Risk Factors For Transfusion Research Articles

Risk factors for severe hyperbilirubinemia and exchange transfusion in neonates

Background Neonatal jaundice is a common cause of neonatal admission to the hospital. The neonatal jaundice frequency has been increased last decade. 65% of term babies develop jaundice clinically in 1st week (in preterm babies 80%).Methods One hundred and sixty four neonates with severe hyperbilirubinemia, were enrolled in this study. Most important relevant informative data was taken during admission to the hospital. American Academy of Pediatrics (AAP) guidelines were applied in management of the patients, which was been either phototherapy or exchange transfusion with phototherapy ResultsMeanTSB level of 164 cases was 16.6mg/dl. TSB was significantly high in the male, with Rh-ve mothers and Rh+ve babies, more than 37weeks gestational age, admitted after 72 hours of life, were having history of previous siblings affected with jaundice and or received phototherapy and family history of hemolytic diseases. Phototherapy alone was used as treatment modality in most of the patients. On admission to the NCU, the mean age of the infants who needed exchange transfusion 4.97 ±2.24 while the mean TSB level was 20.2±2.84 mg/dL. The most common cause for ET was early discharge from the maternity unit & late admission to the NCU 72.4%. ConclusionsSevere hyperbilirubinemia was been more common in male neonates, > 37weeks of gestational age, with Rh-ve mothers and Rh+ve babies, who admitted after 72hrs of life, . Most of cases treated by phototherapy. The most common cause for ET was early discharge from the maternity unit & late admission to the NCU.

Frequency of Transfusions and Risk Factor for Bleeding Risk to Guide a Blood-Sparing Program during Hip Arthroplasty in Gabon

Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.

A Decline in Overutilization of Transfusion after Total Knee Arthroplasty Using Pharmacological Agents for Patient Blood Management in South Korea: An Analysis Based on the Korean National Health Insurance Claims Database from 2008 to 2019.

This study aimed to evaluate the annual trends of transfusion rates and utilization of blood management agents in total knee arthroplasty (TKA) based on the operation type and to analyze the risk factors of transfusion after TKA. Using the Korean National Insurance claims database of 797,106 primary and revision TKAs between January 2008 and October 2019, data on the patients' characteristics, comorbidities, utilization of transfusion, and blood management agents were collected. The patients were categorized into three groups based on the operation type: primary, revision, and simultaneous bilateral TKA. The transfusion rate and utilization of blood management agents (intraoperative tranexamic acid [TXA] and preoperative iron supplements) were compared, and the risk factors for transfusion were evaluated. After excluding the inaccurate data, 730,554 arthroplasties (636,292 primary, 10,540 revision, and 41,861 simultaneous bilateral TKAs) were identified. The transfusion rates of primary, revision, and simultaneous bilateral TKAs in 2019 were 64.0%, 67.7%, and 68.9%, respectively, which were significantly decreased compared with 83.2%, 88.0%, and 92.5% in 2008, respectively (p < 0.001). Conversely, the utilization of intraoperative TXA and preoperative iron supplements was significantly increased from 4.6% and 13.8%, respectively, in 2008 to 52.4% and 27.0%, respectively, in 2019 (p < 0.001). The utilization of intraoperative TXA and preoperative iron supplements significantly lowered the risk of transfusion after TKA (odds ratio [OR], 0.20; p < 0.001 and OR, 0.71; p < 0.001). The transfusion rate after TKA decreased gradually from 83.5% to 64.5% between 2008 and 2019 in South Korea corresponding with the increased utilization of blood management agents. Therefore, consistent attention to patient blood management should be emphasized to reduce the transfusion rate after TKA.

Maternal race as a risk factor for maternal ICU admission, cesarean delivery, and maternal transfusion

Maternal race as a risk factor for maternal ICU admission, cesarean delivery, and maternal transfusion

Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion.

The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS &gt; 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p &lt; 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p &lt; 0.01; 100 vs. 92, p &lt; 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p &lt; 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested.

Correlation of the severity of anemia in patients undergoing total joint arthroplasty with preoperative deep vein thrombosis: a retrospective cohort study

BackgroundTo explore the correlation of the severity of preoperative anemia with deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA).MethodsA total of 2461 TJA patients were classified into anemia and non-anemia groups or DVT and non-DVT groups. A logistic regression model was established using propensity score matching (PSM) analysis with preoperative anemia of TJA patients as a dependent variable and DVT-related variables as covariates. The caliper value was set as 0.01, and the anemia and non-anemia groups were matched based on the ratio of 1:1 (835 pairs). Finally, data of all patients were analyzed by binary logistic regression.ResultsPreoperative anemia was observed in 872 cases (35.43%) and DVT in 170 cases (6.91%). Binary logistic regression after PSM revealed that the DVT risk of patients with preoperative, moderate and severe anemia increased by 1.82 [P = 0.00, 95% confidence interval (95% CI) (1.32–2.48)], 2.77 [P = 0.00, 95% CI (1.72–4.45)], and 8.26 [P = 0.00, 95% CI (3.22–21.16)] times, respectively. The risks of blood transfusion in the perioperative period in patients with anemia, mild anemia, moderate anemia, and severe anemia increased by 3.52 times [P = 0.00, 95% CI (2.78–4.47)], 2.13 [P = 0.00, 95% CI (1.63–2.79)], 7.22 [P = 0.00, 95% CI (5.30–9.83)], and 61.37 [P = 0.00, 95% CI (14.21–265.04)] times, respectively.ConclusionPreoperative anemia is an independent risk factor for preoperative DVT and blood transfusion in the perioperative period for TJA patients. The more severe the preoperative anemia, the greater the risk of preoperative DVT and perioperative blood transfusion in TJA patients. Therefore, patients with preoperative anemia, especially with moderate and severe anemia, should be screened for DVT formation before undergoing TJA.Trial registration ChiCRT2100054844.

Prevalence of pre-operative anemia and its implication for patient blood management in a Nigerian Hospital

Objectives: Pre-operative anemia is common in Sub-Saharan Africa including Nigeria. Anemia is a known risk factor for blood transfusion. In our hospital, like many others, patients are usually admitted a day before elective surgeries and the default treatment for anemia by most surgeons and anesthetists is allogenic blood transfusion. Anemia and blood transfusion are independently and synergistically associated with complications and undesirable outcomes. Patient blood management (PBM) is gaining popularity and has been advocated by the World Health Organization (WHO) for member countries to adopt as a means of improving patient outcomes. There is currently no research from the University of Calabar Teaching Hospital highlighting the prevalence of pre-operative anemia. This research was aimed at filling this gap and also presenting a baseline for comparison as the hospital strives to implement the three pillars of PBM strategies: Manage anemia, minimize blood loss and harness tolerance to anemia to improve patient outcomes. Material and Methods: All surgical patients who consented to the study were recruited prospectively. Patients who had no pre-operative hemoglobin (Hgb) or packed cell volume (PCV) recorded were excluded from the study. Demographic data, type of surgery, and pre-operative PCV levels were documented. Anemia was defined using the WHO standard as PCV &lt;39% (Hgb 13.0 g/dL) in men and &lt;36% (Hgb 12.0 g/dL) in women. Data were obtained about transfusion at the end of surgery. Surgeries were categorized into general, orthopedic, obstetric, gynecological, urologic, pediatric, ear, nose, throat/maxillofacial, burns and plastic unit (BPU), neurological, and thoracic. The information was entered into SPSS version 20. Data were cleaned and analyzed. The statistical significance was placed at P &lt; 0.05. Results are presented as tables, chats, and histograms. Results: A total of 237 patients were recruited with a mean age of 37.30 ± 19.05. More of them were females (54.0%) and a higher proportion of them (64.6%) had elective surgery. The categories of surgeries were predominantly general surgical (24.9%) and gynecological (21.9%) followed by orthopedic (17.7%), ENT/maxillofacial (9.3%), urologic (8.0%), and obstetric (7.2%) cases. The rest were neurosurgical (3.4%) and pediatric surgical (2.1%) cases. The overall prevalence of anemia was found to be 54.9%. The mean pre-operative PCV was 34.90 ± 7.37%. The highest proportion of pre-operative anemia was found among the pediatric surgical cases (80.0%) followed by the urologic (68.4%) and neurosurgical cases (62.5%). The prevalence of pre-operative anemia among the different surgical patients was gynecological (46.2%), general surgical (45.8%), obstetric (41.2%), ENT/maxillofacial (40.9%), and orthopedic (38.1%) cases. The lowest proportion of pre-operative anemic patients was found among the thoracic (25.0%) and Burns and Plastics (11.1%) cases. Most of the patients (86.5%) were not transfused intraoperatively. Whereas 20% of the anemic patients were transfused; only 5.6% of the non-anemic ones needed a blood transfusion. Conclusion: Pre-operative anemia remains prevalent in our environment and anemia is a risk factor for a blood transfusion which carries both risk and cost implications. PBM has as its first pillar the management of anemia. This pre-emptive approach to allogeneic blood transfusion avoidance is aimed at improving patient outcomes. Prevention and treatment of pre-operative anemia will be beneficial not just to the patients but to all healthcare stakeholders.

Association of red cell distribution width/albumin ratio with intraoperative blood transfusion in cervical cancer patients.

Although minimally invasive surgical techniques have reduced intraoperative bleeding, the risk of transfusion exists. However, few studies have evaluated risk factors for transfusion in radical hysterectomy. We aimed to evaluate the association between preoperative red cell distribution width/albumin ratio (RDW/albumin) and transfusion in cervical cancer patients. We analyzed 907 patients who underwent radical hysterectomy between June 2006 and February 2015. Logistic regression and Cox regression analyses were performed to determine the risk factors for transfusion and mortality at 5-year and overall. Net reclassification improvement (NRI) and integrated identification improvement (IDI) analyses were performed to verify the improvement of the intraoperative transfusion model upon the addition of RDW/albumin. RDW/albumin was an independent risk factor for transfusion (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.02-1.77, p = 0.035). Additionally, body mass index, operation time, laparoscopic surgery, total fluids, and synthetic colloid were risk factors for transfusion. RDW/albumin was an independent risk factor for 5-year mortality (hazard ratio [HR]: 1.51, 95% CI: 1.07-2.14, p = 0.020), and overall mortality (HR: 1.48, 95% CI: 1.06-2.07, p = 0.021). NRI and IDI analyses showed the discriminatory power of RDW/albumin for transfusion (p<0.001 and p = 0.046, respectively). RDW/albumin might be a significant factor in transfusion and mortality in cervical cancer patients.

Impact of fresh frozen plasma transfusion on mortality in extracorporeal membrane oxygenation.

Patients who receive extracorporeal membrane oxygenation (ECMO) support require substantial transfusions. Red blood cell (RBC) and platelet (PLT) transfusions have been reported to be associated with adverse outcomes in ECMO patients. However, little is known about whether the transfusion of fresh frozen plasma (FFP) is associated with mortality and morbidity among patients receiving ECMO. The aim of this study was to examine the relationship between FFP transfusion and mortality in ECMO patients and assess risk factors for the transfusion of FFP. The clinical parameters of 116 ECMO patients were collected. The machine learning approach of the Boruta algorithm was employed to select the variables associated with ECMO patients' in-hospital mortality. Univariate and multivariate logistic regression analyses were applied to identify the association between the selected variables and in-hospital mortality. Spearman correlation and backwards stepwise multiple linear regression analyses were used to examine parameters contributing to FFP transfusion. Among the 116 patients who received ECMO support, the in-hospital mortality was 32.8%. The median FFP (mL/kg/d) transfusion was higher in dead patients (5.07, IQR 1.78-8.90) when compared to alive patients (2.16, IQR 0.79-4.66) (p = 0.007). After adjustment for confounders, FFP transfusion (mL/kg/d) was associated with in-hospital mortality (OR 1.09, 95% CI, 1.01-1.18; p = 0.035). Further analysis found that higher activated partial thromboplastin time (APTT), higher levels of uric acid (UA) and lower PLT counts were significant risk factors for FFP transfusion, with estimated values of 0.06 (95% CI, 0.02-0.11; p = 0.009), 0.01 (95% CI, 0.00-0.02; p = 0.003) and -0.03 (95% CI, -0.05--0.01; p = 0.007), respectively. FFP transfusion is markedly associated with in-hospital mortality among patients receiving ECMO, and higher APTT, higher levels of UA and lower PLT counts are risk factors for FFP transfusion. This suggests that better management of patients' coagulation system and kidney function may reduce the utilization of FFP, thus improving ECMO patient outcomes.

Predictors and complications of blood transfusion in rheumatoid arthritis patients undergoing total joint arthroplasty.

Our research investigated predictors of postoperative blood transfusion rate following total joint arthroplasty (TJA) in patients with rheumatoid arthritis (RA) and evaluated the incidence of complications in the transfusion group and non-transfusion group. The authors retrospectively analyzed risk factors among 320 RA patients who underwent elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 2010 to December 2018. Demographic characteristics, laboratory results, medication history, and surgical protocol were gathered from electronic medical records. Univariable and multivariable logistic regression analyses were conducted to measure the impact of relevant variables on the need for transfusions. In addition, we compared the incidence of complications associated with transfusion. The cohort comprised 320 RA patients, aged 57.4 ± 12.0years, of whom 137 required postoperative blood transfusions and 183 did not. BMI, type of surgery, duration of surgery, disease activity score 28 (DAS28-CRP), tranexamic acid (TXA) administration, and preoperative hemoglobin (Hb) were all risk factors for transfusion after adjusting for the planned procedure. Previously published predictors, such as BMI, low preoperative hemoglobin, duration of surgery, procedure type (THA), were also identified in our analysis. Moreover, TXA administration and the DAS28-CRP showed the potential to influence risk. The incidence of postoperative complications was increased in patients who received blood transfusions compared to non-transfusion group. Our findings could help to identify RA patient population requiring blood transfusions, to ensure the necessary steps are adopted to limit blood loss and improve blood management strategies. Key Points • The risk factors for blood transfusion in rheumatoid arthritis patients undergoing total joint arthroplasty were BMI, the type of surgery, duration of surgery, TXA administration, DAS28-CRP, and preoperative hemoglobin. • The incidence of postoperative complications was increased in patients who received blood transfusions compared to non-transfusion group.

P9.14: Massive Blood Transfusion: Risk Factors and Consequences

Introduction: Massive blood transfusion (MBT) is a common occurrence in liver transplant patients. Recipient-related risk factors include cirrhosis, history of multiple surgeries and suboptimal donors. And, while advances in surgical techniques, anaesthetic management and graft preservation have decreased the need for transfusions, this complication has not been completely eliminated. Materials and Methods: One thousand four hundred and sixty nine liver transplants were performed at our institution between May 1998 and December 2019, and data was available regarding transfusion for 1469 of them. We divided the patients into two groups, with regards to transfusion of 6 or more units of packed red blood cells in the first 24 hours post transplant, and we analyzed the differences between the groups. We analyzed the risk factors for massive transfusion, as well as factors that influence patient survival by using Cox regression. Results: Out of the 1198 patients, 607 (50.7%) met criteria for massive transfusion.Both groups were statistically different with regards to hepatocellular carcinoma, autoimmune cause, liver/kidney transplant, uDCD, retransplantation, albumin serum levels, creatinine, sodium, bilirubin, haemoglobin, platelets, INR, MELD, McCluskey and Child scores. Out of the variables from the McCluskey index, only the following were significant for massive bleeding: Haemoglobin <10, INR >2 and creatinine >1.2. We contrasted the efficiency of all of the previously mentioned scores for capacity to predict massive transfusion, but none reached an area below the curve above 0.7. Survival was statistically lower at 1, 3, and 5 years when comparing the groups that had MBT compared to those that did not (92,6%, 85,2% and 79,7% respectively in the non MBT group, vs. 78,1%, 71,6% y 66,8%, respectively, in the MBT group). Regarding survival analysis, MBT was associated with a 1.5 mortality risk as opposed to no MBT. Conclusion: Massive blood transfusion impacts patient survival in a statistically significant way. The most significant risk factors are preoperative haemoglobin, INR and creatinine.

Associations of anaemia and race with peripartum transfusion in three United States datasets.

Transfusion complicates a significant proportion of births in the United States, and Black women have greater prevalence of transfusion at delivery than White women. Antepartum anaemia, a risk factor for peripartum transfusion, is more common among Black women than White women. We aimed to describe the racial distribution of antepartum anaemia in three national datasets and to evaluate the peripartum transfusion rate and characteristics of transfusion recipients, to investigate disparities in haemostatic outcomes. We performed a retrospective analysis of Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network Cesarean Registry (CR), NICHD Consortium on Safe Labor Registry (CSL), and a cohort of deliveries at Universal Health Services hospitals (UHS). Univariable associations and multivariable logistic regressions were calculated between race, anaemia and transfusion. Covariates included age, parity, smoking, body mass index, type of insurance, and delivery mode. We included n=56,964 deliveries from CR (28% Black), 87,465 from UHS (12% Black), and 140,324 from CSL (24% Black). Anaemia prevalence was 8% in CR, 7% in UHS, and 13% in CSL. Anaemia was more common among Black patients (ORs 2.52, 2.61, and 1.48 respectively) and was associated with transfusion in all databases (ORs 6.46 [95% CI 5.78-7.22]; 5.79 [4.74-7.27]; 1.27 [1.18-1.37] respectively). After adjusting for covariates, Black patients had greater odds of transfusion than non-Black patients in CR (aOR 1.32 [1.16-1.50]), but not in UHS or CSL (aORs 1.19 [0.89-1.59] and 0.40 [0.36-0.44] respectively). In our retrospective cohort study using three US registries, we emphasized the link between anaemia and transfusion. Although anaemia was more prevalent among Black patients, the race-transfusion relationship differed between databases, indicating other unexplored factors are involved.

The association between preterm delivery and postpartum bleeding in otherwise uncomplicated pregnancies

Objective:The primary aim was to investigate whether preterm delivery was an independent risk factor for blood or blood products transfusion in the intrapartum or postpartum period, considered as a proxy for severe obstetric bleeding.Material and Methods:Throughout a 9-month-period, 216 uncomplicated singleton deliveries were included in a cross-sectional study after exclusion of severe maternal and fetal morbidity, such as chorioamnionitis, and use of medications including tocolytics. Maternal and neonatal data were evaluated and compared across preterm (between 24 0/7-36 6/7 weeks’ gestation) and term (between 37 0/7-41 6/7 weeks’ gestation) deliveries. Primary and secondary outcomes were requirement for blood or blood products transfusion until discharge and change in hemoglobin value and hematocrit from baseline to postpartum hour 6, respectively. Logistic regression models were constructed to evaluate the effect of preterm delivery on the primary outcome.Results:There were 90 (41.7%) preterm deliveries with an overall cesarean section rate of 77.8%. Preterm delivery was not an independent risk factor for the primary outcome, when route of delivery, maternal body-mass index, antenatal steroid administration, and baseline (admission) platelet and leukocyte counts were controlled for [adjusted risk ratio, 2.46; 95% confidence interval (CI), 0.69-8.77; p=0.16]. Subgroup analysis, including cesarean deliveries, revealed a similar result (adjusted risk ratio, 1.65; 95% CI, 0.42-6.48; p=0.47). Secondary outcomes, including decrease in mean or percent values of hemoglobin and hematocrit measurements, were also similar across preterm and term groups, both after vaginal and cesarean delivery (for all comparisons, p>0.05).Conclusion:Preterm delivery is not independently associated with increased requirement for blood transfusions or decreased hemoglobin and hematocrit values following otherwise uncomplicated vaginal or cesarean delivery of singletons.

O-07: TRANSFUSION PRACTICE, POST-TRANSFUSION COMPLICATIONS AND RISK FACTORS IN SICKLE CELL DISEASE IN SENEGAL

Purpose: Blood transfusion is an indispensable therapy in sickle cell disease, despite its multiple and often harmful complications. The objective of this study was to evaluate the complications of alloimmunization, infection and iron overload secondary to blood transfusion in sickle cell disease patients. Materials and methods: This was a six-month cross-sectional case-control study conducted in the Clinical Hematology Department of Dakar (Senegal) on 253 patients followed for major sickle cell disease (153 polytransfused and 100 non-transfused patients). Transfusion practice (modalities, indications), post-transfusion complications (alloimmunization, iron overload, infections) and risk factors (sociodemographic, clinical, biological) for the occurrence of these complications were evaluated. Results: The median age of the patients was 28.5 years (5-59). The sex ratio (M/F) was 0.86. Homozygous sickle cell disease was more frequent (95.3%). The median follow-up time was 9.1 years (2-26). Simple transfusion was performed in 142 patients, exchange transfusion in 29 patients; 22 patients were on a transfusion program. The indications for transfusion were dominated by acute anemia (57.06%) and prolonged CVO (14%). Red blood cell concentrates were administered in 143 patients (93.46%). The median number of units of blood received per patient was 10 units (2 - 48). The frequency of alloimmunization was 16% and the most frequent alloantibodies were anti-rhesus (34.19%) and anti-Kell (23.67%). The prevalence of hepatitis C in transfused subjects was 1.33% and 1% in non-transfused subjects (p=0.64). The prevalence of HBV was 2% in transfused patients and 3% in non-transfused patients (p=0.45). HIV antibodies were not found in either the transfused or the non-transfused patients. Twelve patients (7.84%) had post-transfusion iron overload (ferritin level >1000 ng/ml). The higher the transfusion, the higher the ferritin level (strong positive correlation, r = 0.8). The number of packed red blood cells transfused was the only risk factor for alloimmunization (p=0.03) and post-transfusion iron overload (p=0.023). The frequency of blood transfusion was not related to the transmission of infectious. Conclusion: The management of sickle cell disease often requires blood transfusion to correct anemia or prevent certain complications. Despite the progress made in transfusion safety, this therapy still remains a risk for the recipient. The authors do not declare any conflict of interest

Does the transfusion rate following reverse total shoulder arthroplasty warrant aggressive perioperative blood management? An indications-based analysis

HypothesisWe hypothesized that certain operative conditions are more likely to require transfusion after reverse total shoulder arthroplasty (RTSA), but found no data comparing transfusion rates for traumatic, post-traumatic, and non-traumatic indications. MethodsRetrospective review identified 1083 patients with RTSA. After exclusion of revision and tumor cases, 783 patients were divided into 3 groups as follows: traumatic (acute fractures, fracture-dislocations), post-traumatic (nonunions, malunions, chronic dislocations), or non-traumatic (chronic rotator cuff insufficiency, glenohumeral arthritis with advanced glenoid wear). Demographics, operative indications, preoperative hematocrit, postoperative hematocrit, change in hematocrit, estimated blood loss, operative time, and blood transfusion rates were compared. We constructed a logistic regression model to determine the risk factors predicting blood transfusion. ResultsIndications were acute trauma in 83 patients, post-traumatic sequelae in 65, and non-traumatic conditions in 635. There were no statistically significant differences regarding body mass index (P = .5) or American Society of Anesthesiologists score (P = .11). There were more females in the traumatic and post-traumatic cohorts than in the non-traumatic cohort (P < .001). Surgical age was younger in the post-traumatic cases (P = .002). The overall frequency of blood transfusion was 4.6% (36/783): traumatic, 19% (16/83); post-traumatic, 17% (11/65); and non-traumatic, 1.4% (9/635). Both the traumatic and post-traumatic groups had significantly higher rates of blood transfusion than non-traumatic cases (P < .001). Preoperative hematocrit was lower in the traumatic group and estimated blood loss was higher in the traumatic and post-traumatic groups (P = .001). Post-traumatic patients experienced the greatest drop in postoperative hematocrit from preoperative levels. The multivariate logistic regression model showed that traumatic and post-traumatic indications for surgery were each an independent risk factor for blood transfusion, as was change in hematocrit, body mass index, surgical age, estimated blood loss, and preoperative hematocrit. ConclusionsOur results suggest that acute trauma as the indication for RTSA is the strongest independent risk factor for blood transfusion followed by post-traumatic sequelae. Surgeons should be aware of the markedly increased risk of transfusion based purely on these 2 surgical indications especially when in combination with other predictors of transfusion.

Maximum surgical blood order schedule for flap reconstruction in oral and maxillofacial cancer patients

BackgroundWe established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients.MethodWe enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010 to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS.Results(1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. (2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3–T4 stage, ASA III, IV grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3–T4 stage, ASA grade III–IV in mildly anemic patients; and ASA grade III–IV in moderately anemic patients. (3) A MSBOS was established for flap reconstruction in head and neck cancer patients.ConclusionA MSBOS for head and neck cancer procedures was reduced by approximately 30% perioperative blood preparation while ensuring that clinical blood use standards were met. It help optimize blood inventory, and save blood resources.

Association of Intraoperative and Perioperative Transfusions with Postoperative Cardiovascular Events and Mortality After Infrainguinal Revascularization

Patients undergoing open or endovascular infrainguinal revascularization are at an elevated risk for postoperative cardiovascular complications due to high rates of comorbidities and the physiologic stress of surgery. Transfusions are known to be associated with adverse events but knowledge of specific risks associated with transfusion timing, product type, and long-term outcomes while accounting for preoperative cardiovascular risk factors is not well understood in this population. This study aimed to characterize the association of intraoperative and perioperative transfusion, anemia, and cardiovascular risk factors with cardiovascular events and mortality in patients undergoing infrainguinal revascularization. A single-center retrospective study was performed on 564 infrainguinal revascularization procedures, including both open (n=250) and endovascular (n=314) approaches (2016-2020). Comprehensive clinical data were collected including patient demographics, cardiovascular risk factors, preoperative hemoglobin, and detailed transfusion data. Multivariable logistic regression tested the association of transfusions with composite 30-day outcomes of cardiac complications (postoperative myocardial infarction [postop-MI], congestive heart failure, or dysrhythmia) and with major adverse cardiovascular events (MACE-postop-MI or death). Kaplan-Meier analysis and Cox proportional hazard modeling examined the association of transfusions, anemia, and cardiovascular risk factors with mortality up to 1year. Intraoperative transfusion was performed in 15% of cases and 13% underwent transfusion in the early postoperative period. Intraoperative transfusion was associated with higher Revised Cardiac Risk Index (RCRI), lower preoperative hemoglobin, increased blood loss, and open procedures (all P<0.05). Within each RCRI score, intraoperative transfusion was associated with 2-4-fold increased MACE at 30days. Intraoperative packed red blood cells transfusion and early postoperative packed red blood cells transfusion was associated with more than 2-fold adjusted odds of any cardiovascular complication and intraoperative transfusion was also associated with MACE (all P<0.05). Intraoperative transfusion was associated with mortality at 1year on unadjusted analysis, but after adjustment for RCRI, age, and preoperative hemoglobin, only RCRI scores of 2 and 3+ and preoperatively hemoglobin remained significant risk factors for mortality. Intraoperative and early perioperative transfusions are strongly associated with worse cardiovascular outcomes after infrainguinal revascularization. These findings may have a prognostic value for further risk stratifying patients perioperatively at a high risk for complications. However, prospective studies are needed to elucidate whether optimizing transfusion strategies mitigates these risks.

The surgical outcomes and risk factors of giant hepatic haemangiomas: a single centre experience

ObjectiveTo evaluate the safety of performing surgery on cavernous haemangiomas in the liver larger than 10 cm and establish preoperative predictors of intraoperative blood transfusion and morbidity.MethodsA total of 373 patients with haemangiomas larger than 10 cm who underwent surgery in our hospital were retrospectively analysed. According to tumour diameter, the patients were divided into a giant haemangioma (GH) group (241 cases) (10 cm ≤ diameter < 15 cm) and an enormous haemangioma (EH) group (132 cases) (diameter ≥ 15 cm). Clinical parameters were then compared between the two groups.ResultsCompared with the GH group, the EH group had higher rates of leukopenia (10.6% vs. 4.5%), anaemia (26.5% vs. 15.7%), and thrombocytopenia (13.6% vs. 6.2%). The occlusion time in the EH group was longer than that in the GH group (26.33 ± 14.10 min vs. 31.85 ± 20.09 min, P < 0.01). The blood loss and blood transfusion in the EH group were greater than those in the GH group (P < 0.05). Moreover, the morbidity in the EH group was higher than that in the GH group (17.4% vs. 9.13%, P < 0.05). According to the results of the multivariable analysis, the operation time and size of the haemangioma may be independent risk factors for blood transfusion (P < 0.05). Additionally, the size of the haemangioma may be an independent risk factor associated with complications (P < 0.05).ConclusionEnormous haemangioma is more likely to cause haematologic abnormalities than giant hepatic haemangioma. The risks of the operation and postoperative complications of enormous haemangioma are higher than those of giant hepatic haemangioma.

Resection type is a predictor of postoperative complications in laparoscopic partial liver resection.

Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system. From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n = 56) and intermediate (n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated. In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p = 0.005), operation time (p = 0.005), and Clavien-Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p = 0.011) and IWATE criteria score (p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p = 0.011) and BSR (p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p = 0.017). Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.

The role of routine laboratory tests after unilateral total knee arthroplasty

BackgroundRecent studies suggest that routine laboratory tests are not required within 1 day after partial knee arthroplasty. In this study, we evaluated the utility of routine postoperative laboratory tests after initial unilateral total knee arthroplasty (TKA) in an Asian population. In addition, we explored risk factors associated with abnormal test results.MethodsClinical data of patients who underwent original unilateral TKA between 2015 and 2020 were retrospectively analyzed. Patient characteristics and laboratory test results were recorded. Multivariate binary logistic regression analysis was performed to identify risk factors associated with 3 abnormal laboratory results.ResultsA total of 713 patients, who underwent relevant laboratory tests within 3 days of TKA surgery, were enrolled. Among them, 8.1%, 9.9%, and 3.4% patients with anemia, hypoalbuminemia, and abnormal serum potassium levels required clinical intervention after surgery. Binary logistic regression analysis revealed that preoperative hemoglobin levels, estimated blood loss, and age were independent risk factors of postoperative blood transfusion in TKA patients. On the other hand, preoperative albumin levels, intraoperative blood loss, and operation time were risk factors associated with postoperative albumin supplementation. In addition, lower body mass index (BMI) and preoperative hypokalemia were potential risk factors of postoperative potassium supplementation.ConclusionConsidering that more than 90% of abnormal postoperative laboratory tests do not require clinical intervention, we believe that routine laboratory tests after surgery have little significance in patients with primary unilateral TKA. However, postoperative laboratory testing is necessary for patients with established risk factors.