scholarly journals Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tadashi Matsuoka ◽  
Nao Ichihara ◽  
Hiroharu Shinozaki ◽  
Kenji Kobayashi ◽  
Alan Kawarai Lefor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Blood Loss ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Confounding Factors ◽  
Intraoperative Blood Loss ◽  
Antithrombotic Drugs ◽  
Generalized Peritonitis ◽  
Blood Loss Volume

Abstract Background The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan. Method This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates. Results A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery. Conclusion This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

scholarly journals Antithrombotic Drugs Have A Minimal Effect on Intraoperative Blood Loss During Emergency Surgery for Generalized Peritonitis: A Nationwide Retrospective Cohort Study In Japan

2021 ◽  
Author(s):  
Tadashi Matsuoka ◽  
Nao Ichihara ◽  
Hiroharu Shinozaki ◽  
Kenji Kobayashi ◽  
Alan Kawarai Lefor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Blood Loss ◽  
Surgical Approach ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Confounding Factors ◽  
Intraoperative Blood Loss ◽  
Antithrombotic Drugs ◽  
Generalized Peritonitis

Abstract Background:The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study is to evaluate whether antithrombotic drugs affect intraoperative blood loss in generalized peritonitis using a nationwide surgical registry in Japan.Method:This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative patient’s state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss; adjusted ratio of intraoperative blood loss after adjustment for confounding factors; variable importance of all covariates.Results: A total of 70,105 of the eligible 75,666 patients were included in this study, and 2,947 patients were taking antithrombotic drugs. Propensity score matching yielded 2,864 well-balanced pairs. There was a statistically difference in the blood loss. (antithrombotic drugs vs control: 100 [10-349] vs 70 [10-299] ml, p<0.01). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16 – 1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery.Conclusion:This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in emergency surgery for generalized peritonitis, the difference is negligible and not clinically significant.

scholarly journals Maternal and neonatal outcomes of placenta previa with and without coverage of a uterine scar: A retrospective cohort study in a tertiary hospital

2020 ◽  
Author(s):  
Jiaming Rao ◽  
Dazhi Fan ◽  
Zixing Zhou ◽  
Gengdong Chen ◽  
Pengsheng Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Fetal Distress ◽  
Neonatal Outcomes ◽  
Intraoperative Blood Loss ◽  
Maternal And Neonatal Outcomes ◽  
Uterine Scar ◽  
Singleton Pregnancies

Abstract Background To compare the maternal and neonatal outcomes of placenta previa (PP) with and without coverage of a uterine scar in Foshan, China. Methods A retrospective cohort study comparing all singleton pregnancies with PP was conducted at a tertiary, university-affiliated medical center from 1 January 2012 to 31 April 2017 in Foshan, China. Demographic, clinical and laboratory data were extracted from electronic medical records. Maternal and neonatal outcomes of PP with and without coverage of a uterine scar were compared by statistical method. Results There were 58,062 deliveries during the study period, of which 738 (1.27%) were complicated PP in singleton pregnancies and were further classified into two groups: the PP with coverage of a uterine scar group (PPCS, n = 166) and the PP without coverage of a uterine scar group (Non-PPCS, n = 572). Overall, premature birth (< 37 weeks,68.1% vs 54.8%; P = 0.010), cesarean section(100% vs 97.6%; P = 0.042), Intraoperative blood loss > 1000 ml (78.3% vs 16.0%; P < 0.001) or > 3000 ml (29.5% vs 3.0%; P < 0.001), postpartum hemorrhage(48.8% vs 15.7%; P < 0.001), transfusion (35.2% vs 16.1%; P < 0.001), hemorrhage shock(8.4% vs 1.9%; P < 0.001), hysterectomy (3.0% vs 0.5%; P = 0.006) and fetal distress (36.1% vs 12.0%; P < 0.001) had a significant difference between PPCS group and Non-PPCS group. After grouping by whether complicated with AIP, we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml, intraoperative blood loss༞3000 ml, bleeding within 2–24 hours after delivery, fetal distress and higher hospitalization expenses than the Non-PPCS group. After grouping by whether complicated with AIP and different placenta positions(Anterior, Posterior and Ante-posterior or laterally positioned), we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml and higher hospitalization expenses than the Non-PPCS in AIP women and more intraoperative blood loss༞1000 ml, postpartum hemorrhage and higher hospitalization expenses in Non-AIP women. Conclusion The PPCS group had poorer maternal and neonatal outcomes than the Non-PPCS group after grouping by whether pregnancies complicated with AIP or with different placental positions.

scholarly journals Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259733
Author(s):  
Yuko Ono ◽  
Yudai Iwasaki ◽  
Takaki Hirano ◽  
Katsuhiko Hashimoto ◽  
Takeyasu Kakamu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Propensity Score ◽  
Emergency Physician ◽  
Retrospective Cohort Study ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Time Course ◽  
Transarterial Embolization ◽  
Injured Patients

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

scholarly journals Anaesthetic challenges for pelvic reconstruction with custom three-dimensional-printed titanium implants: A retrospective cohort study

2019 ◽  
Vol 47 (4) ◽  
pp. 368-377
Author(s):  
Alfred WY Chua ◽  
Matthew J Chua ◽  
Peter CA Kam ◽  
Demien Broekhuis ◽  
Sascha Karunaratne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Reconstructive Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Titanium Implants ◽  
Pelvic Reconstructive Surgery ◽  
Intraoperative Blood Loss ◽  
3D Printed ◽  
Prolonged Surgery

Custom 3D printed titanium implant pelvic reconstructive surgery was implemented as a novel technique at our institutions in the last five years. It provided an option for pelvic bone malignancy patients who were previously deemed unsuitable for re-implantation of irradiated resected bone segments, as well as in revision total hip arthroplasty associated with excessive acetabular bone loss. A retrospective cohort study of the anaesthetic management of patients who underwent pelvic reconstructive surgery using custom 3D printed titanium implants from August 2013 to July 2018 was conducted. Twenty-seven patients were included in the study; 23 patients completed single-stage procedures with a mean (standard deviation) duration of surgery of 7.5 (3.3) hours (median 6.8, range 3.0–15.8 hours), and mean intraoperative blood loss of 5400 (3100) mL (median 6000, range 1400–10,000 mL). Surgery involving the sacrum ( n = 7) was associated with longer intensive care stay, longer total length of hospital stay and, in three cases, unplanned two-stage procedures. The twenty procedures not involving the sacrum were successfully completed in a single stage. The major anaesthetic challenges included massive blood loss, prolonged surgery, interventions to prevent calf compartment syndrome, and perioperative thromboembolism. Preoperative pelvic radiotherapy, malignant tumours, and procedures involving the sacrum were associated with massive intraoperative blood loss and more prolonged surgery.

Antithrombotic drugs do not increase the risk of laparotomy for gastrointestinal cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Okino
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Gastrointestinal Cancer ◽  
Thromboembolic Event ◽  
Intraoperative Blood Loss ◽  
Antithrombotic Drugs ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Long Term Mortality

Abstract Background Some patients with gastrointestinal cancer requiring laparotomy take antithrombotic drugs (AT). However, safety of continuing or withdrawing AT before surgery is controversial. Purpose To investigate whether the use of AT increases intraoperative blood loss, perioperative thromboembolic event and mortality in patients undergoing laparotomy for gastrointestinal cancer. Methods In this retrospective study carried out from January 2016 to July 2019, we took a survey of laparotomy for gastrointestinal cancer in our hospital. AT was defined as aspirin, Adenosine-diphosphate receptor antagonists (ADPi), direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA). Patients were stratified into three groups; non-AT (group N), continuing AT (group C) and withdrawing AT before surgery (group W). We investigated differences in risks of events, including intraoperative blood loss, thromboembolic events within 60 days including acute coronary syndrome, cerebral infarction and venous thromboembolism, and long-term mortality. We also compared between continuing and withdrawing AT after propensity score matching. Results A total of 335 patients (123 females, mean age 72.5±9.5 years) were enrolled and stratified into group C (n=24), W (n=45) and N (n=266). Mean follow-up period was 684±400 days. Aspirin was taken in twenty of group C and twenty-six of group W. ADPi was taken in ten and nine of each group respectively. DOAC was taken in three and six of each group respectively. And VKA was taken in one and eleven of each group respectively. Patients of group C had more coronary artery disease (75.0% of group C, 33.3% of group W and 2.3% of group N, p&lt;0.001) and prior coronary stent implantation (54.2%, 20.0% and 0% of each group respectively, p&lt;0.001). There was no significant difference in cancer site and cancer stage. There was no significant difference in intraoperative blood loss (median [interquartile] (mL): 102 [8, 154] in group C, 140 [50, 310] in group W, and 150 [53, 324] in group N (p=0.095). Thromboembolic event had occurred in 4.4% of group W and 1.9% of group N (p=NS). Long term mortality was 33.3% of group C, 20% of group W and 22.9% of group N (p=NS). Kaplan-Meier analysis showed there was also no significant difference of long-term mortality (Log-rank p=NS). In patients with AT, after propensity score matching, there was no significant difference in intraoperative blood loss (102 [8,154] vs. 88 [18,217], p=NS), thromboembolic event (none in both group) and long-term mortality (33.3% vs. 12.5%, p=0.168) between continuing AT and withdrawing AT. Kaplan-Meier analysis revealed there was a tendency of higher mortality in group C but not significant difference (Log-rank p=0.0643). Conclusion This study suggests that patients taking AT do not have significant higher risk of intraoperative blood loss, thromboembolic event and mortality in laparotomy of gastrointestinal cancer. Funding Acknowledgement Type of funding source: None

scholarly journals Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nozomu Ohtomo ◽  
Hideki Nakamoto ◽  
Junya Miyahara ◽  
Yuichi Yoshida ◽  
Hiroyuki Nakarai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Operating Time ◽  
Open Group ◽  
Intraoperative Blood Loss ◽  
Satisfaction Rate ◽  
Lumbar Spinal

Abstract Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

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