Total Estimated Blood Loss Research Articles

Association of single bolus versus bolus followed by infusion of tranexamic acid with blood loss in adolescent idiopathic scoliosis surgery

BackgroundAdolescent idiopathic scoliosis (AIS) corrective surgery may involve significant blood loss and blood transfusion requirements. Antifibrinolytic agents such as tranexamic acid (TXA) have been used to reduce blood loss, but its optimal dose is uncertain. The objective of this study is to determine the estimated blood loss and rate of blood transfusion between two groups of AIS patients receiving TXA as a single bolus versus bolus followed by infusion in scoliosis surgery.MethodsThis was a retrospective analysis of a single bolus versus bolus followed by infusion of TXA in AIS surgery. AIS patients undergoing posterior spinal fusion (PSF) from December 2018 to September 2019 at a tertiary university hospital were identified. Inclusion criteria were patients aged between 10 and 21 years who received either a single bolus of 30 mg/kg TXA (Group A) or a single bolus of 30 mg/kg followed by continuous infusion of 10 mg/kg/h of TXA (Group B). Patient demographics, operative data, estimated blood loss, blood transfusion rate, and complications were recorded.ResultsA total of 129 AIS patients were included. All operative surgeries were performed by two senior consultants. The mean age was 14.8 ± 3.4 years old, and 89.1% were female. The Cobb angle, number of fusion levels, number of screws, length of skin incision, and duration of surgery were comparable between the two groups. There was no difference in the total estimated blood loss between the two groups: 723.3 ± 279.4 mL (range: 175.0–1607.0 mL) in Group A and 819.4 ± 302.6 mL (range: 330.0–1556.0 mL) in Group B (p = 0.065). There were no complications, and none received blood transfusion.ConclusionTXA when administered as a single bolus or bolus followed by infusion in AIS patients undergoing PSF surgery was associated with similar estimated total surgical blood loss and blood transfusion requirement.

Tranexamic Acid in Patients Undergoing Liver Resection

Tranexamic acid reduces bleeding and blood transfusion in many types of surgery, but its effect in patients undergoing liver resection for a cancer-related indication remains unclear. To determine whether tranexamic acid reduces red blood cell transfusion within 7 days of liver resection. Multicenter randomized clinical trial of tranexamic acid vs placebo conducted from December 1, 2014, to November 8, 2022, at 10 hepatopancreaticobiliary sites in Canada and 1 site in the United States, with 90-day follow-up. Participants, clinicians, and data collectors were blinded to allocation. A volunteer sample of 1384 patients undergoing liver resection for a cancer-related indication met eligibility criteria and consented to randomization. Tranexamic acid (1-g bolus followed by 1-g infusion over 8 hours; n = 619) or matching placebo (n = 626) beginning at induction of anesthesia. The primary outcome was receipt of red blood cell transfusion within 7 days of surgery. The primary analysis included 1245 participants (mean age, 63.2 years; 39.8% female; 56.1% with a diagnosis of colorectal liver metastases). Perioperative characteristics were similar between groups. Red blood cell transfusion occurred in 16.3% of participants (n = 101) in the tranexamic acid group and 14.5% (n = 91) in the placebo group (odds ratio, 1.15 [95% CI, 0.84-1.56]; P = .38; absolute difference, 2% [95% CI, -2% to 6%]). Measured intraoperative blood loss (tranexamic acid, 817.3 mL; placebo, 836.7 mL; P = .75) and total estimated blood loss over 7 days (tranexamic acid, 1504.0 mL; placebo, 1551.2 mL; P = .38) were similar between groups. Participants receiving tranexamic acid experienced significantly more complications compared with placebo (odds ratio, 1.28 [95% CI, 1.02-1.60]; P = .03), with no significant difference in venous thromboembolism (odds ratio, 1.68 [95% CI, 0.95-3.07]; P = .08). Among patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications. ClinicalTrials.gov Identifier: NCT02261415.

Use of Drains in Spine Surgery Systematic Review & Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis.

Tranexamic acid (TXA) has gained popularity in spinal surgery because of its potential to reduce blood loss. However, concerns regarding its safety and efficacy remain. This systematic review and meta-analysis aimed to evaluate the efficacy of TXA in reducing blood loss and its safety profile in spinal surgeries. A comprehensive search was conducted in electronic databases for randomized controlled trials and prospective studies evaluating the use of TXA in spinal surgery. The primary outcomes were intraoperative and total estimated blood loss (EBL), and the secondary outcomes included the incidence and types of complications associated with TXA use. Meta-analyses were performed using random-effects models. Thirteen studies involving 1,213 participants were included in the meta-analysis. The use of TXA was associated with significant reductions in both intraoperative (mean difference: -46.56 mL [-73.85, -19.26], p<0.01]) and total EBL (mean difference: -210.17 mL [-284.93, -135.40], p<0.01) while also decreasing the need for blood transfusions (risk ratio: 0.68 [0.51, 0.90], p<0.01). No significant difference was found in the incidence and types of thrombotic complications when TXA was used in spinal surgery. Subgroup analysis showed consistent results in instrumentation and fusion surgery and different doses of TXA. TXA is effective in reducing intraoperative and overall blood loss in spinal surgery without increasing the risk of complications. These findings support the use of TXA to improve patient outcomes. However, caution should be exercised because of the heterogeneity among the included studies. Further research is needed to confirm these findings and explore potential long-term complications.

The Negative Impacts of Sarcopenia on Primary Total Knee Arthroplasty under the Enhanced Recovery after Surgery Protocol.

Sarcopenia, as an emerging public health concern, has been associated with postoperative adverse outcomes in various surgical procedures. However, the evidence regarding the impacts of sarcopenia on total knee arthroplasty (TKA) remained limited. This study aimed to assess the impacts of sarcopenia on primary TKA based on the enhanced recovery after surgery (ERAS) protocol. This retrospective study included 291 patients who received unilateral TKA from October 2017 to May 2018 in our institution. Sarcopenia was diagnosed based on the algorithm of Asian Working Group for Sarcopenia 2019. The handgrip strength was measured using a handheld dynamometer and the muscle mass was estimated by a previously validated anthropometric equation. Patients were classified into sarcopenia group and non-sarcopenia group. The outcomes included complications, postoperative length of stay (LOS), total hospitalization cost, operative time, total estimated blood loss, blood transfusion rate, and the 12-item forgotten joint score (FJS-12) at the follow-up. The propensity score matching (PSM) was used to adjust confounding factors. We compared continuous variables using Student's t-test and the Wilcoxon Mann-Whitney U test for normal and non-normal distributions, respectively, and categorical variables with chi-square tests. Of the 291 patients, 58 (19.9%) patients were identified as having sarcopenia. After PSM, each group matched 42 patients. All matched patients were followed-up at least 5 years. Patients with sarcopenia had higher rates of surgical complications compared to the non-sarcopenia group (p = 0.019), and no significant difference was observed in 30-day readmission, and periprosthetic joint infection. The sarcopenia group had significantly longer LOS (p = 0.038), higher total hospitalization (p = 0.015) than the non-sarcopenia group. For the FJS-12 scores at follow-up, patients with sarcopenia had significantly higher scores than the non-sarcopenia group (p = 0.024). Our findings indicated sarcopenia may be a risk factor for postoperative complications, prolonged LOS, increased hospitalization cost and reduced patient satisfaction.

Timely use of Bakri intrauterine balloon tamponade contributes to the effectiveness in controlling severe postpartum hemorrhage.

The aim of the present study was to explore the effectiveness of Bakri intrauterine balloon tamponade (IUBT) in treating severe postpartum hemorrhage (SPPH). A cohort of 198 women with SPPH using IUBT were retrospectively selected. The baseline and maternal outcome characteristics were examined. The results demonstrated that women with SPPH had a high proportion of placenta accrete (53.0%). Bakri IUBT demonstrated a global effectiveness of 84.5% in SPPH treatment, accounting for 82.9% in women with placenta accrete. Compared with women with Bakri failure, women who experienced Bakri success had reduced rates of less use of pre-/post-IUBT intervention, blood transfusion, lower genital tract trauma, estimated blood loss (EBL), and a longer indwelling duration (P<0.05). Logistic regression revealed that the pre-IUBT intervention (OR=3.910; 95% CI: 1.684-9.079; P=0.002) was positively associated with hemostasis success, while lower genital tract trauma was negatively associated with Bakri success (OR=0.091; 95% CI: 0.009-0.894; P=0.040). Moreover, women diagnosed with placenta accrete underwent a greater number of transabdominal placed Bakri IUBT and pre-IUBT interventions than those without placenta accrete (P<0.05). No significant differences were observed in Bakri success, total EBL, pre-/post-IUBT EBL, infused volume of IUBT, IUBT indwelling duration, even the rate of hemostasis, lower genital tract trauma, blood transfusion, post-IUBT intervention, and puerperal fever between women with and without placenta accrete (P>0.05). In conclusion, placenta accrete may be the leading cause of SPPH. Bakri IUBT is an effective and safe measure for SPPH. Pre-IUBT intervention may be predictive of Bakri's success. The timely use of IUBT during labor may mitigate the impact of risk factors identified on PPH.

Tumescent anesthesia use for cutaneous malignancies does not impact sentinel node identification but decreases estimated blood loss

Sentinel node biopsy is performed to stage clinically and radiographically occult regional disease in cases of malignancy, including cutaneous cancer such as melanoma. The use of tumescent anesthesia with sentinel node biopsy for cutaneous malignancies has not been well studied. Therefore, we aimed to compare the rate of successful sentinel node identification and estimated blood loss between patients who underwent sentinel node biopsy with and without the use of tumescent anesthesia. A retrospective review was conducted of a prospectively maintained single-institution database of all patients who underwent reconstruction after the extirpation of a cutaneous malignancy over an 18-month period. Patient demographics, tumor histology, and characteristics, indication for and success of sentinel node biopsy, use of tumescent anesthesia, and total estimated blood loss were examined. Sentinel node biopsy was performed in 15 of 39 patients (38.5%) receiving tumescent anesthesia compared with 6 of 26 patients (23.1%) not receiving it (p=0.19). Sentinel node biopsy had a success rate of 100% in the tumescent and nontumescent anesthesia groups. The mean estimated blood loss in the tumescent anesthesia group was 36.7mL versus 59.6mL in the nontumescent anesthesia group (p<0.001). Complication rates were comparable between the tumescent anesthesia (12.8%) and nontumescent anesthesia (19.2%) groups (p=0.48). The use of tumescent anesthesia in cutaneous malignancy extirpation and immediate reconstruction was not associated with a decreased sentinel node identification rate or change in complication rates. However, tumescent anesthesia was associated with a decrease in the estimated blood loss.

Development of a Machine Learning Model of Postoperative Acute Kidney Injury Using Non-Invasive Time-Sensitive Intraoperative Predictors.

Acute kidney injury (AKI) is a major postoperative complication that lacks established intraoperative predictors. Our objective was to develop a prediction model using preoperative and high-frequency intraoperative data for postoperative AKI. In this retrospective cohort study, we evaluated 77,428 operative cases at a single academic center between 2016 and 2022. A total of 11,212 cases with serum creatinine (sCr) data were included in the analysis. Then, 8519 cases were randomly assigned to the training set and the remainder to the validation set. Fourteen preoperative and twenty intraoperative variables were evaluated using elastic net followed by hierarchical group least absolute shrinkage and selection operator (LASSO) regression. The training set was 56% male and had a median [IQR] age of 62 (51-72) and a 6% AKI rate. Retained model variables were preoperative sCr values, the number of minutes meeting cutoffs for urine output, heart rate, perfusion index intraoperatively, and the total estimated blood loss. The area under the receiver operator characteristic curve was 0.81 (95% CI, 0.77-0.85). At a score threshold of 0.767, specificity was 77% and sensitivity was 74%. A web application that calculates the model score is available online. Our findings demonstrate the utility of intraoperative time series data for prediction problems, including a new potential use of the perfusion index. Further research is needed to evaluate the model in clinical settings.

Maternal Outcomes in Placenta Accreta Spectrum Disorders Managed With REBOA [ID: 1370002

INTRODUCTION: Pregnancies complicated by placenta accreta spectrum (PAS) are increasing. In PAS, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control life-threatening hemorrhage, although supporting data are conflicting. The aim of this study was to determine the outcomes in pregnancies complicated by PAS managed with REBOA. METHODS: This was an IRB-exempt retrospective cohort study of pregnancies complicated by PAS at a single institution. The primary outcome was arterial thrombus. Secondary outcomes were estimated blood loss, operative room time, transfusion risk, and hospital and intensive care unit stays. Demographics and outcomes were compared by univariate analysis. Multivariable logistic regression with a mixed effects model was used to control for confounders. RESULTS: Ninety-one pregnancies (16 REBOA and 75 non-REBOA) were included. REBOA was associated with an increased risk of arterial thrombus, adjusted odds ratio of 1.33 (95% CI 1.05–1.77, P&lt;.001). Patients with an arterial thrombus had longer hospital (P&lt;.003) and intensive care unit stays (P&lt;.001). REBOA use was associated with increased total operative time (249 versus 171 minutes, P=.001). REBOA was not associated with lower total estimated blood loss (EBL, 2,699 versus 3,455 mL, P=.28). CONCLUSION: The use of REBOA in PAS is associated with an increased risk of arterial thrombus compared to management without. This risk remains elevated after controlling for demographic and clinical variables. REBOA use was not associated with clinical benefits such as decreased EBL or operative time.

Endoscopic anterior to psoas lumbarinterbody fusion: indications, techniques, and clinical outcomes.

The retrospective study aimed to report the surgical technique and clinic-radiological outcomes of endoscopic anterior to psoas interbody lumbar fusionthrough the retroperitoneal approach with direct and indirect decompression. We retrospectively analyzed the results of clinical parameters of patients who underwent endoscopic anterior to psoas interbody lumbar fusion between June 2013 and June 2022. Clinical outcomes were evaluated by the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The radiological outcomes were measured and statistically compared in disc height index (DHI), whole lumbar lordosis (WLL), pelvic Incidence (PI), pelvic tilt (PT), Segmental lordosis (SL), the sagittal vertical axis (SVA). A total of 35 patients were selected for the procedure ranging in age from 51 to 84years with 17.83 ± 8.85months follow-up. The mean operation time in lateral position for one level was 162.96 ± 35.76min (n = 24), and 207.73 ± 66.60min for two-level fusion. The mean endoscopic time was 32.83 ± 17.71min per level, with a total estimated blood loss of 230.57 ± 187.22cc. The mean postoperative VAS back, leg pain score and ODI improved significantly compared to the preoperative values; Radiological data showed significant change in WLL, SL, DHI, PI, PT, and SS; however, there is no significant difference in SVA postoperatively. Subgroup analysis for the radiographic data showed 50mm length cage has significantly improved for the DHI, SS and SVA compare to 40mm length cage. The subgroup analysis results showed that hypertensive patients had significantly higher proportion in the incomplete fusion group compare to complete fusion group at one-year follow-up. The endoscopic anterior to psoas interbody lumbar fusion achieves satisfactoryindirect and direct decompression. This convergent techniquepresents an effective choice for treating lumbar instability associated withdischerniations and foraminal stenosis, thus complementing the indications for oblique lumbar interbody fusion.

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

V05-12 ANTERIOR RETROPERITONEAL APPROACH TO THE SINGLE PORT PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023V05-12 ANTERIOR RETROPERITONEAL APPROACH TO THE SINGLE PORT PARTIAL NEPHRECTOMY Grace Chen and Simone Crivellaro Grace ChenGrace Chen More articles by this author and Simone CrivellaroSimone Crivellaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the Food and Drug Administration’s (FDA) approval of the da Vinci Single-Port (SP) robotic platform in 2018, a wealth of new surgical techniques have been described that capitalize on the SP platform’s proficiency in small spaces. A rarely described technique even among robotic surgeons is the anterior retroperitoneal approach. To our knowledge, this is the first description of this approach utilizing the SP platform in the literature. Our objective is to describe the technique used at our institution for the anterior retroperitoneal single port partial nephrectomy. METHODS: This video abstract uses intraoperative recordings from one patient who underwent a SP partial nephrectomy at our institution. The clinical techniques are described in detail following detailed discussion with an experience robotic surgeon (SC). No pathologic or short-term outcomes were available. RESULTS: Retroperitoneal access was successfully obtained via an anterior incision for a 3.7 cm interpolar mass. The mass was successfully treated without need for conversion to multi-port or open approaches. Total operative time was 192 minutes. Total estimated blood loss (EBL) was 20 cc. The total hospital length of stay (LOS) was 8 hours. The patient was successfully discharged home with a non-narcotic pain control plan. CONCLUSIONS: The anterior retroperitoneal approach to SP robotic partial nephrectomy is safe and feasible. Theoretical advantages of this approach include increased efficiency and decreased positional injuries due to the ability to perform surgery in the supine position, less bowel manipulation, and potentially decreased opioid requirements. Further outcomes data is anticipated. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e428 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Chen More articles by this author Simone Crivellaro More articles by this author Expand All Advertisement PDF downloadLoading ...

Thromboelastometry-guided treatment algorithm in postpartum haemorrhage: a randomised, controlled pilot trial

BackgroundPostpartum haemorrhage causes significant mortality among parturients. Early transfusion of blood products based on clinical judgement and conventional coagulation testing has been adapted to the treatment of postpartum haemorrhage, but rotational thromboelastometry (ROTEM) may provide clinicians means for a goal-directed therapy to control coagulation. We conducted a parallel design, randomised, controlled trial comparing these two approaches. We hypothesised that a ROTEM-guided protocol would decrease the need for red blood cell transfusion. MethodsWe randomised 60 parturients with postpartum haemorrhage of more than 1500 ml to receive either ROTEM-guided or conventional treatment, with 54 patients included in the final analysis. The primary outcome was consumption of blood products, and secondarily we assessed for possible side-effects of managing blood loss such as thromboembolic complications, infections, and transfusion reactions. ResultsThe median (25th–75th percentile) number of RBC units transfused was 2 (1–4) in the ROTEM group and 3 (2–4) in the control group (P=0.399). The median number of OctaplasLG® units given was 0 in both groups (0–0 and 0–2) (P=0.030). The median total estimated blood loss was 2500 ml (2100–3000) in the ROTEM group and 3000 ml (2200–3100) in the control group (P=0.033). No differences were observed in secondary outcomes. ConclusionsROTEM-guided treatment of postpartum haemorrhage could have a plasma-sparing effect but possibly only a small reduction in total blood loss. Clinical trial registrationNCT02461251.

Comparison of Intraarticular Versus Combined Intravenous and Intraarticular Tranexamic Acid Administration in Patients Undergoing Primary Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial in the Middle Eastern Patient Population.

This study aimed to determine whether combined intravenous (IV) and intraarticular (IA) tranexamic acid (TXA) reduces blood loss and the requirement of blood transfusion compared to IA use alone in the middle eastern patients undergoing primary cemented unilateral total knee arthroplasty (TKA). The present study is a double-blind randomized controlled trial (RTC) comparing the efficacy of IA alone to combined IA and IV routes of TXA administration in patients undergoing primary cemented TKA using a tourniquet performed by two senior surgeons. There were 21 patients in the IA alone and 29 in the combined group. The primary outcome measure was blood transfusion requirement, hemoglobin drop, and the total estimated blood loss on day three of postoperative period. The secondary outcomes were complications including thromboembolic events, wound complications, periprosthetic infection, patient-reported outcomes (PROs) of pain visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and EuroQol 5-dimension (EQ-5D) as well as the range of motion (ROM) at one-year follow-up. None of the patients in either of the comparison group required blood transfusion in the perioperative period. The drop in hemoglobin levels (2.1±1.0 vs. 2.2±1.1, P=0.84) and the total estimated blood loss (884±489 vs. 877±324, P=0.96) on the third postoperative day in the IA alone group showed no statistically significant difference compared to that in the combined group. Moreover, there were no complications noted in patients of either group. At one-year follow-up, there was no significant difference between the two comparison groups regarding the mean PROs of pain VAS, WOMAC, and EQ-5D, as well as ROM. According to the obtained results, this RCT in the middle eastern patient population found no additional benefit of TXA administration through combined IV and IA route over the IA alone in reducing the requirement of blood transfusion and the total blood loss. Further similar studies with larger sample sizes are needed to ascertain the ideal route of TXA administration in patients undergoing primary TKA.

The Effect of Intravenous Tranexamic Acid on Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Myomectomy is the preferred surgical treatment for symptomatic women with uterine myomas who wish to preserve their fertility. The procedure may be associated with significant intraoperative blood loss, which predisposes to increased transfusion rates and morbidity. The objective of our systematic review and meta-analysis is to investigate whether intravenous (IV) use of tranexamic acid (TXA) may reduce blood loss during myomectomy. Three electronic databases were screened until June 2022. The eligible studies were assessed for risk of bias. Four randomized controlled trials that reported outcomes from a total of 310 women were finally included in the meta-analysis—155 patients received intravenous TXA while the remaining 155 received placebo injection with normal saline or water for injection. Total estimated blood loss was significantly lower in patients who received TXA before myomectomy compared to control (230 patients MD −227.09 mL 95% CI −426.26, −27.91, p = 0.03). This difference in favor of TXA group remained when intraoperative and postoperative blood loss was separately analyzed. Postoperative hematocrit values and hemoglobin levels did not differ among the two groups (180 patients MD 0.67% 95% CI −0.26, 1.59, p = 0.16 and 250 patients MD 0.17 mg/dL 95% CI 0.07, 0.41, p = 0.17, respectively). The number of patients that received blood transfusion was also not different (310 patients OR 0.46 95% CI −0.14, 1.49, p = 0.19). Total operative time was significantly prolonged in control group compared to TXA (310 patients MD −16.39 min 95% CI −31.44, −1.34 p = 0.03). Our data show that the IV use of TXA may significantly reduce intraoperative blood loss in patients undergoing myomectomy and contribute to reduced operative time.

180. Who bleeds during elective anterior lumbar surgery?

<h3>BACKGROUND CONTEXT</h3> Blood loss during elective anterior lumbar access for interbody fusion or disc replacement is a potentially major complication. Patients undergoing this surgery have a variety of co-morbidities and medication which may contribute. <h3>PURPOSE</h3> The aim of this study was to examine which factors effect intraoperative estimated blood loss (EBL) during anterior lumbar surgery. <h3>STUDY DESIGN/SETTING</h3> A prospective study of consecutive anterior retroperitoneal approaches for lumbar surgery was performed between January 2010 and November 2021, by a single vascular surgeon and a single spine surgeon. <h3>PATIENT SAMPLE</h3> All patients (n=368) underwent an anterior lumbar interbody fusion (ALIF) at L4–5 and/or L5–S1, a total disc replacement (TDR) at L4–5 and/or L5–S1, or a hybrid procedure with a TDR at L4–5 and an ALIF at L5–S1. <h3>OUTCOME MEASURES</h3> We examined the effects of patient age, sex, body mass index (BMI), low-dose aspirin (LD-ASA), operative level, prosthesis and intraoperative heparinization. <h3>METHODS</h3> The Cell Saver was used in all cases with blood loss measured and recorded by an independent autotransfusionist. Saturation probes were placed on the second toes bilaterally. Heparin was administered intravenously when the saturation meter signal lost pulsatility indicating lower limb arterial flow was interrupted. <h3>RESULTS</h3> The mean age of the 368 patients was 47 ± 13.2 yrs [95% CI = 45 – 48]; and 210 (57%) were male. BMI showed a negative association with EBL. Age showed no effect on EBL in non-heparinized patients but a negative trending correlation with EBL in heparinized patients. Continuation of LD-ASA did not significantly affect EBL. Most patients underwent an ALIF (265 patients,72%), 55 (15%) had a TDR, and 48 (13%) had a hybrid operation (with a TDR at L4–5 and an ALIF at L5–S1) and the majority (249 patients,68%) had a single-level procedure (54 (26.9%) at L4–5 and 195 (73.1%) at L5–S1) and 119 (32%) underwent a 2-level procedure (L4–5 and L5–S1). There was more than twice mean EBL with TDR (135ml) and hybrid (104ml) compared to ALIF (59ml) but were not statistically significant. Intraoperative heparinization was administered in 104 patients (28%). The total mean EBL for the heparin group (125ml) was significantly higher than for the non-heparin group (56ml) (p< 0.0004). A significant difference was observed when comparing heparin vs nonheparin patients and the procedure type. With ALIF (p < 0.002), TDR (p< 0.03) and hybrid (p< 0.02) there was a significantly higher EBL with heparinized patients compared to nonheparinized patients. <h3>CONCLUSIONS</h3> TDR showed the highest EBL across procedure types. In non-heparinized patients, older age, increasing BMI and continuation of LD-ASA were not predictors for increased EBL. However, in heparinized patients, age and BMI showed a negative correlation with increased EBL. This study suggested younger, leaner, heparinized patients who undergo TDR surgery demonstrated the highest EBL risk in anterior lumbar surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Pertes hématiques non détectées pendant la chirurgie de la scoliose

IntroductionPosterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS) have higher blood loss than other pediatric orthopedic surgeries. There is a paucity of literature estimating the hidden blood loss (HBL) in patients with AIS undergoing PSF. The purpose of this study was to compare intraoperative and postoperative estimated blood loss (EBL) in patients undergoing PSF for AIS to determine HBL. HypothesisWith contemporary blood loss prevention strategies, HBL will be higher than intraoperative EBL. Material and methodsOver a 3-year period, 67 patients with preoperative and postoperative hemoglobin (Hgb) measurements undergoing PSF for AIS were evaluated. Intraoperative EBL was estimated using a volumetric method and recorded by a perfusionist managing a cell saver machine. Total perioperative EBL was estimated using the validated formula: EBL=weight (kg)×age sex factor×(preoperative Hgb−postoperative Hgb)/preoperative Hgb. HBL was calculated as the total perioperative EBL minus the intraoperative EBL. ResultsCalculated total EBL was higher than intraoperative EBL (771±256mL vs. 110±115mL, p<0.001). Mean HBL after wound closure was 660±400mL. Patients 14 years or greater (p=0.03), with a BMI≥25kg/m2 (p=0.02) and with surgical times over 3.5 hours (p=0.05) had increased HBL. Multivariate analysis determined BMI≥25kg/m2 (OR 9.91; CI, 1.01–104.26; p=0.05) was associated with increased HBL. Allogenic blood transfusion was rare (4 %) and associated with increased HBL (897±112mL vs. 540±402mL, p=0.05). DiscussionFor patients undergoing PSF for AIS there is more HBL after wound closure than intraoperative blood loss. This HBL is higher in older patients who undergo longer operations and have a BMI≥25kg/m2. Level of evidenceIV; retrospective cohort study.

Is Blood Transfusion Justified During Soft Tissue Surgery in Noma Patients? A One-Year Appraisal at Noma Children Hospital, Sokoto, Nigeria.

Background:Non-utilization of blood and inappropriate blood transfusion are common in surgical operations. Some surgical procedures are associated with minimal bleeding that does not warrant blood transfusion. No previous study has looked at the pattern of blood loss in noma defect repair to determine the possible need for blood transfusion.Aim/Objectives:This study aimed to determine the total amount of blood loss, the number of units of blood transfused, and the correlation between estimated blood loss and total operating time in patients who had surgical correction of noma defects.Materials and Methods:This is a hospital-based cross-sectional study of 35 patients who underwent surgical correction of noma defects. Age, sex, pre- and post-operative haemoglobin (Hb), number of requested blood units, total operating time, and total estimated blood loss were recorded. The methods used for the blood loss estimation were gauze swabs, Abdo-packs, drapes, and suction bottles.Results:Comparison of the mean pre- and post-operative Hb did not yield any statistically significant difference. The total estimated blood loss in these surgeries was in the range of 65–209 mL, with a mean of 117.20 ± 35.88 mL. No correlation between estimated blood loss and total operating time was noted (P = 0.940). No blood was transfused in any of the subjects.Conclusion:This study observed minimal blood loss in surgical corrections of the soft tissue noma defect. Apart from blood grouping, there may be no need for routine cross-matching of blood pre-operatively for surgical repair of noma defect. However, more studies are needed to buttress this finding.

Role of balloon tamponade during cesarean section in women with placenta previa: a systematic review and meta-analysis.

To explore the role of balloon tamponade insertion in pregnancies complicated by placenta previa. Medline, Embase and ClinicalTrials.gov databases were searched electronically on October 17. Inclusion criteria were women with placenta previa undergoing, compared to those not undergoing, balloon tamponade insertion at the time of the cesarean section (CS). The outcomes observed were total, intra- and post-operative estimated blood loss (EBL), need for blood transfusion, admission to intensive care unit (ICU), hysterectomy and additional surgical or medical procedures to achieve hemostasis. Results were reported as pooled odd ratios (OR) or mean difference (MD) according to the outcome investigated. Four studies (593 women) were included. Total EBL was significantly lower in women undergoing balloon tamponade insertion during CS compared to controls (MD: -556.3, 95% CI -496 to -617.0, P=0.001). Likewise, women undergoing balloon tamponade insertion had significantly lower intra- (MD: -699.8, 95% CI -766.1 to -633.5, P=0.001) and post-operative (MD: -1162 mL (95% CI -1211.1 to -1134.4, P<0.001) compared to women who did undergo such procedure. Furthermore, women undergoing balloon tamponade insertion had a significantly lower risk of requiring additional surgical (OR: 0.16, 95% CI 0.1-0.5, I2=0%; P=0.001) or medical (OR: 0.02, 95% CI 0.003-0.1, I2=0; P=0.001) procedures to achieve hemostasis. Conversely, there was no significant difference in either the need for blood transfusion (P=0.071), admission to ICU (P=0.459) or need for hysterectomy (P=0.312) between women undergoing, compared to those not undergoing, balloon tamponade insertion during CS for placenta previa. Elective balloon tamponade insertion at the time of CS for placenta previa seems to be associated with a lower EBL and a reduced risk of additional medical and surgical procedures to control hemostasis. Large and adequately powered randomized controlled trials are needed to validate these results and introduce elective balloon tamponade insertion at the time of CS for placenta previa in clinical practice.

Hidden blood loss in adolescent idiopathic scoliosis surgery

IntroductionPosterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS) have higher blood loss than other pediatric orthopedic surgeries. There is a paucity of literature estimating the hidden blood loss (HBL) in patients with AIS undergoing PSF. The purpose of this study was to compare intraoperative and postoperative estimated blood loss (EBL) in patients undergoing PSF for AIS to determine HBL. HypothesisWith contemporary blood loss prevention strategies, HBL will be higher than intraoperative EBL. Material and methodsOver a 3-year period, 67 patients with preoperative and postoperative hemoglobin (Hgb) measurements undergoing PSF for AIS were evaluated. Intraoperative EBL was estimated using a volumetric method and recorded by a perfusionist managing a cell saver machine. Total perioperative EBL was estimated using the validated formula: EBL=weight (kg)×age sex factor×(preoperative Hgb – postoperative Hgb)/preoperative Hgb. HBL was calculated as the total perioperative EBL minus the intraoperative EBL. ResultsCalculated total EBL was higher than intraoperative EBL (771±256mL vs. 110±115mL, p<0.001). Mean HBL after wound closure was 660±400mL. Patients 14 years or greater (p=0.03), with a BMI≥25kg/m2(p=0.02) and with surgical times over 3.5hours (p=0.05) had increased HBL. Multivariate analysis determined BMI≥25kg/m2 (OR 9.91; CI, 1.01–104.26; p=0.05) was associated with increased HBL. Allogenic blood transfusion was rare (4%) and associated with increased HBL (897±112mL vs. 540±402mL, p=0.05). DiscussionFor patients undergoing PSF for AIS there is more HBL after wound closure than intraoperative blood loss. This HBL is higher in older patients who undergo longer operations and have a BMI≥25kg/m2. Level of evidenceIV; retrospective cohort study.