Presence Of Transfusion Research Articles

Transfusion practice in the bleeding critically ill: An international online survey-The TRACE-2 survey.

BackgroundTransfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non‐bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients.Study design and methodsAn international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non‐massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines.ResultsSix hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p < .001). For RBC transfusion in the general non‐massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0–7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26–50] × 109/L was applied.DiscussionHalf of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non‐massively bleeding ICU population restrictive transfusion triggers were chosen.

Real-world assessment of myelodysplastic syndrome: Japanese claims data analysis.

Aim: To describe the treatment landscape and associated economic burden for myelodysplastic syndromein Japan. Methods: We studied nationwide retrospective claims data from 2008 to 2019. The study cohort was categorized into patients receivingtransfusion, erythropoiesis-stimulating agent, erythropoiesis-stimulating agent+transfusion, azacitidine, azacitidine +transfusion and others. Results: Our study found that theazacitidine+transfusiongroup had the highest medical cost and severity of disease compared withtheother groups. In those patients, healthcare resource utilization and thecosts of transfusions, including iron chelation therapy, increased medical costs. Conclusion: Our retrospective analysis provides a current snapshot of real-world treatment patterns and associated incremental economic costs of iron chelation therapy with thepresence of transfusions that drive an increase in total costs.

Single Port Laparoscopic Liver Resection

Introduction: Recently, due to improved laparoscopic instruments and increasing experience with laparoscopic and liver surgery, the technical difficulty of laparoscopic liver resection is slowly being overcome. More recently, in an attempt to decrease abdominal wall trauma and visible scar, single-port access surgery has been developed, and this field is rapidly evolving. We herein report early initial experience of single port laparoscopic liver resection for hepatic neoplasms. The aim of this study was to evaluate the technical feasibility and limitation of this procedure for hepatic neoplasms. Method: In this study, 45 patients underwent laparoscopic liver resection from December 2009 to December 2016 in Korea University Ansan Hospital were enrolled. Result: Mean age was 55.9 ± 9.9 years old. Male to female ratio was 4.6:1. Mean operation time is 154 ± 94 minutes and portal clamping was not used for all patients. Mean size of tumor was 2.3 ± 1.34 cm. The resection margin was free in all cases, however, the mean length from tumor to nearest resection margin was 1.34 ± 1.28 cm. Twelve patients (26.7%) were transfused in perioperative period. Ten patients underwent single port laparoscopic liver resection and 1 patients had conversion to conventional laparoscopic operation. Nonanatomical resection were performed in 29 patients (64.4%). Tumors were located in segment 2 (5 cases, 11.1%), segment 3 (10 cases, 22.2%), segment 4 (3 cases, 6.7%), segment 5 (10 cases, 22.2%), segment 6 (15 cases, 33.3%), and segment 8 (2 cases, 4.4%). There was no significant difference in gender, operation time, tumor size, tumor location, margin status, presence of transfusion, length of hospital stay, operative type and recurrence. Conclusion: Single port laparoscopic liver resection can be performed safely and effectively in patients with hepatic malignancy.

Impact of Anemia and Transfusion on Readmission and Length of Stay After Spinal Surgery: A Single-center Study of 1187 Operations.

Retrospective cohort study. To determine whether receipt of blood transfusion and preoperative anemia are associated with increased rates of 30-day all-cause readmission, and secondarily with a prolonged hospital stay after spinal surgery. Increased focus on health care quality has led to efforts to determine postsurgical readmission rates and predictors of length of postoperative hospital stay. Although there are still no defined outcome measures specific to spinal surgery to which providers are held accountable, efforts to identify appropriate measures and to determine modifiable risk factors to optimize quality are ongoing. Records from 1187 consecutive spinal surgeries at Northwestern Memorial Hospital in 2010 were retrospectively reviewed and data were collected that described the patient, surgical procedure, hospital course, complications, and readmissions. Presence or absence of transfusion during the surgery and associated hospital course was treated as a binary variable. Multivariate negative binomial regression and logistic regression were used to model length of stay and readmission, respectively. Nearly one fifth (17.8%) of surgeries received transfusions, and the overall readmission rate was 6.1%. After controlling for potential confounders, we found that the presence of a transfusion was associated with a 60% longer hospital stay [adjusted incidence rate ratio=1.60 (1.34-1.91), P<0.001], but was not significantly associated with an increased rate of readmission [adjusted odds ratio=0.81 (0.39-1.70), P=0.582]. Any degree of preoperative anemia was associated with increased length of stay, but only severe anemia was associated with an increased rate of readmission. Both receipt of blood transfusion and any degree of preoperative anemia were associated with increased length of hospital stay after controlling for other variables. Severe anemia, but not receipt of blood transfusion, was associated with increased rate of readmission. Our findings may help define actions to reduce length of stay and decrease rates of readmission.

Postoperative Nonpathologic Fever After Spinal Surgery: Incidence and Risk Factor Analysis

Although there are many postoperative febrile causes, surgical-site infection has always been considered as one of the major causes, but it should be excluded; we encountered many patients who showed delayed postoperative fever that was not related to wound infection after spinal surgery. We aimed to determine the incidence of delayed postoperative fever and its characteristics after spinal surgery, and to analyze the causal factors. A total of 250 patients who underwent any type of spinal surgery were analyzed. We determined febrile patients as those who did not show any fever until postoperative day 3, and those who showed a fever with an ear temperature of greater than 37.8°C at 4 days after surgery. We collected patient data including age, sex, coexistence of diabetes mellitus or hypertension, smoking history, location of surgical lesion (e.g., cervical, thoracic, lumbar spine), type of surgery, surgical approach, diagnosis, surgical level, presence of revision surgery, operative time, duration of administration of prophylactic antibiotics, and the presence of transfusion during the perioperative period, with a chart review. There were 33 febrile patients and 217 afebrile patients. Multivariate logistic regression showed that surgical approach (i.e., posterior approach with anterior body removal and mesh graft insertion), trauma and tumor surgery compared with degenerative disease, and long duration of surgery were statistically significant risk factors for postoperative nonpathologic fever. We suggest that most spinal surgeons should be aware that postoperative fever can be common without a wound infection, despite its appearance during the late acute or subacute period.

Risk Factors Influencing Development Of Surgical Site Infection In Patients Who Were Operated Due To Endometrial Cancer

Endometrial cancer is the most commonly encountered malignancy of female genital system. Surgery is the main treatment approach in endometrial cancer. The frequency of surgical site infections (SSI) has recently increased. Prediction of risk factors which may cause SSI and taking due precautions may provide a decrease in frequency of these infections. The aim of this study was to determine the risk factors for SSI after surgery for endometrial cancer. The medical records of patients who were operated due to endometrial cancer in Kanuni Sultan Suleyman Education and Research Hospital between January 1, 2015, and July 31, 2015, were retrospectively reviewed. The patients were divided into two groups; those that developed SSI following the operation and those that did not develop SSI. SSI was diagnosed based on Center for Disease Control and Prevention criteria. Ages, comorbid diseases, body mass index, American Society of Anesthesiologists (ASA) scores, smoking, durations of operation, the presence of drainage, blood transfusion, pre-operative hemoglobin level, and pre-operative glucose level of patients were recorded. A P < 0.05 was considered to be statistically significant. Of the 103 patients included, 12 patients (11.65%) developed SSI. We found a relationship between SSI development and high body mass index; the presence of diabetes mellitus, presence of transfusion, and high pre-operative glucose level. No relationship among age, hypertension, smoking, ASA score, presence of drainage, duration of operation, pre-operative hemoglobin level, and development of SSI has been determined. In conclusion, although there are patient-related and non-modifiable risk factors, we are in thought of that prediction of modifiable risk factors, such as blood glucose level, may reduce the frequency of SSI after endometrial cancer surgery.

Vaginal Birth After Caesarean for Women With Three or More Prior Caesareans: Assessing Safety and Success

The rate of uterine rupture and other complications is relatively low in women with a history of 2 prior cesareans who attempt vaginal birth (VBAC). Outcome data for women who have had more than 2 previous cesareans are limited, largely because prior studies often combined women with a history of more than 2 cesareans into 1 group and also had small sample sizes. It is possible that the risk of morbidity among women with more than 2 prior cesareans who attempt VBAC may be less than presumed, especially in women with a high likelihood of success. The aim of this retrospective cohort study was to compare the rate of success and risk of maternal morbidity among women with a history of 3 or more prior cesareans, who attempt VBAC with that of women who had repeat cesarean after 1 or 2 prior cesareans. The study was performed at 17 centers in the Northeast United States between 1996 and 2000. The study population was 25,005 women with at least 1 prior cesarean delivery. Univariate analysis was performed, and stratified analyses were used to adjust for potential confounding variables. The primary study outcome measures were a composite of maternal morbidity, defined as the occurrence of any one of the following: symptomatic uterine rupture, bladder or bowel injury, or uterine artery laceration. Secondary outcomes included VBAC success, the individual components of the composite outcome, and the presence of transfusion and fever. Of the 25,005 women, 860 (3.4%) had 3 or more prior cesareans; 89 (10.3%) of these attempted VBAC, and 771 (89.7%) had an elective repeat cesarean. No cases of composite maternal morbidity were found among the 89 women who attempted VBAC. Univariate analysis showed that women who attempted VBAC after 3 or more prior cesareans had a similar likelihood of success as women who attempted VBAC after 1 prior cesarean (79.8% vs. 75.5%). After adjusting for previous vaginal delivery, induction use of oxytocin, and diabetes, the similarity remained; the adjusted odds ratio was 1.4, with a 95% confidence interval of 0.81 to 2.41, P = 0.22. These findings indicate that there is no higher risk of maternal morbidity or failed VBAC attempt among women who attempt VBAC after 3 or more prior cesarean deliveries compared with women who attempt VBAC after 1 prior cesarean, as well as those having had 2 prior cesareans. These data are consistent with other studies and suggest that the current recommendations for VBAC attempts in women with more than 1 prior cesarean should be re-evaluated.

The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy

Purpose: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy (RRP). Materials and Methods: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model. Results: The mean age of the patients was 64.6 years (range, 40 to 83). 32 (8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8 (25.8%) of 32 patients developed an inguinal hernia within 6 months, 23 (61.8%) within 1 year, 26 (83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25 (78.1%) developed an inguinal hernia in the right side, 3 (9.4%) in left and 4 (12.5%) developed an inguinal hernia in both sides. The operative time (p 50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia. Conclusions: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia. (Korean J Urol 2008;49:981-985) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏