outcomes. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The American College of Surgeons NSQIP Risk Calculator is a reliable predictor of complications in the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to risk for complication.

Analysis of risk factors affecting mortality in elderly patients operated on for hip fractures: A retrospective comparative study.

The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 ± 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 ± 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 ± 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 ± 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 ± 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores ≥3, the existence of ≥ 3 comorbidities were found as main predictors of increased mortality rates. The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty. Level III, Therapeutic Study.

Intraoperative Allogeneic Red Blood Cell Transfusion Negatively Influences Prognosis After Radical Surgery for Pancreatic Cancer: A Propensity Score Matching Analysis.

We aimed to investigate the real impact of allogeneic red blood cell transfusion (ABT) on postoperative outcomes in resectable pancreatic ductal adenocarcinoma (PDAC) patients. Of 128 patients undergoing resectable PDAC surgery at our facility, 24 (18.8%) received ABT. Recurrence-free survival (RFS) and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ABT. In the entire cohort, ABT was significantly associated with decreased RFS (P = 0.002) and DSS (P = 0.014) before PSM. Cox regression analysis identified ABT (risk ratio, 1.884; 95% confidence interval, 1.015-3.497; P = 0.045) as an independent prognostic factor for RFS. Univariate and multivariate analysis identified preoperative hemoglobin value, preoperative total bilirubin value, and intraoperative blood loss as significant independent risk factors for ABT. Using these 3 variables, PSM analysis created 16 pairs of patients. After PSM, the ABT group had significantly poorer RFS rates than the non-ABT group (median, 9.8 vs 15.8 months, P = 0.022). Similar tendencies were found in DSS rates (median, 19.4 vs 40.0 months, P = 0.071). This study revealed certain negative effects of intraoperative ABT on postoperative survival outcomes in patients with resectable PDAC.

P14.33 Preoperative Lactate Dehydrogenase levels as a predictor of venous thromboembolism development in glioblastoma patients

Abstract BACKGROUND Venous thromboembolism (VTE) is a common complication in patients with glioblastoma. Despite high incidence of up to 30% per year, concerns about bleeding complications have limited the use of primary anticoagulant prophylaxis. Finding a suitable biomarker to assess the risk of occurrence is therefore of utmost clinical interest. We performed an exploratory study of preoperative routinely used haematological markers as predictor for the development of VTE in glioblastoma patients. MATERIAL AND METHODS Data was retrospectively collected from an existing database of 307 patients diagnosed with glioblastoma by the Oncology Network South-East Netherlands (OnzoZON) between 2006 and 2020. Collected preoperative haematological markers included: haemoglobin, platelets, lactate dehydrogenase, neutrophils, lymphocytes, albumin and derived ratios. In addition, type and date of VTE were retrieved from medical records. Receiver operating curve was used to identify the optimal cut-off values of the preoperative haematological markers. Univariate and multivariate logistic regression analyses were performed to predict VTE for each haematologic marker independently. Variables included in the multivariate analyses were age, gender, type of surgery, Karnofsky performance score, MGMT status, weight, height and BMI, already available from the primary database. RESULTS In the total dataset, 45 patients (15%) suffered from a VTE, most common pulmonary embolism (51%) followed by deep vein thrombosis (31%). Mean time from diagnosis until VTE was 4.3 months (SD = 5.5). Preoperative haemoglobin value was available for analyses in 265 patients, platelets value in 226, lactate dehydrogenase in 98, neutrophils in 133, lymphocytes in 133 and albumin in 56 patients. A preoperative lactate dehydrogenase value &amp;gt; 243 U/L was found to increase the risk of VTE in both univariate and multivariate analysis (P &amp;lt;0.05). Seventeen out of 98 patients of whom lactate dehydrogenase level was available suffered from a VTE, most common pulmonary embolism (59%), followed by deep vein thrombosis (29%) and cerebral venous sinus thrombosis (12%). An elevated lactate dehydrogenase in serum increased the odds for getting a VTE by 3.2 (1.1–9.4). None of the other investigated haematological markers or ratios were found to be significantly correlated with the occurrence of VTE in our study. CONCLUSION Glioblastoma initiates locally haemostatic abnormalities, that propagate systemically though circulating mediators. Our exploratory analysis shows for the first time that preoperative lactate dehydrogenase levels might aid clinicians in identifying patients at risk for a venous thromboembolism. Ultimately this could lead to preventive measures and patient education, but larger and prospective validation of these findings is warranted.