scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

scholarly journals Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Alessandro Tafuri ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Marco Sebben ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Open Approach ◽  
Intraoperative Blood Loss ◽  
Tertiary Referral ◽  
Robot Assisted ◽  
The Third ◽  
Major Complications

AbstractTo investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs.  ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥  3 vs.  < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

P42 Predicting bleeding risk during meningioma surgery

2019 ◽  
Vol 90 (3) ◽  
pp. e35.3-e35
Author(s):  
A Tsyben ◽  
M Surour ◽  
K Budohoski ◽  
R Kirollos ◽  
A Helmy
Keyword(s):  
Multivariate Analysis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Estimate Blood Loss ◽  
Bleeding Risk ◽  
Intraoperative Blood Loss ◽  
Dural Tail ◽  
Meningioma Surgery ◽  
Tumour Characteristics

ObjectivesSurgical treatment of meningioma is frequently accompanied by significant intraoperative blood loss and the associated risks of blood transfusion. Surgical adjuncts such as pre-operative embolisation and the use of tranexamic acid have attendant risks. An ability to estimate blood loss can appropriately target these interventions.DesignRetrospective studySubjectsPatients following surgery for meningioma between 2015–2018MethodsIntraoperative blood loss, pre- to post-operative haemoglobin difference and blood transfusion were evaluated. Pre-operative imaging included size, shape and location of meningioma, involvement of sinuses and blood vessels, T1 and T2 weighted characteristics, restricted diffusion, peritumoral oedema, dural tail and hyperostosis. Multivariate analysis was used to determine the relationship between meningioma characteristics and blood loss.ResultsTumour diameter and venous sinus opening were significantly related to blood loss on multivariate analysis (p=0.004 and p=0.001 respectively). Furthermore, on univariate analysis additional factors included procedure duration (p<0.0001), pre-operative radiotherapy (p=0.042) and pre-operative platelet count (p=0.03).ConclusionsOnly size of tumour and opening venous sinuses was related to intraoperative bloods loss in this cohort of patients. Further research is required to define tumour characteristics that can be used to identify patients suitable for pre- and intra-operative adjunct therapies.

scholarly journals A structured training pathway to implement robot-assisted minimally invasive esophagectomy: the learning curve results from a high-volume center

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
B Feike Kingma ◽  
Edin Hadzijusufovic ◽  
Pieter C Van der Sluis ◽  
Erida Bano ◽  
Hauke Lang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
High Volume ◽  
Learning Curves ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
High Volume Center

ABSTRACT To ensure safe implementation of robot-assisted minimally invasive esophagectomy (RAMIE), the learning process should be optimized. This study aimed to report the results of a surgeon who implemented RAMIE in a German high-volume center by following a tailored and structured training pathway that involved proctoring. Consecutive patients who underwent RAMIE during the course of the program were included from a prospective database. A single surgeon, who had prior experience in conventional MIE, performed all RAMIE procedures. Cumulative sum (CUSUM) learning curves were plotted for the thoracic operating time and intraoperative blood loss. Perioperative outcomes were compared between patients who underwent surgery before and after a learning curve plateau occurred. Between 2017 and 2018, the adopting center adhered to the structured training pathway, and a total of 70 patients were included in the analysis. The CUSUM learning curves showed plateaus after 22 cases. In consecutive cases 23 to 70, the operating time was shorter for both the thoracic phase (median 215 vs. 249 minutes, P = 0.001) and overall procedure (median 394 vs. 440 minutes, P = 0.005), intraoperative blood loss was less (median 210 vs. 400 milliliters, P = 0.029), and lymph node yield was higher (median 32 vs. 23 nodes, P = 0.001) when compared to cases 1 to 22. No significant differences were found in terms of conversion rates, postoperative complications, length of stay, completeness of resection, or mortality. In conclusion, the structured training pathway resulted in a short and safe learning curve for RAMIE in this single center’s experience. As the pathway seems effective in implementing RAMIE without compromising the early oncological outcomes and complication rates, it is advised for surgeons who are wanting to adopt this technique.

scholarly journals P107 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: a systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Amanda Koh ◽  
Alfred Adiamah ◽  
Dhanny Gomez ◽  
Sudip Sanyal ◽  
Amanda Koh
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Tranexamic Acid ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Thromboembolic Events ◽  
Intraoperative Blood Loss ◽  
Perioperative Bleeding ◽  
Perioperative Blood Transfusion

Abstract Introduction Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA) in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery. Method A comprehensive search of Pubmed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model. Results Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies. Conclusion TXA reduces intra-operative blood loss without an increase in complications.

scholarly journals 842 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: A Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Koh ◽  
A Adiamah ◽  
S Sanyal
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Tranexamic Acid ◽  
Weighted Mean Difference ◽  
Thromboembolic Events ◽  
Intraoperative Blood Loss ◽  
Mortality And Morbidity ◽  
Perioperative Bleeding ◽  
Perioperative Blood Transfusion

Abstract Introduction Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA), in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery. Method A comprehensive search of PubMed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model. Results Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies. Conclusions TXA reduces intra-operative blood loss without an increase in complications.

scholarly journals Significance of Postoperative Membranous Urethral Length and Position of Vesico-Urethral Anastomosis for Short Term Continence Recovery Following Robot-Assisted Laparoscopic Radical Prostatectomy

2022 ◽  
Author(s):  
Yasukazu Nakanishi ◽  
Shunya Matsumoto ◽  
Naoya Okubo ◽  
Kenji Tanabe ◽  
Madoka Kataoka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Univariate Analysis ◽  
Operating Time ◽  
Laparoscopic Radical Prostatectomy ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Short Term ◽  
Recovery Rates ◽  
Patient Interview

Abstract Background We assess whether short term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with preoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). Methods Clinical variables including PVUA and pre- and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. Results Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (<25 kg/m2) (p = 0.040), longer preoperative MUL (≥9.5mm) (p = 0.013), longer postoperative MUL (≥9mm) (p <0.001), higher PVUA (<14.5mm) (p = 0.019) and shorter operating time (<170min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90 – 7.40, p <0.001) and higher PVUA (OR 2.02, 95% CI 1.07 – 3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into three groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% vs. 68.2% vs. 85.0% (p <0.001) at three months. Conclusions PVUA and postoperative MUL were significant factors for short term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.

scholarly journals Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

2020 ◽  
Author(s):  
Shengyu Wang ◽  
Chao Liu ◽  
Rongzhi Wei ◽  
Qiuhua Zhang ◽  
Feng Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Operative Time ◽  
Blood Transfusions ◽  
Intraoperative Blood Loss ◽  
Multivariate Logistic Regression ◽  
Perioperative Blood Transfusion

Abstract Background. During surgery for thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and thus require a perioperative blood transfusion. However, the risk factors for increased intraoperative blood loss and perioperative blood transfusion have yet to be identified. The aim of this retrospective study was to determine the predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods. From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified using univariate and multivariate logistic regression analyses. Univariate and multivariate linear regressions were conducted to investigate the risk factors for intraoperative blood loss. The predictors of high levels of intraoperative blood loss were analyzed by multivariate logistic regression analysis.Results. Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean age of patients was 49.6 ± 15.5 years old (range 14-85). Our data revealed significant relationships between blood transfusions and female gender, BMI, vertebral collapse/kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent risk factors for intraoperative blood loss. Specifically, a lower BMI, decreased preoperative hemoglobin levels, four or more levels of instrumentation, a combined surgical approach and a prolonged operative time were identified as risk factors for high levels of intraoperative blood loss.Conclusions. This study identified some clinical predictors of perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to the planning of preoperative blood transfusions and help to minimize intra- or postoperative complications. Level of evidenceLevel IV, retrospective case series.

P99 A STRUCTURED TRAINING PATHWAY TO IMPLEMENT ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): LEARNING CURVE RESULTS FROM A HIGH VOLUME CENTER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Kingma BF ◽  
Hadzijusufovic E ◽  
van der Sluis PC ◽  
Lang H ◽  
Ruurda JP ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
Learning Curves ◽  
Perioperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Invasive Esophagectomy

Abstract Aim The aim of this study was to describe the results of a structured training pathway that was developed to implement robot-assisted minimally invasive esophagectomy (RAMIE) in new centers. Background & Methods To safely and effectively implement RAMIE in new centers, the learning process needs to be optimized. In this context, a structured training pathway was created (Table 1). The results of this training pathway were investigated by evaluating consecutive patients who underwent RAMIE by a single surgeon who followed the structured training pathway. These patients were included from the trainee center’s prospective database. Cumulative sum (CUSUM) learning curves were plotted for thoracic operating time and intraoperative blood loss. Perioperative outcomes were compared between patients who underwent surgery before and after a learning curve plateau occurred. Results Between 2017-2018, the trainee team adhered to the structured training pathway and a total of 70 patients were included. The learning curves showed plateaus after 22 cases. In cases 23-70, the operating time was shorter for both the thoracic phase (median 215 vs. 249 minutes, P=0.001) and overall procedure (median 394 vs. 440 minutes, P=0.005), intraoperative blood loss was less (median 210 vs. 400 milliliters, P=0.029), and lymph node yield was higher (median 32 vs. 23 nodes, P=0.001) when compared to the first 22 cases. No significant differences were found for conversion rates, postoperative complications, length of hospital stay, radicality, or mortality. Conclusions The structured RAMIE training pathway results in a short learning curve and is an effective way to introduce RAMIE without compromising the oncological outcomes and complication rates. The pathway is therefore advised to surgeons who are willing to adopt this technique.

Predictors associated with perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

2020 ◽  
Author(s):  
Chengchao Song ◽  
Chao Liu ◽  
Rongzhi Wei ◽  
Qiuhua Zhang ◽  
Feng Wu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Transfusion ◽  
Linear Regression ◽  
Blood Loss ◽  
Linear Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Allogenic Blood Transfusion ◽  
Intraoperative Blood Loss ◽  
Factors Influencing ◽  
Perioperative Blood Transfusion

Abstract Background During operation on thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and receive a perioperative blood transfusion. However, the risk factors were not identified for increased intraoperative blood loss and perioperative blood transfusion. The aim of this retrospective study is to determine the predictors associated with perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified in a univariate and multivariate logistic regression analysis. Univariate and multivariate linear regression was attempted to investigate the factors influencing intraoperative blood loss. Results Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean patient age was 49.6 ± 15.5 (range 14-85) years for those patients. Our data revealed a significant relationship between blood transfusions and female gender, BMI, vertebral collapse/Kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent factors influencing intraoperative blood loss. Conclusions This study identified some clinical predictors for perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to preoperative blood transfusion planning and minimize intra- or post-operative complications.

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

2018 ◽  
Vol 90 (3) ◽  
pp. 31-36 ◽  
Author(s):  
Stanislav Chernyshov ◽  
Mikhail Alexeev ◽  
Evgeny Rybakov ◽  
Mikhail Tarasov ◽  
Yuri Shelygin ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Total Mesorectal Excision ◽  
Negative Impact ◽  
Univariate Analysis ◽  
Operating Time ◽  
Mesorectal Excision ◽  
Defunctioning Stoma ◽  
Predictive Values ◽  
Restorative Proctectomy ◽  
Perioperative Blood Transfusion

Background: This study aims to examine the factors involved in anastomotic leak (AL) following low anterior resection and total mesorectal excision (LAR-TME) and to determine the usefulness of early measurement of the inflammatory biomarkers C-Reactive Protein (CRP) and Procalcitonin (PCT). Methods: One hundred patients undergoing LAR-TME with a proximal diverting stoma were analyzed between 2013 and 2016. Postoperative CRP and PCT levels were measured on the 3rd and the 6th postoperative days. Results: There were 11 clinical leaks with a negative impact in univariate analysis on AL of male gender, larger and stenotic tumours, intraoperative blood loss > 200 mL, the need for perioperative blood transfusion, postoperative anaemia and an operating time exceeding 180 minutes. On multivariate analysis, only perioperative blood transfusion was an independent AL risk factor. Recorded CRP was higher in AL patients when compared with non-AL cases on both the 3rd postoperative day (152.4 mg/L vs. 93 mg/L, respectively; P < 0.0001) and the 6th postoperative day (130.5 mg/L vs. 68.2 mg/L; P < 0.0001). The PCT levels also significantly differed between AL and non-AL cases on the 3rd postoperative day (0.5 ng/mL vs. 0.2 ng/mL, respectively; P < 0.0001) and the 6th postoperative day (1.16 ng/mL vs. 0.1 ng/mL, respectively; P < 0.0001). Both CRP and PCT showed high negative predictive values (NPV) for the diagnosis of an AL on both postoperative days. Conclusion: Following low restorative proctectomy, the high NPV of CRP and PCT measurements for the diagnosis of anastomotic leaks may assist decision-making for early hospital discharge.

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