Effects of controlled hypotension with restrictive transfusion on intraoperative blood loss and systemic oxygen metabolism in elderly patients who underwent lumbar fusion

Abstract Background The effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns. The aim of this study was to evaluate blood loss, oxygen metabolism, and renal function in different levels of controlled hypotension induced by intravenous nitroglycerin, in combination with limited infusion, in elderly patients undergoing posterior lumbar fusion. Methods A total of 40 patients, aged 60–75 with ASA grade II or III, who were planned for posterior lumbar fusion were randomly allocated into two groups: experimental group [target mean arterial pressure 65 mmHg (MAP 65) or control group (MAP 75)]. Indicators for blood loss, hemodynamic, systemic oxygen metabolism, and renal function evaluation index were recorded before operation (T0), 1 h after induced hypotension (T1), 2 h after hypotension (T2), and in recovery (T3). We compared changes in these parameters between groups to evaluate the combined effects of controlled hypotension with restrictive infusion. Results CI, DO2I, and VO2I were lower in both groups at T1–T3 compared with T0 (p < 0.05). DO2I and VO2I in the MAP 65 group were lower than the MAP 75 group after operation. In both groups, SCysC increased at T1, T2, and T3 (p < 0.05) compared with T0. Conclusions Restrictive transfusion and control MAP at 65 mmHg can slightly change in renal function and reduce the risk of insufficient oxygen supply and importantly have no significant effect on blood loss and postoperative complications. Trial registration ChiCTR-INR-16008153. Registered on 25 March 2016.

Download Full-text

Effect of Comprehensive Cerebral Protection Program on Cerebral Oxygen Metabolism and Vascular Endothelial Function in Elderly Patients with Acute Cerebral Infarction

Iranian Journal of Public Health ◽

10.18502/ijph.v48i2.828 ◽

2019 ◽

Author(s):

Meihong ZHOU ◽

Zhaojun HUANG

Keyword(s):

Elderly Patients ◽

Cerebral Infarction ◽

Endothelial Function ◽

Oxygen Metabolism ◽

Acute Cerebral Infarction ◽

Control Group ◽

Cerebral Oxygen ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Cerebral Oxygen Metabolism

Background: We aimed to explore the effect of comprehensive cerebral protection on cerebral oxygen metabolism and vascular endothelial function in elderly patients with acute cerebral infarction. Methods: A total of 168 elderly patients with acute cerebral infarction treated in The First Affiliated Hospital of Nanchang University, China from January 2016 to January 2018 were selected. The patients were divided into a control group and an observation group using random number method, n=84. Patients in the observation group were given comprehensive cerebral protection treatment, and patients in the control group were treated with conventional standardized treatments. The changes of cerebral oxygen metabolism, hemorheology and vascular endothelial function before and after treatment were compared between the two groups. Results: After treatment, oxygen content in arteries and internal jugular veins (Da-vO2), ofoxygen uptake fraction (OEF), Oxygen saturation (SpO2), nitric oxide (NO) were increased in both groups in comparison to before treatment, jugular venous oxygen saturation (SjvO2), brain oxygen uptake rate (ERO2), endothelin (ET), intracranial pressure (ICP), whole blood viscosity, plasma viscosity, reduced viscosity of whole blood, and hematocrit were decreased. However, the changes in the observation group were larger than those in the control group, the difference was statistically significant (P<0.05). Conclusion: The treatment of cerebral infarction in elderly patients with acute cerebral infarction can effectively improve the cerebral oxygen metabolism and vascular endothelial function and improve the blood rheology, which has important clinical value.

Download Full-text

Differences in 30- and 90-Day Readmission Rates After Surgical Treatment for Lumbar Degenerative Disc Disease in Elderly Patients (³ð65 Years): A National Readmission Database Study

Neurosurgery ◽

10.1093/neuros/nyz310_629 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Aladine A Elsamadicy ◽

Andrew B Koo ◽

Megan Lee ◽

Adam Kundishora ◽

Joaquin Q Camara-Quintana ◽

...

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Degenerative Disc Disease ◽

Postoperative Infection ◽

Lumbar Fusion ◽

The Elderly ◽

Disc Disease ◽

Readmission Rates ◽

Posterior Lumbar Fusion ◽

Degenerative Disc

Abstract INTRODUCTION For spine surgery performed for degenerative disc disease (DDD), a paucity of nationwide studies exists describing common complications and readmission rates. The aim of this study was to investigate the differences and complications associated with 30- and 90-d readmissions following surgical treatment for lumbar DDD in the elderly. METHODS The Nationwide Readmission Database years 2013 to 2015 was queried. Elderly patients (>65 yr old) undergoing anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLIF)/posterolateral lumbar fusion (PLF), or anterior and posterior lumbar fusion (APLF) for lumbar DDD were identified. Unique patient linkage numbers were used to follow patients and identify 30- and 31 to 90-d readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 d (30-R), and readmission within 31 to 90 d (90-R). RESULTS We identified 11 651 elderly patients undergoing ALIF, PLIF/PLF, or APLF for lumbar DDD, with 1213 (10.4%) patients encountering a readmission (30-R: n = 812[7.0%]; 90-R: n = 401[3.4%]; Non-R: n = 10 438). The greatest proportion of each cohort had 2 to 3 vertebral levels fused (30-R: 63.7%, 90-R: 69.2%, Non-R: 70.2%). Iliac crest bone graft was the most common fusion agent used (30-R: 59.9%, 90-R: 51.4%, Non-R: 53.5%), followed by bone morphogenetic protein (30-R: 24.6%, 90-R: 22.9%, Non-R: 21.2%). The most common inpatient complications observed were acute posthemorrhagic anemia (30-R: 26.6%, 90-R: 22.3%, Non-R: 18.2%), postoperative infection (30-R: 6.2%, 90-R: 9.7%, Non-R: 3.5%), and genitourinary complication (30-R: 7.7%, 90-R: 2.7%, Non-R: 3.5%). The most prevalent 30- and 90-d complications seen among the readmitted cohort were postoperative infection (30-R: 18.7%, 90-R: 8.9%), device complications (30-R: 5.2%, 90-R: 9.1%), and sepsis (30-R: 6.9%, 90-R: 4.9%). On multivariate regression analysis, obesity, chronic pulmonary disease, smoking, and any complication during index admission were independently associated with 30-d readmission; private insurance and coagulopathy were independently associated with 90-d readmission. CONCLUSION Our study suggests that 30- and 90-d readmissions for treatment of lumbar DDD in the elderly are common, and that multiple patient-level factors independently predict hospital readmission.

Download Full-text

Hidden blood loss and the risk factors after posterior lumbar fusion surgery

Medicine ◽

10.1097/md.0000000000020103 ◽

2020 ◽

Vol 99 (19) ◽

pp. e20103

Author(s):

Fei Lei ◽

Zhongyang Li ◽

Wen He ◽

Xinggui Tian ◽

Lipeng Zheng ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

Hidden Blood Loss

Download Full-text

Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000999 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Xianren Zhu ◽

Qian Shi ◽

Dongya Li ◽

Jibin Wu ◽

Kaijin Guo ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Reduce Blood Loss ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery

Download Full-text

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/v2 ◽

2020 ◽

Author(s):

Huiping Wei ◽

Qiuping Xiao ◽

Jianfeng He ◽

Tianji Huang ◽

Wantang Xu ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Topical Application ◽

Control Group ◽

Specific Method ◽

Intertrochanteric Fractures ◽

Perioperative Blood Loss ◽

Perioperative Bleeding

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

Download Full-text

The Effect of Tranexamic Acid Administration on Early Endothelial Damage Following Posterior Lumbar Fusion Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10071415 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1415

Author(s):

Hye Jin Kim ◽

Bora Lee ◽

Byung Ho Lee ◽

So Yeon Kim ◽

Byongnam Jun ◽

...

Keyword(s):

Postoperative Complications ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Endothelial Glycocalyx ◽

Control Group ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

Post Surgery

Tranexamic acid (TXA) protects against endothelial glycocalyx injury in vitro. We aimed to evaluate whether TXA could protect against endothelial glycocalyx degradation in patients undergoing posterior lumbar fusion surgery. Patients aged 30–80 years were enrolled. The TXA group was administered a loading dose of 10 mg/kg, followed by a 1 mg/kg/h infusion. Serum syndecan-1 and heparan sulfate concentrations, which are biomarkers of glycocalyx degradation, were measured at preoperative baseline (T0), immediately post-surgery (T1), and 2 h post-surgery (T2). Postoperative complications were assessed, including hypotension, desaturation, and acute kidney injury. Among the 121 patients who completed the study, 60 received TXA. There were no significant differences in the marker concentrations at each time point. However, the postoperative increase in syndecan-1 levels from baseline was significantly attenuated in the TXA group compared with the control group (median (interquartile range); T1 vs. T0: −1.6 (−5.3–2.6) vs. 2.2 (−0.7–4.8), p = 0.001; T2 vs. T0: 0.0 (−3.3–5.5) vs. 3.6 (−0.1–9.3), p = 0.013). Postoperative complications were significantly associated with the magnitude of the change in syndecan-1 levels (for T2 vs. T0: odds ratio: 1.08, 95% confidence interval: 1.02–1.14, p = 0.006). TXA administration was associated with reduced syndecan-1 shedding in patients undergoing posterior lumbar fusion surgery.

Download Full-text

Combined Use of Intravenous and Topical Tranexamic Acid Efficiently Reduce Blood Loss in Patients Aged over 60 operated with 2-level lumbar fusion

10.21203/rs.2.22192/v2 ◽

2020 ◽

Author(s):

Jianjiang Li ◽

Long Wang ◽

Tao Bai ◽

Yanlu Liu ◽

Yifei Huang

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Lumbar Fusion ◽

Control Group ◽

Transfusion Rate ◽

Total Blood ◽

Fusion Surgery ◽

Combined Use ◽

Group A ◽

Hemoglobin Drop

Abstract Purpose: The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid （TXA）in patients (aged over 60) scheduled for 2-level lumbar fusion surgery. Methods: 280 patients scheduled for 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local,15 mg/kg IV-TXA, 2 g TXA in local ,and 100 ml IV, respectively. The results of total blood loss (TBL) , maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded. Results: The TBL was 635.49 ± 143.60, 892.62 ± 166.85, 901.11 ± 186.25, and 1,225.11 ± 186.25 mL for the combined group, the IV group, the topical group, and the control group, respectively.(p = 0.015, p = 0.001 respectively).The average maximum hemoglobin drop in the four above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64 ，and 3.40 ± 1.32 g/dL, respectively. No PE event was reported during the follow-up. Although asymptomatic DVT events was reported by 1, 2, and 2 patients in the combined group, topical group, and control group, respectively, there is no intergroup difference. Conclusions: The combined use of TXA effectively reduced total blood loss and blood transfusion rate in patients aged over 60 scheduled for 2-level lumbar fusion, without increasing the incidence of DVT and PE formation.

Download Full-text

The further exploration of hidden blood loss in posterior lumbar fusion surgery

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2017.01.011 ◽

2017 ◽

Vol 103 (4) ◽

pp. 527-530 ◽

Cited By ~ 9

Author(s):

D. Xu ◽

Z. Ren ◽

X. Chen ◽

Q. Zhuang ◽

S. Hui ◽

...

Keyword(s):

Blood Loss ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

Hidden Blood Loss

Download Full-text

Hidden blood loss following 2- to 3-level posterior lumbar fusion

The Spine Journal ◽

10.1016/j.spinee.2019.07.010 ◽

2019 ◽

Vol 19 (12) ◽

pp. 2003-2006 ◽

Cited By ~ 2

Author(s):

Yoji Ogura ◽

John R. Dimar II ◽

Jeffrey L. Gum ◽

Charles H. Crawford ◽

Mladen Djurasovic ◽

...

Keyword(s):

Blood Loss ◽

Lumbar Fusion ◽

Posterior Lumbar Fusion ◽

Hidden Blood Loss

Download Full-text

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.

Download Full-text