Risk Of Transfusion In Patients Research Articles

Preoperative SSRI use increases perioperative transfusion need in patients undergoing surgical procedures on the hip joint.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery.

J-shaped association of operation duration and blood transfusion risk in patients undergoing primary total knee arthroplasty.

Blood transfusion is a common perioperative complication of primary total knee arthroplasty (TKA) that can lead to adverse outcomes, prolonged hospital stays, and increased medical costs. The purpose of our study was to explore the risk factors for blood transfusion and to establish whether operation duration is independently related to blood transfusion risk in patients undergoing primary TKA after adjusting for other covariates. This was a secondary analysis of data from a retrospective cohort study involving patients who underwent primary TKA in Singapore. The patients' baseline data, comorbidity, and surgical characteristics were collected. The independent variable was operation duration and the dependent variable was blood transfusion events. Patients were divided into three groups according to operation durations (90 and 120min). Univariate logistic regression was used to explore the risk factors associated with blood transfusion after primary TKA. Multivariate analysis was used to assess the independent effect of operation duration on blood transfusion risk after adjusting for other covariates. Additionally, we performed subgroup analyses to identify specific groups, test the robustness of the relationships, and explore whether there were interactions between the different variables. Furthermore, restricted cubic splines (RCS) were used to identify the relationship between the two variables. A total of 2,562 patients were included in the study, of whom 136 (5.61%) had a transfusion event. Operation durations were 95.55 ± 36.93 and 83.86 ± 26.29min for blood transfused and non-transfused patients, respectively. Univariate logistic regression analysis showed that age, BMI, ASA status, Hb level, OSA, CHF, creatinine level > 2mg/dL, and anaesthesia type were risk factors for blood transfusion. After adjusting for all covariates, multivariate logistic regression models showed that operation duration was positively associated with blood transfusion risk (odds ratio [OR] = 1.87, 95% CI = 1.174-2.933, P = 0.007). Compared to patients with an operation duration of less than 90min, those with an operation duration of more than 120min had a 2.141-fold increased risk of blood transfusion (OR = 2.141, 95% CI = 1.035-4.265, P = 0.035). Stratified analysis results showed that the association persisted in patients aged > 50years, Chinese, BMI > 30kg/m 2, Hb level > 11g/dL, ASA status levels 2 and 3, general anaesthesia, and unilateral primary TKA. A non-linear (P-non-linear = 0.30) and J-shaped relationship was identified. The risk of transfusion increased as the operation duration decreased or exceeded the inflection point (73.2min). Our study demonstrated a non-linear and J-shaped relationship between operation duration and blood transfusion events in patients undergoing primary TKA. Blood transfusion risk was the lowest when the operation duration was 73.2min. A shorter operation duration implies irregular surgical procedures and incomplete intraoperative haemostasis, leading to increased perioperative blood loss and blood transfusion. These results will be useful for clinical decision-making.

Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

BackgroundThere are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA.MethodsRandomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared.ResultsTotally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best.ConclusionsOur meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

Risk of Transfusion in Patients with Non-Dialysis-Dependent CKD Increases with Hemoglobin Levels &lt;10 g/dL vs. ≥10 g/dL: Pooled Results from Roxadustat Phase 3 Studies

Risk of Transfusion in Patients with Non-Dialysis-Dependent CKD Increases with Hemoglobin Levels &lt;10 g/dL vs. ≥10 g/dL: Pooled Results from Roxadustat Phase 3 Studies

Risk of Transfusion in Patients with Dialysis-Dependent CKD Increases with Hemoglobin Levels &lt;10 g/dL vs. ≥10 g/dL: Pooled Results from Roxadustat Phase 3 Studies

Risk of Transfusion in Patients with Dialysis-Dependent CKD Increases with Hemoglobin Levels &lt;10 g/dL vs. ≥10 g/dL: Pooled Results from Roxadustat Phase 3 Studies

A clinical calculator for predicting intraoperative blood loss and transfusion risk in spine tumor patients

BACKGROUND CONTEXTSurgery for vertebral column tumors is commonly associated with intraoperative blood loss (IOBL) exceeding 2 liters and the need for transfusion of allogeneic blood products. Transfusion of allogeneic blood, while necessary, is not benign, and has been associated with increased rates of wound complication, venous thromboembolism, delirium, and death. PURPOSETo develop a prediction tool capable of predicting IOBL and risk of requiring allogeneic transfusion in patients undergoing surgery for vertebral column tumors. STUDY DESIGN/SETTINGRetrospective, single-center study. PATIENT SAMPLEConsecutive series of 274 patients undergoing 350 unique operations for primary or metastatic spinal column tumors over a 46-month period at a comprehensive cancer center OUTCOME MEASURESIOBL (in mL), use of intraoperative blood products, and intraoperative blood products transfused. METHODSWe identified IOBL and transfusions, along with demographic data, preoperative laboratory data, and surgical procedures performed. Independent predictors of IOBL and transfusion risk were identified using multivariable regression. RESULTSMean age at surgery was 57.0±13.6 years, 53.1% were male, and 67.1% were treated for metastatic lesions. Independent predictors of IOBL included en bloc resection (p<.001), surgical invasiveness (β=25.43 per point; p<0.001), and preoperative albumin (β=−244.86 per g/dL; p=0.011). Predictors of transfusion risk included preoperative hematocrit (odds ratio [OR]=0.88 per %; 95% confidence interval [CI, 0.84, 0.93]; p<0.001), preoperative MCHgb (OR=0.88 per pg; 95% CI [0.78, 1.00]; p=0.048), preoperative red cell distribution width (OR=1.32 per %; 95% CI [1.13, 1.55]; p<0.001), en bloc resection (OR=3.17; 95%CI [1.33, 7.54]; p=0.009), and surgical invasiveness (OR=1.08 per point; [1.06; 1.11]; p<0.001). The transfusion model showed a good fit of the data with an optimism-corrected area under the curve of 0.819. A freely available, web-based calculator was developed for the transfusion risk model (https://jhuspine3.shinyapps.io/TRUST/). CONCLUSIONSHere we present the first clinical calculator for intraoperative blood loss and transfusion risk in patients being treated for primary or metastatic vertebral column tumors. Surgical invasiveness and preoperative microcytic anemia most strongly predict transfusion risk. The resultant calculators may prove clinically useful for surgeons counseling patients about their individual risk of requiring allogeneic transfusion.

&lt;p&gt;Preoperative Anemia Screening and Treatment Practices in Patients Having Total Joint Replacement Surgery: A Retrospective, Observational Audit&lt;/p&gt;

BackgroundSurgical patients with preoperative anemia are more likely to experience adverse outcomes. Patient blood management (PBM) guidelines recommend screening and treating patients for anemia preoperatively to enable optimisation before surgery. This study investigates compliance with PBM guidelines and reports the association between length of stay and transfusion risk in patients with preoperative anemia.Study Design and MethodsA retrospective, observational, chart audit that included all patients having primary, total hip and knee replacement surgery between July–December 2018 at a tertiary, metropolitan healthcare facility.ResultsSix hundred and seven patients patients were included, 96% (n = 583) patients had blood tests available (full blood count), and 8.1% (n = 49) had iron studies. Most patients 53% (n = 324) were screened between 2 and 6 days before surgery; 14.6% (n = 85) were anaemic preoperatively and only 5.9% (n = 5) of anaemic patients received treatment. Patients who had anemia preoperatively were more likely to receive a blood transfusion (odds ratio 8.65 [95% CI 3.98–18.76]) and stayed longer in hospital (median difference = 1, χ2 LR = 17.2, df=1, p<0.007).ConclusionTests ordered for patients having major surgery should include iron studies, renal function, CRP and full blood count to enable detection and classification of preoperative anemia. Timing of screening relative to surgery needs to be sufficient to allow patient optimisation to occur. Appropriate treatment should be provided to anaemic patients to prevent unnecessary blood transfusions and reduce the length of stay. A standardised preoperative anemia pathway may assist in improving practice.

Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty

BackgroundThe need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in patients following TKA and develop a nomogram.MethodsThe nomogram was developed based on a training set of 5402 patients who underwent TKA at the Affiliated Hospital of Qingdao University between September 2013 and November 2018. The independent predictors of transfusion were identified by univariate, LASSO, and binary logistic regression analyses. Then, a nomogram was established based on these independent predictors. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. The results were validated using an independent set of 1116 patients who underwent TKA between December 2018 and September 2019. In addition, we also carried out subgroup analyses in the training and testing sets based on the independent predictors.ResultsFive independent predictors were identified by multivariate analysis and were used to establish the nomogram. The AUCs of the nomogram were 0.884 (95% CI: 0.865–0.903) and 0.839 (95% CI, 0.773–0.905) in the training and testing sets, respectively. In both the training and testing sets, the calibration curve indicated that the prediction by the nomogram was highly consistent with the actual observation, and the DCA indicated that the nomogram had a favorable level of clinical usefulness. In addition, the AUC of the nomogram was significantly higher than the AUC of any independent predictor for predicting transfusion risk following TKA, and the subgroup analysis showed good performance in 20 subgroups.ConclusionLower preoperative Hb levels, simultaneous bilateral TKA, lower BMI, older age, and coronary heart disease were identified as independent predictors of postoperative transfusion in patients following TKA. A nomogram incorporating the above five predictors could accurately predict the transfusion risk.

114 Roxadustat Lowers Risk of RBC Transfusion in Patients with Anemia of CKD

114 Roxadustat Lowers Risk of RBC Transfusion in Patients with Anemia of CKD

Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study...

Determinants of perioperative transfusion risk in patients with adult spinal deformity.

OBJECTIVE To determine predictors of perioperative allogeneic packed red blood cell (pRBC) transfusion requirement (total units transfused) in patients with adult spinal deformity (ASD). METHODS The authors retrospectively analyzed records of patients aged 18 years or older who underwent surgical correction of ASD that involved 4 or more spinal levels by the same spine surgeon between 2010 and 2016. Data regarding patient characteristics, comorbidities, surgical factors, and perioperative transfusions (up to 10 days after surgery) were analyzed using a linear regression model. Significance was set at p < 0.05. RESULTS The authors analyzed 165 patients (118 women) with a mean (± SD) age of 61 ± 12 years. Three-column osteotomies were associated with a mean intraoperative transfusion volume of 1.74 additional units of pRBCs. Each unit of intraoperatively salvaged blood used was associated with a mean 0.39-U increase in postoperative transfusion volume (p = 0.031). Every unit of allogeneic blood transfused intraoperatively was associated with a mean 0.23-U decrease in postoperative transfusion volume (p = 0.001). A preoperative hemoglobin concentration of 11.5 g/dl or more was associated with significantly fewer units transfused intraoperatively; a preoperative hemoglobin concentration of 14.0 g/dl or more was associated with fewer units transfused postoperatively. A history of smoking and intraoperative antifibrinolytic use were associated with increased and decreased numbers of units transfused postoperatively, respectively. CONCLUSIONS Effective blood management is key to perioperative care of patients with ASD. Three-column osteotomies were associated with a greater number of units of blood transfused. When considering postoperative transfusion requirements, surgeons should note that intraoperative blood salvage might be inferior to intraoperative allogeneic blood transfusion. Using antifibrinolytics and increasing the preoperative hemoglobin concentration to 11.5 g/dl or more are strategies for decreasing the need for perioperative transfusion. A history of smoking is a risk factor for postoperative transfusion requirement (total units transfused).

Blood Conservation

Blood Conservation

Blood loss and risk of blood transfusion in patients undergoing caesarean section

Background: Caesarean delivery is one of the most common operations performed worldwide. Maternal morbidity and risk of blood transfusion increased greatly with caesarean compared with that of vaginal delivery. Aims: This study was carried out to evaluate blood loss and requirement of blood transfusion in patients undergoing caesarean section. Materials and methods: A prospective observational study was carried out in a peripheral military hospital, India where 173 women underwent caesarean section and data were obtained on age, parity, gestational age, delivery type (elective/ emergency), indication for caesarean section, pre operative and post operative haemoglobin levels. Number of patients required blood transfusion were also noted. Results: There was no significant increase in blood loss by indication of caesarean section (p<0.05). A total of 1.7% patients received blood transfusion. Conclusion: Transfusion risk in patients undergoing caesarean section is low and haemoglobin testing after caesarean section should be limited to women at high risk of blood transfusion.

On admission haemoglobin in patients with hip fracture

Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture. We could find no study in the English literature estimating the magnitude of this fall in haemoglobin after re-hydration prior to surgery. We conducted a prospective study to estimate the magnitude of fall in haemoglobin after re-hydration prior to surgery by repeating the full blood count after at least 12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive at one centre and 52 consecutive at another). The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) ( p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL ( p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL ( p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements for perioperative transfusion during this study. Their predicted average postoperative haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL. The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures, and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.

Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty.

The aim of this study was to identify clinical factors associated with an increased need for perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. We evaluated eighty-five consecutive nonanemic patients who underwent elective, unilateral, cementless, primary total hip arthroplasty and met our inclusion criteria. We attempted to determine whether clinical parameters influencing perioperative blood loss, such as age, gender, hypertension, and body mass index, were also associated with the need for perioperative blood transfusion. Perioperative blood transfusion was required in twenty-four (28%) of the eighty-five nonanemic patients. When considered alone, age, gender, hypertension, and body mass index were not significantly associated with an increased risk of perioperative blood transfusion, on the basis of the numbers available. In contrast, there was a significantly increased risk of blood transfusion when two or more of these clinical parameters were present (p = 0.02). Our findings indicate that clinical variables such as age, gender, hypertension, and body mass index may have a synergistic effect on the risk of transfusion in patients undergoing elective total hip arthroplasty. The simultaneous analysis of these parameters might help to stratify patients with different risks for transfusion and may increase the efficiency and reduce the cost of blood-ordering practices associated with total hip arthroplasty. Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

The predictive power of baseline hemoglobin for transfusion risk in surgery patients.

Preoperative hemoglobin concentration may be an important predictor of transfusion risk in surgical procedures with significant expected blood loss. Contemporary studies investigating transfusion risk with regard to the relationship between perioperative administration of Epoetin alfa and baseline hemoglobin provide data to test this hypothesis. The predictive power of seven preoperative variables (hemoglobin concentration, age, erythropoietin level, ferritin concentration, serum iron, total iron-binding capacity, and predicted blood volume) on transfusion risk was examined via retrospective logistic regression analysis of 276 orthopedic surgical patients. In the two studies used to perform the regression analysis, patients were treated daily with either Epoetin alfa or placebo. Based on the retrospective analyses, a prospective study was conducted to validate the hypothesis. Of the seven variables evaluated, baseline hemoglobin concentration and predicted blood volume were significantly predictive of transfusion risk in both Epoetin alfa- and placebo-treated patients. Further, an inverse correlation between hemoglobin concentration and transfusion risk was demonstrated in placebo-treated patients. Placebo-treated patients with hemoglobin > 10 to < or = 13 g/dL had an approximately twofold greater risk of transfusion than patients with hemoglobin > 13 g/dL. In contrast to placebo treatment, Epoetin alfa significantly reduced transfusion risk in patients with hemoglobin > 10 to < or = 13 g/dL. Baseline hemoglobin concentration is an excellent predictor of transfusion risk in orthopedic surgical patients. As a result, hemoglobin testing should be considered a part of routine preoperative testing for orthopedic surgical patients.

Predictors of transfusion risk in elective knee surgery.

Two hundred seventy-nine patients undergoing primary unilateral total knee replacement and 280 patients undergoing primary bilateral total knee replacements were reviewed retrospectively. Patients' height, weight, hemoglobin level before donation, hemoglobin level before surgery, autologous donation, number and type of transfusions whether autologous or allogeneic, and hemoglobin at discharge were collected from hospital and clinic records. The average drop in hemoglobin was 3.85 g/dL in the group of patients undergoing unilateral total knee replacement and 5.42 g/dL in the group of patients undergoing bilateral total knee replacements. The preoperative hemoglobin and blood volume seemed to be very strong, statistically significant predictors of transfusion risk in single and bilateral knee replacements. In unilateral total knee replacement, patients with a hemoglobin of greater than 13 g/dL had only an 8% chance of transfusion and if they donated autologous blood, 66% of the blood was wasted. Preoperative anemia was a strong predictor of transfusion risk in patients undergoing unilateral and bilateral total knee replacements and carried a very high allogeneic transfusion exposure risk, even in patients who had donated blood preoperatively. A nomogram was developed using blood volume and predonation hemoglobin to predict transfusion risk and need to predeposit autologous blood in patients undergoing unilateral and bilateral total knee replacements.

234 Reduction of the risk of transfusion in patients with small cell lung cancer (SCLC) undergoing chemotherapy

This open-label, controlled, multicentre study examined the efficacy of subcutaneous (SC) Epoetin alfa (administered 3 times weekly) in preventing anaemia in 130 initially non-anaemic (Hb ≥ 10.5 g/dl) SCLC patients (pts) scheduled to receive 4–6 cycles of platinum-based combination chemotherapy. Patients were randomized to receive Epoetin alfa 300 IU/kg (group A, n = 44), 150 IU/kg (group B, n = 42) or no Epoetin alfa (group C). Treatment began 1 day after completion of the monthly chemotherapy cycle, and finished 3 days before initiation of the next cycle, for up to 6 cycles. Reductions in Epoetin alfa dose were made if Hb ≥ 15 gjdl. Logistic regression analysis of group C pts showed that low baseline Hb levels or a reduction in Hb level from higher baseline Hb levels, during the first cycle of chemotherapy, were important risk factors for transfusion. Group C required significantly more transfusions than Groups A and B (59%, 21%,45%, respectively; P ≥ 0.05). In addition, significantly more pts in group C experienced reduced Hb levels (Hb In conclusion, Epoetin alfa is effective and well tolerated in preventing anaemia and reducing the risk of transfusion in SCLC pts undergoing cyclic chemotherapy.