Risk Of Intraoperative Blood Loss Research Articles

Development and validation of a web-based artificial intelligence prediction model to assess massive intraoperative blood loss for metastatic spinal disease using machine learning techniques

BACKGROUND CONTEXTIntraoperative blood loss is a significant concern in patients with metastatic spinal disease. Early identification of patients at high risk of experiencing massive intraoperative blood loss is crucial as it allows for the development of appropriate surgical plans and facilitates timely interventions. However, accurate prediction of intraoperative blood loss remains limited based on prior studies. PURPOSEThe purpose of this study was to develop and validate a web-based artificial intelligence (AI) model to predict massive intraoperative blood loss during surgery for metastatic spinal disease. STUDY DESIGN/SETTINGAn observational cohort study. PATIENT SAMPLETwo hundred seventy-six patients with metastatic spinal tumors undergoing decompressive surgery from two hospitals were included for analysis. Of these, 200 patients were assigned to the derivation cohort for model development and internal validation, while the remaining 76 were allocated to the external validation cohort. OUTCOME MEASURESThe primary outcome was massive intraoperative blood loss defined as an estimated blood loss of 2,500 cc or more. METHODSData on patients’ demographics, tumor conditions, oncological therapies, surgical strategies, and laboratory examinations were collected in the derivation cohort. SMOTETomek resampling (which is a combination of Synthetic Minority Oversampling Technique and Tomek Links Undersampling) was performed to balance the classes of the dataset and obtain an expanded dataset. The patients were randomly divided into two groups in a proportion of 7:3, with the most used for model development and the remaining for internal validation. External validation was performed in another cohort of 76 patients with metastatic spinal tumors undergoing decompressive surgery from a teaching hospital. The logistic regression (LR) model, and five machine learning models, including K-Nearest Neighbor (KNN), Decision Tree (DT), XGBoosting Machine (XGBM), Random Forest (RF), and Support Vector Machine (SVM), were used to develop prediction models. Model prediction performance was evaluated using area under the curve (AUC), recall, specificity, F1 score, Brier score, and log loss. A scoring system incorporating 10 evaluation metrics was developed to comprehensively evaluate the prediction performance. RESULTSThe incidence of massive intraoperative blood loss was 23.50% (47/200). The model features were comprised of five clinical variables, including tumor type, smoking status, Eastern Cooperative Oncology Group (ECOG) score, surgical process, and preoperative platelet level. The XGBM model performed the best in AUC (0.857 [95% CI: 0.827, 0.877]), accuracy (0.771), recall (0.854), F1 score (0.787), Brier score (0.150), and log loss (0.461), and the RF model ranked second in AUC (0.826 [95% CI: 0.793, 0.861]) and precise (0.705), whereas the AUC of the LR model was only 0.710 (95% CI: 0.665, 0.771), the accuracy was 0.627, the recall was 0.610, and the F1 score was 0.617. According to the scoring system, the XGBM model obtained the highest total score of 55, which signifies the best predictive performance among the evaluated models. External validation showed that the AUC of the XGBM model was also up to 0.809 (95% CI: 0.778, 0.860) and the accuracy was 0.733. The XGBM model, was further deployed online, and can be freely accessed at https://starxueshu-massivebloodloss-main-iudy71.streamlit.app/. CONCLUSIONSThe XGBM model may be a useful AI tool to assess the risk of intraoperative blood loss in patients with metastatic spinal disease undergoing decompressive surgery.

Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ2 test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27+4 weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.

The Ratio of Intraoperative Red Blood Cell Transfusion to Blood Loss Associated with Early Postoperative Complications in Pediatric Liver Transplantation Patients

Introduction: Liver transplantation (LT) is an operation purposed to save the lives of children with acute or chronic liver diseases, hepatic tumors, and some genetic and metabolic diseases. However, patients who underwent LT have a significant risk of intraoperative blood loss and red blood cell (RBC) transfusion, especially in pediatric patients. Methods: In this study, 569 pediatric patients (<18 years old) who underwent LT at a tertiary university hospital between 2013 and 2020 were included. Multiple logistic regression was used to analyze the association between the ratio of intraoperative RBC transfusion to blood loss (IRTBL) and the complications after LT in pediatric patients. IRTBL was divided into quartiles in the adjusted model. Odds ratios, 95% confidence intervals, and p values for trends were calculated. Restricted cubic spline (RCS) regression was used to evaluate the nonlinear association between IRTBL and complications. Results: Compared with the lowest level and the highest level of IRTBL, Q2 and Q3 quartiles of IRTBL showed significantly positive association with early complications. A significantly nonlinear association was observed between the IRTBL and early complications in the RCS model with the multiple adjustments of potential covariates (P overall<0.01, P nonlinear<0.01). However, no significant association was observed between late complications and IRTBL. Conclusion: In this study, we found there was a nonlinear relationship between the ratio of IRTBL and early postoperative complications in pediatric LT patients, which provides a theoretical basis for RBC transfusion in pediatric LT patients.

O066 Outcomes following fenestrated and branched endovascular repair (F/BEVAR) of complex aneurysms in octogenarians: a time to event meta-analysis

Abstract Introduction Objective: To evaluate the clinical outcomes of F/BEVAR among octogenarians. Methods Databases were systematically searched for studies that compared outcomes following F/BEVAR between octogenarians and non-octogenarians. The primary outcome measures were peri-operative mortality, survival, re-intervention, aortic rupture, and aneurysm-related deaths. Secondary outcomes were peri-operative outcomes. Results Seven studies published between 2017 and 2022 were included reporting on a total of 7,552 patients (&amp;gt;80yrs, 1536; &amp;lt;80yrs, 6016). More males (OR [95% CI] 0.83 [0.73-0.94], p.003), smokers (OR 0.50 [0.43-0.58], p&amp;lt;.001) patients with ASA &amp;gt;3 (OR 0.72 [0.52-0.98], p=.04), hypercholesterolaemia (OR 0.56, [0.42-0.73], p&amp;lt;.001), and pulmonary disease (OR 0.75, [0.66-0.86], p&amp;lt;.001) were observed in non-octogenarians. There was no significant difference in the peri-operative mortality between the two groups, but the hazard of overall mortality during follow-up was significantly higher in the octogenarian group (HR 1.67 [1.27–2.20], p&amp;lt;.001). There was no statistically significant difference in re-intervention (HR 0.96, [0.85-1.09], p=.057) or aneurysm-related deaths (OR 0.02, [-0.02-0.07], p=.31) between the two groups, but older patients were at greater risk of aortic rupture during follow-up (OR 4.71, [1.73–12.85], p=.002). Octogenarians were at a greater risk of intra-operative blood loss (WMD 54.73 [17.89-91.58], p=.004), endoleaks on completion angiogram (ORs 1.42, [1.20-1.67], p&amp;lt;.001), cardiac events (1.34 [1.12-1.62], p=.002) and endoleaks during follow-up (OR 1.40[1.03-1.91], p=.03). The body of evidence for most primary outcomes was judged to be low. Conclusion Survival is lower in octogenarians but there was no significant difference in aneurysm-related deaths or re-interventions, despite the increased incidence of aortic rupture and endoleaks during follow-up.

Predictors of hospital bypass for rural residents seeking common elective surgery

BackgroundSurgical bypass occurs when rural residents receive surgical care at a nonlocal hospital. Given limited knowledge of current bypass rates, we evaluated rates and predictors of bypass for common procedures. MethodsWe used 2014 to 2016 all-payer claims data from the Healthcare Cost and Utilization Project State Inpatient Databases to study rural patients from 13 states who underwent 1 of 11 common elective surgical procedures. Bypass was measured by whether a patient received elective surgical care at the closest hospital offering the requested procedure or another nonlocal hospital. Bypass probability was then modeled as a function of patient-level and hospital-level characteristics. ResultsOf the 121,297 rural elective surgery visits in our sample, 78,268 (64.5%) bypassed their local hospital. Bypass rate was greatest for coronary artery bypass graft or valve replacement (74.8%) and lowest for laparoscopic cholecystectomy (53.7%). In addition, average bypass rate was greatest for surgeries with the highest risk of intraoperative blood loss and postoperative complications. The probability of bypass significantly (P < .001) increased for patients who were younger, privately insured, and lived farther from the closest hospital. In addition, the probability of bypass significantly (P < .001) increased for patients whose local hospital had fewer full-time equivalents, lower operating margin, and fewer recommendations from previous patients. ConclusionAmong rural patients seeking elective surgery, bypass of the local hospital was common among both low-risk and high-risk procedures. These findings suggest that there is a substantial amount of bypass, which may negatively impact a hospital’s financial performance and, hence, wellbeing of the local community.

Renal calyx access does not affect intraoperative blood loss in percutaneous nephrolithotomy: a single-center retrospective study

Objective: Percutaneous nephrolithotomy (PCNL) is one of the most effective ways of dealing with large renal calculi but also comes with a risk of intraoperative blood loss. Previous evidence is contradictory as regards the difference in blood loss between different renal calyx access. We conducted this study to compare intraoperative blood loss between different renal access calyx. Materials and Methods: We conducted a retrospective study analyzing 132 cases of single access PCNL, dividing them into an upper pole group (n = 93) and a non-upper pole group (n = 39). Intraoperative blood loss was calculated from pre-and post-operative hematocrit level, gender, body surface area, and amount of blood transfusion. Blood loss was compared between the two groups using univariable and multivariable analysis. Results: Overall blood loss was 500 ml (IQR 200-814 ml) with a median blood loss of 461 ml (IQR 158-738 ml) in the upper pole group and 650 ml (IQR 332-1233 ml) in non-upper pole group. Median hematocrit change was 2.9% and 3.9% in the upper and non-upper pole groups, respectively. The blood transfusion rate was 4.5% in the upper pole group and 8.3% in the non-upper pole group. The multivariable analysis did not demonstrate any statistically significant difference in average blood loss, hematocrit change or blood transfusion rate. Conclusions: Our study did not find any significant difference in intraoperative blood loss between different renal access routes in PCNL.

Cardiac Surgery and Blood-Saving Techniques: An Update.

Cardiac surgery is typically attributed with a significant risk of intraoperative blood loss and allogeneic blood transfusions. Intraoperative blood loss, allogenic blood transfusions, high dose anticoagulation requirement, and interactions with cardiopulmonary bypass (CPB) have all been linked to cardiac surgeries. To reduce unnecessary transfusions and their negative effects, it is recommended to follow evidence-based multidisciplinary strategies, which are collectively termed patient blood management (PBM). This review highlights the most recent blood conservation strategies in adult cardiac surgery, which can be employed pre-operatively, intra-operatively, and postoperatively, to enhance red cell mass and attenuate the utilization of packed red blood cells (PRBCs) and other blood products.

English

BACKGROUND Perioperative haemorrhage is an important concern during any surgical procedure. The purpose of this study was to assess the effect of tranexamic acid (TXA) irrigation on perioperative haemorrhage during the surgical removal of impacted mandibular third molar. METHODS In this double-blind, randomized controlled clinical trial, 120 participants who underwent surgical removal of horizontally impacted mandibular third molar were divided into 2 groups. The patients in the Group 1 received 0.9 % normal saline for irrigation during the procedure and the patients in the Group 2 received TXA irrigation with normal saline (1 mg / mL), age, gender, operation duration, amount of blood loss and visual assessment of surgical field were the variables that were studied. The use of TXA solution for irrigation was the predictive factor of the study. RESULTS Each group consisted of 60 patients. Group 1 consisted of 31 male patients (51.7 %) and 29 female patients (48.3 %) and group 2 consisted of 30 male patients (50 %) and 30 female patients (50 %). There was no difference in the distribution of the variables between the 2 groups, except for the duration of the operation. The mean operative time was 20.94 ± 0.61 minutes in group 1 and 26.17 ± 0.98 minutes in group 2 (P &gt; .05) which was not statistically significant. The mean intraoperative blood loss was 44.47 ± 6.416 mL in group 1 and 84.73 ± 7.861 in group 2 (P &lt; .05). The mean volume of irrigation was 100.08 ± 7.658 mL in group 1 and 140.33 ± 12.332 mL in group 2 (P &lt; .05). CONCLUSIONS TXA is effective in reducing the risk of intraoperative blood loss in patients for whom substantial blood loss is anticipated. KEY WORDS Tranexamic Acid, TXA, Blood Loss, Third Molar Surgery, Impacted Tooth Removal.

Analysis of surgical treatment of liver hemangiomas

Objective. Development of criteria for optimal tactics of surgical treatment of liver hemangiomas of various sizes and localizations.&#x0D; Materials and methods. A retrospective analysis of 247 patients with hepatic hemangiomas observed on an outpatient basis and in a hospital was carried out; 59 of them (23.89 %) were operated including 12 men and 47 women over the period of 19992019. Liver resection with hemangioma was performed in 30 patients, hemangioma enucleation in 21, X-ray endovascular occlusion in 8 patients. The diagnosis was established on the basis of ultrasound of the abdominal organs, CT and MRI with contrast as well as angiographic research methods.&#x0D; Results. The postoperative complications developed in 4 (6.78 %) cases: reactive pleurisy was detected in 2 patients after the right-sided hemihepatectomy, hematomas in the resection zone of segments of the right lobe of the liver with a tumor were diagnosed in 2 patients. All complications were eliminated by conservative measures. There were no lethal outcomes.&#x0D; Conclusions. Surgical treatment of patients with hemangiomas includes resection of the liver with a tumor, enucleation of the hemangioma, and various types of local destruction. In order to reduce the blood circulation of the tumor and decrease the risk of intraoperative blood loss, the ECA of the branches of the hepatic artery was indicated. A comparative analysis of the results of treatment of patients with liver hemangiomas using various methods of surgical interventions made it possible to develop optimal surgical tactics, a system of intra- and perioperative safety in this category of patients.

Pooling of neglected and delayed trauma patients – Consequences of ‘lockdown’ and ‘Unlock’ phases of COVID-19 pandemic- A retrospective cohort analysis from a tertiary centre

BackgroundThe COVID-19 pandemic resulted in nationwide lockdown and quarantine strategies to break the chain of transmission of the SARS-CoV-2 virus in India. Management of patients with trauma has been particularly challenging across the country. AimsTo evaluate the effect of delay in surgery in patients with traumatic injuries along with the peri-operative outcomes during the ‘Lockdown’ and ‘Unlock’ phases of the COVID-19 pandemic at a Level I Trauma centre in the National Capital Region (NCR) of India. MethodsThis retrospective, observational cohort study included 488 patients. Comparative analysis to assess patient characteristics, mechanism of trauma, clinical outcomes in patients managed operatively during ‘Lockdown period’ (24 March 2020 to 31 May 2020) Group A with Group B, who presented during ‘Unlock phases’ (01 June 2020 to 31 December 2020). ResultsThe average delay in surgery, surgical time and hospital stay was significantly increased in group B patients (p-value <0.05). The average blood loss, stay in the Intensive Care Unit (ICU) and blood transfusion requirement were clinically higher in group B but these differences were not statistically significant (p-value >0.05). Only in group B; 9.01% patients (42 out of 466) required bone grafting. Conclusion‘Neglect’ and delay in receiving operative management of orthopaedic trauma has led to unprecedented rise in number of complications of fractures, such as mal-union, delayed union or non-union during COVID-19 Pandemic. Patients have had to undergo longer surgical procedures with increased risk of intra-operative blood loss, need of peri-operative blood transfusion and bone grafting supplementation to facilitate union. Diligent attention to achieve the most optimal configuration of fractures should be planned in conservatively managed injuries during the pandemic to minimize future intra-operative difficulties.

What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients.

Multicenter cohort. To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.Level of Evidence: 3.

Synchronous portal or superior mesenteric vein resection during pancreatectomy for pancreatic ductal adenocarcinoma: a single center study

Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis without surgery. Selected patients with portal or superior mesenteric vein (PV/SMV) infiltration undergo venous resection. The present study aimed to compare the perioperative factors and survival outcomes for pancreatic resection with/without PV/SMV resection in patients with PDAC. Methods: A total of 108 patients requiring pancreatectomy combined with PV/SMV resection for PDAC between 1/2009 and 12/2017 were included in this retrospective analysis. 216 of 798 resected PDAC patients without PV/SMV resection during the same period were matched to control group by TNM stage, preoperative CA19-9, tumor differentiation, adjuvant chemotherapy and year of operation. Results: Patients undergoing PV/SMV resection had an increased risk of intraoperative blood loss (400.0 vs. 275.0 ml; P< 0.001), reoperation (1.9% vs. 0%; P=0.045) and 30-day mortality (1.9% vs. 0%; P=0.045) compared with those undergoing standard surgery. A trend toward worse survival in PV/SMV resection was observed from median survival time (13.3 vs 18.3 mo.; P=0.092), although the study was not powered to detect a difference. In PV/SMV resection group, there was a significant difference between tumor axis < 3cm and ≥3cm in terms of median survival time (21.7 vs. 10.8 mo.; P=0.002) while length of PV/SMV resection showed no relation to survival. Conclusion: PV/SMV resection was associated with increased intraoperative risk and postoperative mortality. PDAC patients with PV/SMV resection seemed to have a worse survival compared with those undergoing standard surgery, especially when the tumor axis ³3cm. This may be related to more advanced disease in this group.

Antithrombotic drugs do not increase the risk of laparotomy for gastrointestinal cancer

Abstract Background Some patients with gastrointestinal cancer requiring laparotomy take antithrombotic drugs (AT). However, safety of continuing or withdrawing AT before surgery is controversial. Purpose To investigate whether the use of AT increases intraoperative blood loss, perioperative thromboembolic event and mortality in patients undergoing laparotomy for gastrointestinal cancer. Methods In this retrospective study carried out from January 2016 to July 2019, we took a survey of laparotomy for gastrointestinal cancer in our hospital. AT was defined as aspirin, Adenosine-diphosphate receptor antagonists (ADPi), direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA). Patients were stratified into three groups; non-AT (group N), continuing AT (group C) and withdrawing AT before surgery (group W). We investigated differences in risks of events, including intraoperative blood loss, thromboembolic events within 60 days including acute coronary syndrome, cerebral infarction and venous thromboembolism, and long-term mortality. We also compared between continuing and withdrawing AT after propensity score matching. Results A total of 335 patients (123 females, mean age 72.5±9.5 years) were enrolled and stratified into group C (n=24), W (n=45) and N (n=266). Mean follow-up period was 684±400 days. Aspirin was taken in twenty of group C and twenty-six of group W. ADPi was taken in ten and nine of each group respectively. DOAC was taken in three and six of each group respectively. And VKA was taken in one and eleven of each group respectively. Patients of group C had more coronary artery disease (75.0% of group C, 33.3% of group W and 2.3% of group N, p&amp;lt;0.001) and prior coronary stent implantation (54.2%, 20.0% and 0% of each group respectively, p&amp;lt;0.001). There was no significant difference in cancer site and cancer stage. There was no significant difference in intraoperative blood loss (median [interquartile] (mL): 102 [8, 154] in group C, 140 [50, 310] in group W, and 150 [53, 324] in group N (p=0.095). Thromboembolic event had occurred in 4.4% of group W and 1.9% of group N (p=NS). Long term mortality was 33.3% of group C, 20% of group W and 22.9% of group N (p=NS). Kaplan-Meier analysis showed there was also no significant difference of long-term mortality (Log-rank p=NS). In patients with AT, after propensity score matching, there was no significant difference in intraoperative blood loss (102 [8,154] vs. 88 [18,217], p=NS), thromboembolic event (none in both group) and long-term mortality (33.3% vs. 12.5%, p=0.168) between continuing AT and withdrawing AT. Kaplan-Meier analysis revealed there was a tendency of higher mortality in group C but not significant difference (Log-rank p=0.0643). Conclusion This study suggests that patients taking AT do not have significant higher risk of intraoperative blood loss, thromboembolic event and mortality in laparotomy of gastrointestinal cancer. Funding Acknowledgement Type of funding source: None

Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors.

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy.

The effect of routine intraoperative tranexamic acid in elective cesarean section

Objective: To find the role of routine intraoperative tranexamic acid infusion at elective cesarean section.Study Design: Randomized case control studyStudy Setting: AlKarkh Maternity Hospital, Baghdad Iraq.Methodology: A total of 110 term pregnant women presenting in to our obstetric unit during the period between May, 2019 and January, 2020 and who were offered elective cesarean section, were randomly assigned to either receiving intraoperative tranexamic acid 1 gram in 100 milliliter saline infusion or saline infusion. Demographic characteristics were collected for all participants. Ten cases (1 in the tranexamic and 9 in the control group) were excluded as there were associated extensions of uterine incision in order to reduce confounders. A comparison of the outcomes of the two groups was done, it included an intraoperative blood loss determinator, a postoperative blood loss determinator, and an overall loss risk assessment. The corresponding parameters were the intraoperative surgical soaked packs count, average reduction in packed red blood cell volume 24 hour postoperatively, occurrance of postpartum hemorrhage and the overall need to receive blood transfusion. In term of associated side effects of receiving tranexamic acid, we sought whether there was any significant change in the blood pressure as well as the incidence of developing fever. Exclusion criterias were the contraindication to receive tranexamic acid assessed by referral to internist physician specialist review.Results: Confounding factors including patient’s age, parity and gestation length were taken into consideration and found to be similar between the two groups studied. There was a significant difference between the postpartum decline of packed red blood cell volume (PCV) (pvalue 0.001), with mean postpartum PCV in tranexamic group 35.2% versus 33.3% in the saline infusion group. 21.9% of women in the control group had decline of PCV exceeding 10% of preoperative value, versus only 3.3% in studied group. We found that the number of cesareans where additional packs got required was significantly less in tranexamic group (15.3% vs.22%, p=0.001), no cases in the tranexamic group did receive a blood transfusion vs. 7.3% in the saline group (pvalue 0.03).Slightly higher incidence of hypotensive episodes in the tranexamic group (27.1% vs. 12.2%, pvalue 0.07).Fever was found to be more likely following cesarean in the control group (34.1% vs. 18.6%, pvalue 0.06).Conclusion: The use of tranexamic infusion with inducton of anaesthesia at time of elective cesarean section is associated with less risk of intraoperative blood loss improving postoperative packed red blood cell volume decline significantly.

Effectiveness and safety of the use of antifibrinolytic agents in total-knee arthroplasty

Background:Antifibrinolytic agents have been successfully used to reduce blood transfusion demand in patients undergoing elective knee arthroplasty. The purpose of this study was to investigate different antifibrinolytic agents for patients undergoing total-knee arthroplasty (TKA).Methods:We searched the randomized controlled trials assessing the effect of antifibrinolytic agents on TKA in MEDLINE, PubMed, Embase, and the Cochrane Library. Participants are divided into antifibrinolytic agent group and control group under TKA. Double extraction technology is used and the quality of its methodology is evaluated before analysis. Outcomes analyzed included blood loss, number of blood transfusions, rates of blood transfusion, and deep vein thrombosis (DVT).Results:A total of 28 randomized controlled trials involving 1899 patients were included in this study. Compared with the control group, the antifibrinolytic agents group exhibited significantly reduced the amounts of total blood loss (weighted mean difference [WMD] with 95% confidence interval [CI]: −272.19, −338.25 to −206.4), postoperative blood loss (WMD with 95% CI: −102.83, −157.64 to −46.02), average units of blood transfusion (risk ratio with 95% CI: 0.7, 0.12 to 0.24), and average blood transfusion volumes (WMD with 95% CI: −1.34, −1.47 to −1,21). Antifibrinolytic agents significantly reduced the rate of blood transfusions and did not increase the occurrence risk of intraoperative blood loss and DVT. Several limitations should also be acknowledged such as the heterogeneity among the studies.Conclusion:The application of antifibrinolytic agents can significantly reduce blood loss and blood transfusion requirements. Additionally, these agents did not increase the risk of DVT in patients undergoing TKAs.

Decision Tree-based Modelling for Identification of Predictors of Blood Loss and Transfusion Requirement After Adult Spinal Deformity Surgery.

Multilevel fusions and complex osteotomies to restore global alignment in adult spinal deformity (ASD) surgery can lead to increased operative time and blood loss. In this regard, we assessed factors predictive of perioperative blood product transfusion in patients undergoing long posterior spinal fusion for ASD. A single-institution retrospective review was conducted on 909 patients with ASD, age > 18 years, who underwent surgery for ASD with greater than 4 levels fused. Using conditional inference tree analysis, a machine learning methodology, we sought to predict the combination of variables that best predicted increased risk for intraoperative percent blood volume lost and perioperative blood product transfusion. Among the 909 patients included in the study, 377 (41.5%) received red blood cell (RBC) transfusion. The conditional inference tree analysis identified greater than 13 levels fused, American Society of Anesthesiologists (ASA) score > 1, a history of hypertension, 3-column osteotomy, pelvic fixation, and operative time > 8 hours, as significant risk factors for perioperative RBC transfusion. The best predictors for the subgroup with the highest risk for intraoperative percent blood volume lost (subgroup mean: 53.1% ± 42.9%) were greater than 13 levels fused, ASA score > 1, preoperative hemoglobin < 13.6 g/dL, 3-column osteotomy, posterior column osteotomy, and pelvic fixation. Patients who underwent major blood transfusion intraoperatively had significantly longer length of stay (8.5 days) versus those who did not (6.1 days) (P < .0001). The overall 90-day complication rate in patients who underwent major blood transfusion intraoperatively was 49%, compared with 19% in those who did not (P < .0001). By multivariate regression analysis, patients with a preoperative hemoglobin > 13.0 were less likely to require major blood transfusion (odds ratio: 0.52, P = .046). Using a supervised learning technique, this study demonstrates that greater than 13 levels fused, ASA score > 1, 3-column osteotomy, and pelvic fixation are consistent risk factors for increased intraoperative percent blood volume lost and perioperative RBC transfusion. The addition of having a preoperative hemoglobin < 13.6 g/dL or undergoing a posterior column osteotomy conferred the highest risk for intraoperative blood loss. This information can assist spinal deformity surgeons in identifying at-risk individuals and allocating healthcare resources. 3.

MP80-16 FAVORABLE OUTCOMES OF THE INSTITUTION OF A MASSIVE TRANSFUSION PROTOCOL IN PATIENTS UNDERGOING MAJOR UROLOGIC ONCOLOGY SURGERY WITH HIGH ANTICIPATED BLOOD LOSS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2018MP80-16 FAVORABLE OUTCOMES OF THE INSTITUTION OF A MASSIVE TRANSFUSION PROTOCOL IN PATIENTS UNDERGOING MAJOR UROLOGIC ONCOLOGY SURGERY WITH HIGH ANTICIPATED BLOOD LOSS Julio Slongo, Jonathan B. Cohen, Sephalie Y. Patel, Wade J. Sexton, Ricardo D. Gonzalez, and Philippe E. Spiess Julio SlongoJulio Slongo More articles by this author , Jonathan B. CohenJonathan B. Cohen More articles by this author , Sephalie Y. PatelSephalie Y. Patel More articles by this author , Wade J. SextonWade J. Sexton More articles by this author , Ricardo D. GonzalezRicardo D. Gonzalez More articles by this author , and Philippe E. SpiessPhilippe E. Spiess More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2704AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent scientific literature, most notably in the trauma literature, would support improved patient-related outcomes in adoption of a massive transfusion protocol (MTP) in patients at risk of significant blood loss. This question has never been explored among patients undergoing major surgical resections, with high anticipated blood loss, most notably in the setting of urologic oncology. Having developed such a protocol at our tertiary care referral center, our aim was to evaluate the patient related outcome and cost benefit of introducing a coordinated MTP within the setting of patients undergoing major urologic oncology surgeries (MUOS) deemed at high risk of intra-operative blood loss. METHODS Our study population of 56 patients underwent MUOS over a period of 6 years (2011-17) with their medical records retrospectively reviewed. RESULTS The mean age of our study population was 57.1 years (23-89 years), with surgeries performed consisting of radical nephrectomy in 39 (70% total): 33% of those associated with extensive retroperitoneal lymph node dissection (RPLND) 16% with renal vein thrombectomy, 14% with IVC thrombectomy and 10% requiring distal pancreatectomy and splenectomy). 15 RPLNDs (26% of total) were performed for testicular cancer or other retroperitoneal malignancies (such as schwannomas). The mean surgery time was 226 minutes (60-720) and the mean estimated intra-operative blood loss was 972 mL (100-5110 mL). On the perioperative setting, packed red blood cells (pRBC) were ordered by the surgeon, from 2 to 24 units, with a mean value of 10.2. Regarding the use of products at time of surgery, crystalloids were the principal fluid used for resuscitation, with a mean use of 3.5 L. A mean of 2.1 units (0-16 units) pRBCs were transfused. Frozen plasma was transfused in only 6 cases (mean 2.2 units) and platelets in 4 cases (mean 1.1 unit). The mean length of stay in our study was of 6.62 days (2-22 days), with very low intensive care stay (10 patients, for a mean time of 0.37 days). Most importantly, a very low complication rate, of only 10% was observed: 33%, of Clavien-Dindo class I. There was only one case of class IV complication: an ischemic stroke on a 79 years old patient. A low incidence of readmission was also observed (overall 16% at 30 days post-op period). CONCLUSIONS The present study highlights that the institution of an MTP can have favorable treatment related and cost benefit endpoints within the field of MUOS especially on procedures deemed at high risk of significant blood loss. Major cancer centers performing such procedures may want to consider adopting similar protocols in the appropriate clinical setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1094-e1095 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Julio Slongo More articles by this author Jonathan B. Cohen More articles by this author Sephalie Y. Patel More articles by this author Wade J. Sexton More articles by this author Ricardo D. Gonzalez More articles by this author Philippe E. Spiess More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

SUCCESSFUL TREATMENT OF A SOLITARY FIBROUS TUMOR IN THE SMALL PELVIS: A CASE REPORT

In the article we describe our experience treating a patient with a giant solitary fibrous tumor of the small pelvis. Since the tumor was highly vascularized, the patient underwent preoperative embolization of the vessels perfusing the tumor to reduce the risk of intraoperative blood loss.

Хирургическое лечение больных двусторонним туберкулезом легких

Aim of the study: to compare two surgical tactics for the treatment of bilateral pulmonary tuberculosis. Materials and methods: 189 patients with tuberculous lesions in both lungs underwent lung resections: 91 patients had it done simultaneously on both lungs from the unilateral intercostal-mediastinal access by video-assisted thoracoscopy; 98 patients had resections of the left and right lung done one after another, time period between resections made 20.8 ± 9.4 days on the average. Results. The comparison of two tactics - simultaneous bilateral lung resection from a unilateral access and bilateral consecutive resections - showed the advantages of the first tactic: 97.5 and 85.7% of patients had sputum conversion (p = 0.05, x 2 ); 98.9 and 92.9% of patients had healing of lung cavities (p = 0.04,x 2 ).During simultaneous surgery, the risk of intra-operative blood loss exceeding 300 ml was much lower (OR = 13.57; 95% CI 3.98 - 46.29) as well as the risk of postoperative complications (OR = 3.32; 95% CI 1.04 - 10.61).