Dynamic Analysis of Perioperative Hidden Blood Loss in Intertrochanteric Fractures

To analyze the dynamic variation in perioperative hidden blood loss in patients with intertrochanteric fracture. From January to December 2017, 79 patients with intertrochanteric fracture were treated with proximal femoral nail antirotation. Serial complete blood count assays were performed consecutively in the 3 days after admission, on the day of surgery, and 7 days postoperatively. Blood loss during surgery, postoperative drainage, and perioperative blood transfusion volumes were recorded. Dynamic changes in hemoglobin (Hb) prior to surgery were recorded and compared between males and females. Patients were divided into the no blood transfusion group, the 400-mL blood transfusion group, and the 800-mL blood transfusion group depending on the volume of perioperative blood transfusion. Total and hidden blood loss were separately calculated according to the Gross equation. Lowest mean Hb values occurred on day 2 after admission among men (104.8 g/L) and on day 3 after admission among women (98.6 g/L). The average Hb decrease was 11.4 g/L, 11.8 g/L, and 8.9 g/L in the no, 400-mL, and 800-mL blood transfusion groups, respectively. The lowest Hb value occurred on postoperative day 2. Hemoglobin increased on postoperative day 3 and stabilized by day 6. In the no blood transfusion group, the average total blood loss was 406.0 ± 255.6 mL, 628.3 ± 267.2 mL, and 759.7 ± 322.1 mL in the no blood transfusion, 400-mL blood transfusion, and 800-mL blood transfusion groups, respectively, and hidden blood loss was 326.0 ± 246.6 mL, 512.1 ± 247.3 mL, and 596.1 ± 306.9 mL, respectively. Perioperative hidden blood loss occurred prior to surgery for intertrochanteric fracture and ended on postoperative day 2.

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The efficacy and safety of topical tranexamic acid for spinal surgery: a meta-analysis

Current Pharmaceutical Design ◽

10.2174/1381612827666210713160016 ◽

2021 ◽

Vol 27 ◽

Author(s):

Tai Guo ◽

Wenxia Xuan ◽

Haoyu Feng ◽

Junjie Wang ◽

Xun Ma

Keyword(s):

Blood Loss ◽

Spinal Surgery ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Intraoperative Blood Loss ◽

Total Blood ◽

Blood Content ◽

Drainage Volume ◽

Hidden Blood Loss ◽

Postoperative Drainage

Background: Spinal surgeries are often accompanied by significant blood loss both intraoperatively and postoperatively. Excessive blood loss caused by surgery may lead to several harmful medical consequences. Tranexamic acid (TXA) is a kind of antifibrinolytic agent that has been widely used in spinal surgery. Currently, it is commonly accepted that intravenous TXA (ivTXA) can reduce blood loss in spinal fusion surgeries. Compared with ivTXA, topical TXA (tTXA) seems to be much easier to administer. This advantage provides a maximum concentration of TXA at the hemorrhagic site with little to no TXA entering the circulation. Objective: To evaluate the effect of tTXA on blood loss during and after spinal surgery via a comprehensive meta-analysis of the published data in randomized controlled trials (RCTs) and other comparative cohort studies. Methods: A comprehensive search of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials were performed for RCTs and other comparative cohort studies on the effect of tTXA on blood loss during and after spinal surgery. The outcomes were total blood loss, hidden blood loss, intraoperative blood loss, total postoperative drainage volume, drainage tube duration postoperatively, drainage volume and drainage of blood content at postoperative day (POD) 1 and POD2, length of hospital stay, number of patients who received a blood transfusion, serum HB level at POD1, operative timespan, side effects, and complications. The final search was performed in October 2020. We followed the PRISMA guideline, and the registration number is INPLASY202160028. Results: In total, six studies with 481 patients were included. tTXA treatment, compared with the control conditions, can significantly reduce the total blood loss, hidden blood loss, total postoperative drainage volume, and several patients receiving blood transfusions; reduce the drainage volume and drainage of blood content at POD1; shorten the drainage tube duration postoperatively and length of hospital stay, and enhance the serum HB level at POD1 for spinal surgery. tTXA treatment did not significantly influence the intraoperative blood loss, drainage volume, or drainage of blood content at POD2 or the operative duration. Conclusion: Compared with control conditions, tTXA has high efficacy in reducing blood loss, and drainage volume enable quick rehabilitation and has a relatively high level of safety in spinal surgery.

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Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618783258 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1189-1198 ◽

Cited By ~ 4

Author(s):

Qianzheng Zhu ◽

Caixia Yu ◽

Xingzuo Chen ◽

Xiaodong Xu ◽

Ying Chen ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Intertrochanteric Fracture ◽

Meta Analysis ◽

Total Blood Loss ◽

Thromboembolic Events ◽

Efficacy And Safety ◽

Total Blood ◽

Surgical Blood Loss ◽

Postoperative Drainage

The use of tranexamic acid (TXA) for reducing blood loss in intertrochanteric fracture (IF) surgery remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TXA in reducing transfusion requirements and blood loss for IF surgery. Databases, including PubMED, Cochrane, and Embase, were searched for RCTs that were published before February 2018 and that addressed the efficacy and safety of TXA in patients who underwent IF surgery. A total of 746 patients from 7 RCTs were subjected to meta-analysis. The results showed that TXA group had reduced surgical blood loss (weighted mean difference [WMD] = −37.24, 95% confidence interval [CI]: −48.70 to −25.77, P <.00001), reduced total blood loss (WMD = −199.08, 95% CI: −305.16 to −93.01, P = .0002), higher postoperative hemoglobin (WMD = 0.46, 95% CI: 0.12 to 0.79, P = .007), and hematocrit levels (WMD = 1.55, 95% CI: 0.64 to 2.47, P = .008) compared to control group, while no significant differences were found in transfusion rates (relative risk [RR] = 0.75, 95% CI: 0.50 to 1.11, P = .15), postoperative drainage (WMD = −38.82, 95% CI: −86.87 to 9.22, P = .11), and thromboembolic events (RR = 0.94, 95% CI: 0.41 to 2.19, P = .89). In patients undergoing IF surgery, the administration of TXA significantly reduced surgical blood loss and total blood loss, while it had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events. Nevertheless, due to the variations in the included studies, additional RCTs are required to further validate these conclusions.

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Effects of aminocaproic acid on perioperative hidden blood loss in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation

Journal of International Medical Research ◽

10.1177/0300060519872037 ◽

2019 ◽

Vol 47 (10) ◽

pp. 5010-5018 ◽

Cited By ~ 1

Author(s):

Rui Zhang ◽

Zhuqing Yang ◽

Tao Lei ◽

Zichuan Ping ◽

Guangchao Bai

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Intertrochanteric Fracture ◽

Aminocaproic Acid ◽

Control Group ◽

Hidden Blood Loss ◽

Postoperative Drainage ◽

Femoral Intertrochanteric Fracture ◽

And Control ◽

Experimental Group

Objective To determine the efficacy of aminocaproic acid on perioperative hidden blood loss (HBL) in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation (PFNA). Methods Seventy consecutively admitted elderly patients with femoral intertrochanteric fracture treated with PFNA between 1 May 2017 and 1 May 2018 were recruited. The patients were randomised into the experimental and control groups receiving 1 g aminocaproic acid in 200 mL saline and only 200 mL normal saline intravenously, respectively. The following factors were recorded: demographic characteristics, haemoglobin and haematocrit levels on preoperative day 1 and postoperative days 1 and 3, surgical blood loss, postoperative drainage, the rate and volume of transfusion, and complications. Results No significant differences were seen in surgical blood loss and postoperative drainage between the experimental and control groups, though total blood loss was greater in the control group. Visible blood loss and HBL were significantly lower in the experimental group than in the control group, and a lower rate and volume of transfusion were also recorded in the experimental group. Conclusion Aminocaproic acid significantly reduced perioperative HBL and volume and rate of transfusion in elderly patients with femoral intertrochanteric fracture receiving PFNA.

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Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04914-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhicong Wang ◽

Xi Chen ◽

Yan Chen ◽

Ling Yang ◽

Hong Wang ◽

...

Keyword(s):

Hip Fracture ◽

Blood Transfusion ◽

Blood Loss ◽

Elderly Patients ◽

Intertrochanteric Fracture ◽

Total Blood Loss ◽

Transfusion Rate ◽

Total Blood ◽

Admission Time ◽

Time From Injury

Abstract Background To investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture. Methods From our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression. Results A total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05). Conclusion Hypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion. Level of evidence Level III, retrospective study.

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Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

10.21203/rs.2.21728/v1 ◽

2020 ◽

Author(s):

Huiping Wei ◽

Tianji Huang ◽

Jianfeng He ◽

Menghong Xia

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Topical Application ◽

Intertrochanteric Fracture ◽

Control Group ◽

Drainage Volume ◽

Hidden Blood Loss ◽

Perioperative Blood Loss

Abstract Background: The specific method and dose of tranexamic acid (TXA) topically applied in intertrochanteric fracture have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically treated by our protocol in perioperative bleeding management for elderly patients with intertrochanteric fracture treated undergoing proximal femoral nail anti-rotation (PFNA). Methods: A retrospective comparative analysis was performed. Group TXA was comprised of 82 patients with topical use of TXA and group control was comprised of 82 patients without TXA during the procedure of PFNA. Intraoperative, total and hidden blood loss, drainage volume, postoperative blood transfusion volume and complications were compared between the two groups. Results: Intraoperative, total and hidden blood loss, and drainage volume were significantly lower in the TXA group than those in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between two groups (P>0.05). Conclusion: Topical application of TXA offers an effective and safe option in reducing perioperative blood loss and transfusion for elderly patients with intertrochanteric fractures undergoing PFNA.

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

Journal of Robotic Surgery ◽

10.1007/s11701-021-01262-z ◽

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.

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Acute Isovolaemic Haemodilution: The Best Option for Autologous Blood Transfusion in Africa?

Tropical Doctor ◽

10.1177/004947559502500403 ◽

1995 ◽

Vol 25 (4) ◽

pp. 152-155 ◽

Cited By ~ 1

Author(s):

Zacharia A Berege ◽

Bart Jacobs ◽

Michael R Matasha ◽

Frank Mpelumbe ◽

Ernestini Kimaro

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Autologous Blood ◽

Autologous Blood Transfusion ◽

Total Blood Volume ◽

East African ◽

Homologous Blood ◽

Total Blood ◽

Induction Of Anaesthesia ◽

Donated Blood

The purpose of this study was to identify the best method of autologous blood transfusion to be applied in an East African hospital. One hundred and nine consecutive patients for whom major blood loss was anticipated were enrolled. Seventeen patients donated 1 unit of blood 3 days preoperatively and 92 underwent acute isovolaemic haemodilution prior to induction of anaesthesia. For the haemodiluted patients a 2:1 ratio of sterile pryogen-free saline to collected blood was used. One of the 16 patients from whom 2 units were withdrawn by haemodilution experienced hypovolaemia which was rapidly restored by additional transfusion of colloid. Of the patients who donated blood preoperatively only 23.5% were autotransfused compared to 98.9% of the haemodiluted patients. Of the latter 23.9% (22) had an intraoperative blood loss exceeding 15% of their total blood volume and 7.6% (7) lost more than 25%. Only one received homologous blood in addition. For hospitals with limited blood bank facilities and regular cancellation of surgery, the use of acute isovolaemic haemodilution is recommended. A 3:1 ratio of saline to blood is now advised when 1 unit is withdrawn and a part replacement with crystalloid when 2 units are collected.

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Does the correction angle affect hidden blood loss in HTO?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02071-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zheng Li ◽

Yannong Wang ◽

Guanglei Cao ◽

Shuai An ◽

Mingli Feng ◽

...

Keyword(s):

Clinical Practice ◽

Blood Loss ◽

High Tibial Osteotomy ◽

Total Blood Loss ◽

Tibial Osteotomy ◽

Open Wedge ◽

Total Blood ◽

Correction Angle ◽

Hidden Blood Loss ◽

Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02010-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yimin Zhang ◽

Bao Lang ◽

Guifeng Zhao ◽

Fengming Wang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Study Results ◽

Total Knee

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

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Analysis of Risk Factors for Perioperative Hidden Blood Loss in Unilateral Biportal Endoscopic Spine Surgery: A Retrospective Multicenter Study

10.21203/rs.3.rs-663209/v1 ◽

2021 ◽

Author(s):

Haosheng Wang ◽

Kai Wang ◽

Bin Lv ◽

Wenle Li ◽

Tingting Fan ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Linear Regression ◽

Blood Loss ◽

Spine Surgery ◽

Linear Regression Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Hidden Blood Loss ◽

Independent Risk Factors

Abstract Background Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and it’s possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Methods This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identity independent risk factors of HBL. Results A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6 % of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit(Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028). Conclusions A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

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