Transfusion Rate Research Articles

Oxidised cellulose in musculoskeletal oncology procedure: Does it reduce postoperative blood loss?

Major musculoskeletal oncology procedures often result in perioperative bleeding. This exposes patients to allogeneic red blood cell transfusion and its potential complications, thus increasing the risk of surgical wound infection and prolonged hospital stay. This study aimed to investigate the efficacy of oxidised cellulose, a topical haemostatic agent, in reducing postoperative blood loss and its subsequent risks. In this randomised controlled trial, 40 patients undergoing major musculoskeletal oncology procedures were assigned to control and intervention groups. Oxidised cellulose was inserted into the surgical wound after the resection's conclusion before the wound's closure to reduce postoperative bleeding for patients in the intervention group. Postoperative closed suction drain system (Redivac TM) volume, drop in haemoglobin level, allogeneic red blood cell transfusion rate, duration of surgery, and length of hospital stay were compared between the two groups. The postoperative Redivac volume (Control: 432 MLS vs. Intervention: 431.75 MLS), drop in haemoglobin level (Control: 3.12g/dL vs. Intervention: 3.06g/dL), duration of surgery (Control: 134 vs. Intervention: 156min), and allogeneic red blood cell transfusion were lower in the intervention group (Control: 204 MLS vs. Intervention: 170 MLS), but they were not statistically significant (p > 0.05) (Control: 134 vs. Intervention: 156min). Mean hospital stay was similar in both groups (Control: 5.45days vs. Intervention: 5.85days). Oxidised cellulose use does not significantly affect postoperative blood loss, the rate of allogeneic blood transfusion, and hospital stay. However, we believe its use contributes positively but not considerably towards lower postoperative blood loss in musculoskeletal oncology surgeries.

Are very thin patients at a higher risk of complications when submitted to percutane-ous nephrolithotomy?

To assess the impact of thinness on the outcome of the percutaneous nephrolithotomy (PCNL). A matched case-control study was performed using a prospectively collected database of all patients who underwent PCNL between June 2011 and October 2021. The patients were stratified into two groups according to their phenotypic characteristics, arbitrarily defined according to their body mass index (BMI): <0kg/m2 (Group 1, very thin patients, G<20) and ≥25kg/m2 (Group 2, non-thin patients, G≥25). Patients were randomly matched based on Guy's Stone Score (GSS) according to case complexity at a ratio of 1:3. A total of 204 patients were enrolled in this study: 51 patients (G<20) and 153 controls (G≥25). Complications occurred in 15.2% of the patients, with 5.4% of these complications classified as major complications (Clavien grade ≥ 3). According to complications there were no significant differences between the groups. The overall complication rates were 17.6% in the G<20 and 14.4% in the G≥25 (p = 0.653). The major complication rates were 3.9% in the G<20 and 5.8% in the G≥25 (p=0.429). No differences in transfusion or urinary fistula rates were found. In this study, very thin patients were not at a higher risk of complications when submitted to PCNL than in those with a BMI of ≥25kg/m2. Apparently, this technique can be used in these patients, just as it is used in any other type of patient, independently of their BMI.

Robot-assisted, laparoscopic and open radical cystectomy for bladder cancer: A systematic review and network meta-analysis.

To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer. A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes. Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

Can suction technology be a potential game changer that reshapes pediatric endourological interventions? Results from a scoping review.

To systematically review the use of suction/vacuum-assisted retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in children/adolescents with kidney stones. The PICOS model (Patient Intervention Comparison Outcome Study type) was used to frame and answer the clinical question; P: children and adolescent men with kidney stones; I: use of suction during PCNL or RIRS; C: no suction devices or none; O: complications and stone-free rate (SFR); S: prospective and retrospective studies; case reports. The literature search was performed on 14th May 2024 using Embase, PubMed, and Scopus. Only English papers were accepted. Ten articles were included. There were 9 papers on mini-PCNL and the remaining one compared mini-PCNL with RIRS. PCNL studies found excellent SFR (73-100%) with zero transfusion rate and a low rate of infectious complications (fever up to 9.6% and sepsis rate of 1%). Among these studies, there was a case report on the use of shock pulse lithotripter with complete stone clearance. Our review shows that there is little data on the use of suction/vacuum-assisted mini-PCNL/RIRS in kidney stone children/adolescents. However, these preliminary data demonstrated that vacuum-assisted mini-PCNL had excellent SFR with a low rate of complications.

Does race and insurance status play a role in high-grade renal trauma in the pediatric population? - An analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.

We sought to examine the potential role of race and insurance status on the presentation, management, and outcomes of high-grade renal trauma (HGRT) in a large trauma registry. A retrospective cohort study of a large, multi-center registry of high-grade pediatric renal trauma was performed. Patients < 18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared. A total of 341 patients were initially identified, 32 were excluded. 66.3% were Caucasian(C), 27.5% were African American(AA), and 6.2% were Other races(O). 43.7% had public insurance,49.8% had private insurance and 6.5% were self-pay. Association of Race: AA patients had a higher rate of penetrating trauma (9% AA vs. 4% C, 0% Others, p = 0.002). Those with O and AA races presented at a younger age (9.5 yo O vs. 12.5 yo AA vs. 14 yo C, p = 0.001). However, no differences were found between race groups in the hospital course or outcome. Association of Insurance status: Those with public insurance presented with higher rates of bowel injury and blood transfusion, no differences were found in hospital course or outcome. Private insurance had higher Urology follow up rates (49% Private vs. 34.6% Public vs. 35% Self pay, p = 0.041). Race and insurance status was associated with differences found on the mechanism of injury, transfusion rate and urology follow-up rate; however, they do not influence rates of surgical intervention, post-injury complications or mortality.

Hemostatic Effect and Safety of TXA: An Umbrella Review

Aim: To evaluate the hemostatic effect and safety of TXA. Methods: Meta-analyses were retrieved from databases. Risk ratios (RR), odds ratios (OR), weighted mean difference (WMD), standard mean difference (SMD) and 95% confidence intervals (CI) were extracted to compare the effeteness of TXA in reducing TBL, transfusion rate, Hb drop, mortality, DVT, PE. Results: In total, 136 trials (396 comparisons) including 17 kinds of surgeries were retrieved. The evidence for TXA using in total knee arthroplasty (TKA), total hip arthroplasty (THA), postpartum bleeding, intertrochanteric fractures, orthopaedic surgery, spinal surgery, shoulder arthroplasty, hip fracture surgery, cardiac surgery, menstrual bleeding, plastic surgery, myomectomy, nasal surgery was assessed as possible for the association of reducing TBL. The evidence for TXA using in TKA, THA, postpartum bleeding, orthopaedic surgery, shoulder arthroplasty was assessed as probable for the association of reducing transfusion rate. The evidence for TXA using in liver surgery, spinal surgery, hip fracture surgery, cancer, cardiac surgery was considered to be possible for the association of reducing transfusion rate. The evidence for TXA using in intertrochanteric fractures, orthopaedic surgery, hip fracture surgery was assessed as probable for the association of reducing Hb drop. The evidence for TXA using in TKA, THA, postpartum bleeding, shoulder arthroplasty was considered to be possible for the association of reducing Hb drop. The evidence for TXA using in trauma, gastrointestinal bleeding was assessed as probable for the association of reducing mortality. Conclusion: This umbrella review indicated that TXA was regarded as effective to reduce TBL, transfusion rate, Hb drop, mortality, and did not increase the incidence of DVT and PE. However, more convincing evidence should be provided to further clarify the level of efficacy and safety of TXA.

Transverse versus vertical incision in the surgical management of placenta accreta spectrum.

Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS. Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between 09/2019 and 11/2023. Starting in 10/2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18-20cm and used the patient's prior scar. Primary outcomes included rate of maternal transfusion >4 units of packed red blood cells (PRBC), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA). Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86.0%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, BMI, and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBC (vertical 12% vs transverse 22%, p=0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs transverse 14%, p= 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs transverse 24%, p<0.001). In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes.

Preoperative risk factors for blood transfusion in women requiring surgical management of ectopic pregnancy: a retrospective cohort study

ObjectiveThis study identifies preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy. A retrospective chart review of 252 cases was performed at a single academic-affiliated...

Red Blood Cell Transfusion Practices.

Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes. To evaluate demographic and practice characteristics associated with lower Hgb thresholds and single red blood cell (RBC) unit transfusion practices. This study used the College of American Pathologists (CAP) Q-Probes format with the recent 2020 and 2017 surveys of participating institutions. High rates of transfusion review and compliance were observed with institutions reporting RBC transfusions meeting institutional guidelines. CAP inspection participants and those with a formal policy to encourage single-unit transfusions showed a trend toward greater compliance. Comparison of 2020 and 2017 survey results showed favorable downward trends in the Hgb threshold for transfusion compliance review and pretransfusion and posttransfusion Hgb values. Institutions reporting initiatives to decrease transfusions, teaching hospitals, and those with updated guidelines in alignment with recent literature reported lower pretransfusion Hgb levels in both studies. The 2020 study showed greater single-unit transfusion use among hospitals with patient blood management programs, larger institutions, and those training pathology residents. Single-unit transfusion rates varied by hospital service, with highest rates reported within hematology/oncology (99 of 138 [71.7%]), intensive care (147 of 215 [68.4%]), and medicine (419 of 666 [62.9%]) services. Transfusion practice improvement programs to decrease RBC transfusions include the use of single-unit transfusions and lower institutional pretransfusion Hgb thresholds. Opportunities to lower transfusion thresholds and increase single-unit transfusions exist in surgical and obstetrics services.

Postpartum Hemorrhagic Morbidity with Scheduled versus Unscheduled Cesarean Delivery at Term.

This study aimed to compare the composite maternal hemorrhagic outcomes (CMHOs) among term (≥37 weeks) singletons who had scheduled versus unscheduled cesarean deliveries (CDs). A subgroup analysis was done for those without prior uterine surgeries. Retrospectively, we identified all singletons at term who had CDs. The unscheduled CDs included individuals admitted with a plan for vaginal delivery with at least 1 hour of attempted labor. CMHOs included any of the following: estimated blood loss of ≥1,000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, or maternal death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risks (aRRs) with 95% confidence intervals (CIs). Of 8,623 deliveries in the study period, 2,691 (31.2%) had CDs at term, with 1,709 (67.3%) scheduled CDs, and 983 (36.5%) unscheduled CDs. Overall, the rate of CMHO was 23.3%, and the rate of blood transfusion was 4.1%. CMHOs were two-fold higher among unscheduled (34.5%) than scheduled CDs (16.9%; aRR = 2.18; 95% CI: 1.81-2.63). The aRRs for blood transfusion and surgical interventions to manage postpartum hemorrhage were three times higher with unscheduled than scheduled CDs. The subgroup analysis indicated that among the cohorts without prior uterine surgery, the rate of the CMHOs was significantly higher when the CD was unscheduled versus scheduled (aRR 1.85; 95% CI 1.45-2.37). Compared to scheduled CDs, the composite hemorrhagic adverse outcomes were significantly higher with unscheduled CDs. · Unscheduled cesareans are at higher risk of hemorrhage.. · Unscheduled cesareans are at higher risk of transfusion.. · Atony treatment is higher in unscheduled cesareans..

Application of Intraoperative Ultrasound in Laparoscopic Liver Resection with Pringle Maneuver: A Comparative Study with the Pringle Maneuver.

Background: Appropriate surgical techniques for controlling bleeding and preserving residual liver function are key to the success of laparoscopic liver resection. This study aims to evaluate the application effect of intraoperative ultrasound in the Pringle maneuver of laparoscopic liver resection. Materials and Methods: Between January 2022 and June 2023, 100 patients underwent laparoscopic liver resection and were randomly allocated to receive application of intraoperative ultrasound for Pringle maneuver (intraoperative ultrasound group, n = 50) or conventional Pringle maneuver (conventional group, n = 50). Intraoperative blood loss, blood transfusion, operation time, hepatic portal block time, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failure), and hospital stay were compared between groups, along with the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels at postoperative days 1, 3, and 7. Results: The operation time, postoperative ALT, AST, and TB levels on postoperative days 1, 3, and 7, complications (bile leakage, hemorrhage, ascites, and posthepatectomy liver failures), and hospital stay were comparable between groups. Compared with the conventional group, the intraoperative ultrasound group had significantly less intraoperative blood loss (P = .015), lower blood transfusion rate (P = .035), and less hepatic portal block time (P = .012). Conclusions: Applying intraoperative ultrasound in laparoscopic liver resection for hepatic pedicle occlusion is a safe, simple, and effective method.

Improving RBC inventory by optimizing preoperative ordering and eliminating crossmatch and hold.

Blood product constraints have increased the focus on inventory management as blood banks have faced challenges that impact supply chains and donor availability. Solutions often include a reduction in transfusion volumes through multidisciplinary improvements, but this is often coupled with a reduction in blood bank inventory to match reduced demand. We sought to improve inventory availability within the blood bank without modification of transfusion rates through solutions that prevented unnecessary RBC orders and crossmatching. Improvements were focused on reduction of duplicate orders, preoperative blood orders, excess volume of blood orders, and crossmatching in advance of perioperative needs. The study monitored the improvement of the crossmatch to transfusion ratio as the primary outcome and days of shelf life until expiration as a secondary outcome. The CT ratio of RBCs decreased from 2.03 (16,044/7922) pre-implementation to 1.67 (12,321/7375) post-implementation (p < 0.05). Our inventory was managed more efficiently following our interventions as demonstrated through the day of shelf life of RBCs issued. Pre-implementation, RBCs were issued an average of 17.5 days before expiration, which increased to 20.4 days post-implementation (p < 0.05). Modification of preoperative order sets and education of clinical staff to ensure appropriate blood product ordering can significantly impact available inventory. Although this was also identified within our study, we found that the largest impact comes from a change in crossmatching workflow to reduce unnecessary reserving of RBCs. These changes can be implemented without significant impact to turnaround time.

Comparison of total blood loss between limited tourniquet use and conventional tourniquet use in total knee arthroplasty: a randomized controlled trial

BackgroundThis study examined the differences in total blood loss, the need for blood transfusions, length of hospital stay, wound grading scores, incidence of venous thromboembolism (VTE), and reoperation rates between conventional and limited tourniquet use during unilateral primary total knee arthroplasty (TKA).MethodsThis double-blind, randomized controlled trial included 90 patients undergoing unilateral primary TKA. Forty-five patients were allocated to the limited tourniquet use group (LIM-TKA), and 45 to the conventional tourniquet use group (CON-TKA). The study analyzed differences in total blood loss, the need for blood transfusions, wound grading scores, incidence of VTE, length of hospital stay, and reoperation rates.ResultsThe mean total blood loss in the LIM-TKA group was 589.55 ± 238.2 ml, significantly lower than the 692.31 ± 276.15 ml observed in the CON-TKA group (P = 0.031). Significantly poorer wound grades were seen in the CON-TKA group compared to the LIM-TKA group, with 23 vs. 34, 15 vs. 11, 5 vs. 0, 1 vs. 0 and 1 vs. 0 patients, respectively, having grade 1, 2 A, 2B, 2 C and 3 A wounds according to the Southampton Scoring System (P = 0.032). Patients in the LIM-TKA group also had a shorter hospital stay versus the CON-TKA group (5.6 ± 1.28 vs. 7.2 ± 4.06 days, P = 0.006). The rates of blood transfusion, VTE complications, and reoperation were similar between both groups.ConclusionLIM-TKA results in significantly lower total blood loss and improved wound grading scores, as well as a decreased length of hospital stay compared to CON-TKA. LIM-TKA could be a suitable option for surgeons aiming to minimize tourniquet-related adverse outcomes while maintaining a dry bone surface during TKA cementation.Clinical trial numberThis study was retrospectively registered at Thai Clinical Trials Registry (thaiclinicaltrials.org) on July 28, 2024. Clinical trial number: TCTR20240728002.

Comparison of outcomes between single-port and multi-port robotic radical nephrectomy.

Single-port (SP) robotic surgery is a novel technology, and although there is emerging data, it remains limited in assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. To compare perioperative and postoperative outcomes between SP and MP robotic technologies for radical nephrectomy (RN). This is a retrospective cohort study of patients who have undergone robot-assisted radical nephrectomy using either the SP or MP technology. Baseline demographics, clinical, tumor-specific characteristics, and perioperative and postoperative outcomes were compared using χ2, t-test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust, Poisson, and logistic regressions. A total of 341 patients underwent robotic RN with 47 patients (14%) in the SP group. The two groups exhibited similar baseline characteristics, with no significant differences in age, sex, body mass index, Charlson comorbidities index, and tumor laterality. However, SP group had a smaller average tumor size (5.1cm vs 6.4cm, p = 0.009). The SP had longer operative time (178 ± 84min vs 142 ± 75min; p = 0.011) but showed no significant difference in the estimated blood loss, blood transfusion rate, length of stay, overall 30-day and major complication rates. Controlling for other variables, SP was significantly associated with a longer operative time and shorter length of stay. SP is associated with longer operative time but offers advantages such as smaller incisions and shorter hospital stays with a comparative safety profile to MP for radical nephrectomy.

Open abdomen versus primary closure in nontrauma patients: A weighted analysis of a single-center experience

INTRODUCTION The open abdomen (OA) technique is nowadays a worldwide strategy both for trauma and emergency general surgery. Despite the attempt at conducting prospective studies, a high level of evidence is far from established. The aim of this study was to investigate if we overused this strategy and if it improved the postoperative course of our patients. METHODS Emergency laparotomies from 2017 and 2023 were reviewed and stratified according to OA and closed abdomen (CA). Differences were balanced by inverse probability weighting, and the 90-day mortality was estimated. Subgroup analysis was carried out for patients with a Mannheim Peritonitis Index (MPI) of &gt;26, bowel obstruction, bowel ischemia (BI) and gastrointestinal perforation. RESULTS Of the 320 patients, 167 were CA and 153 were OA. Groups were different for American Society of Anesthesiologists, comorbidities, transfusion rate, Physiologic and Operative Severity Score for the Study of Mortality and Morbidity score, MPI, Clinical Frailty Scale score, diagnosis, and resection. Two balanced pseudo-populations were created. The 90-day survival rate was 50.8% for CA and 60.8% for OA (hazard ratio [HR], 0.79; confidence interval [CI], 0.40–1.55; p = 0.502). At the Cox regression, the Clinical Frailty Scale score (HR, 1.125; 95% CI, 1.01–1.25; p = 0.033) and BI (HR, 5.531; 95% CI, 2.37–12.89; p &lt; 0.001) were independent risk factors for mortality. Transfusion rate (odds ratio [OR], 3.44; 95% CI, 1.44–8.23; p &lt; 0.006) and length of stay in the intensive care unit (OR, 1.13; 95% CI, 1.07–1.20; p &lt; 0.001) were associated with major complications. Open abdomen did not modify mortality in the case of bowel obstruction, MPI &gt;26, or gastrointestinal perforation. Finally, OA (HR, 0.056; 95% CI, 0.01–0.22; p = 0.001) and large bowel resection (HR, 6.442; 95% CI, 1.28–32.31; p = 0.040) were predictors of longer survival in the subgroup of patients with BI. CONCLUSION Open abdomen was not associated with a higher complication rate or higher mortality but did result in a longer in-hospital stay. The only setting where OA seemed to be advantageous was in the BI population. LEVEL OF EVIDENCE Epidemiological and Prognostic Study; Level III.

Safety of abdominal paracentesis in hospitalised patients receiving uninterrupted therapeutic or prophylactic anticoagulants.

Abdominal paracentesis is a frequently performed procedure in hospitalised patients with ascites. Concurrently, most hospitalised adult patients receive pharmacologic anticoagulation, either for therapeutic purposes or prophylactically to prevent venous thromboembolism. Despite this, minimal evidence exists to guide management of anticoagulant therapy pre- and post-paracentesis. The authors aimed to investigate the safety of abdominal paracentesis in hospitalised patients receiving therapeutic or prophylactic anticoagulation, including in patients for whom these medications were withheld periprocedurally. TriNetX, an electronic health record data set, was queried to identify patients between the ages of 18 and 80 years who received an abdominal paracentesis while hospitalised at the authors' institution between September 2017 and June 2022. Patients receiving prophylactic anticoagulation (137), therapeutic anticoagulation (74) and no anticoagulation because of coagulopathy or thrombocytopenia (15) were compared. Rates of withholding anticoagulation, performing service, pre- and post-paracentesis haemoglobin, bleeding complications, thrombotic complications and need for red blood cell transfusion were analysed. Procedure-related bleeding complications occurred in two (1.4%) patients in the prophylactic group and 0 (0%) patients in the therapeutic group (P = 0.54). No thrombotic complications occurred. Rates of red blood cell transfusions post-paracentesis were similar between groups. Analysis of secondary end-points identified significant differences in rates of withholding anticoagulation and mean change in haemoglobin between performing services. Performance of abdominal paracentesis in patients receiving therapeutic or prophylactic anticoagulation appears to be safe regardless of whether anticoagulation was interrupted periprocedurally, with low rates of bleeding complications, thrombotic complications or need for red blood cell transfusions post-paracentesis.

Comparison of robot-assisted, open, and laparoscopic-assisted surgery for cholangiocarcinoma: a network meta-analysis.

The aim of this study is to compare the efficacy of robot-assisted, laparoscopic-assisted and open surgery in the treatment of cholangiocarcinoma, and to evaluate the clinical effect of three surgical methods in the treatment of cholangiocarcinoma by network Meta-analysis. A systematical retrieval in PubMed and Web of Science was performed for relative literature on the effects of robot-assisted(RA), laparoscopy-assisted(LA), and open surgery(OA) for cholangiocarcinoma in treating cholangiocarcinoma. A literature search updated to September 1st, 2024, was performed. Studies have shown that the length of R0 resection, complication rate, 30-day mortality, Transfusion rate, Lymph Node Metastasis Rate, and hospital stay in RA are superior to LA and open surgery. The relative effectiveness of the three surgical methods in terms of operation time were: open surgery, laparoscope-assisted surgery, and robot-assisted surgery, and there was no significant difference among the three groups. Robot-assisted surgery is safe and feasible in the treatment of cholangiocarcinoma, but more clinical evidence is needed to confirm these findings.

Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011-2022).

Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13-71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%.

Vadadustat Three Times Weekly in Patients With Anemia Due to Dialysis-Dependent CKD

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) may offer an alternative erythropoiesis-stimulating agents (ESA) for the treatment of anemia in the setting of CKD. To investigate the efficacy and safety of conversion from long-acting erythropoiesis-stimulating agent (ESA) methoxy polyethylene glycol-epoetin beta (MPG-EPO) to the oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) vadadustat 3-times-weekly versus maintenance on MPG-EPO. Phase 3b, open-label, noninferiority trial. Multicenter study in United States; 456 patients adults with anemia and dialysis-dependent chronic kidney disease. Participants were randomized 1:1:1 either to vadadustat (starting dose: 600 mg thrice weekly), vadadustat (starting dose: 900 mg thrice weekly), or MPG-EPO, for up to 52 treatment weeks and 4 safety follow-up weeks after the end of treatment or early termination. Primary and secondary efficacy endpoints were the mean change in hemoglobin from baseline during primary (weeks 20-26) and secondary (weeks 46-52) evaluation periods, respectively. Noninferiority was specified as a lower bound of the 95% CI above -0.75 g/dL for the difference in mean change in hemoglobin from baseline. Other efficacy endpoints were the proportion of participants with hemoglobin levels within the target range and the proportions of participants requiring ESA or red blood cell transfusion rescue for anemia during the evaluation periods. Transfusion rates were low and occurred at similar rates across treatment groups (2.7% and 4.0% in the combined vadadustat and MPG-EPO groups, respectively). Primary safety endpoints were any treatment-emergent and serious adverse events (AEs). After combining the vadadustat groups (600 mg and 900 mg thrice weekly, n=304), vadadustat was noninferior to MPG-EPO (n=152) for both primary (least squares mean treatment difference, -0.33; 95% CI, -0.53 to -0.13) and secondary efficacy endpoints (-0.33; -0.56 to -0.09). Mean hemoglobin concentrations were stable for all groups, except for an initial slight decline in the vadadustat 600 mg group, which stabilized by week 12. ESA rescue for anemia was more frequent in the MPG-EPO group (primary evaluation period, 27.7%; secondary evaluation period, 16.2%) than in the combined vadadustat (14.2%; 7.3%) groups. The incidences of any treatment-emergent and serious treatment-emergent AEs were similar across treatment groups. Potential errors in attribution of AEs as drug related. Three-times-weekly vadadustat was noninferior to MPG-EPO on their effect on hemoglobin levels without detectable differences in AEs.

Perioperative Considerations in Patients with Rett Syndrome as Compared to Those with Cerebral Palsy.

Retrospective cohort study. This study aimed to compare perioperative outcomes of Rett syndrome and Cerebral palsy patients undergoing posterior spinal fusion for neuromuscular scoliosis. Surgical correction in the treatment of scoliosis for patients with Rett syndrome (RS) has been shown to increase survival rate. Cerebral palsy (CP) patients, like RS patients, are often nonverbal, nonambulatory, with frequent surgical complications. Retrospective review of 36 RS and 80 CP patients undergoing PSF from 2005-2023. Data and x-ray measurements were collected pre- and post-operatively. Sub-analysis was performed comparing non-ambulatory patients (GMFCS IV-V). Wilcoxon-Rank Sum, Fisher's Exact, and Chi-square tests were utilized. The primary outcome measure, complication rates, was similar between the groups (P=0.09). Preoperative Cobb angle, levels fused, fixation points, and LOS were similar (P>0.05). EBL was significantly higher in CP patients as was rate of transfusion (P=0.001) and surgical time (P=0.001). Postoperative Cobb angle (P=0.002) was significantly higher for CP patients. There was no significant difference between CP and RS patients in both preoperative (P=0.383) and postoperative (P=0.051) coronal decompensation. Nonambulatory status was associated with increased odds of having a postoperative complication (OR=6.17, 95% C.I. 1.36 - 28.04). Sub-analysis of non-ambulatory RS and CP patients revealed significantly higher postoperative Cobb (P=0.008), EBL (P=0.019) and surgical time (P=0.017) in CP patients compared to RS patients. There were no significant differences in preoperative Cobb, levels fused, fixation points, hospital stay, or complication rate (P>0.05). RS patients are shown to have better outcomes to CP patients in terms of surgical, perioperative, and radiographic variables. Ambulatory status was identified as an independent risk factor for complications.