Operative blood loss, blood transfusion and 30-day mortality in older patients after major noncardiac surgery

Background: There are current trends towards not using a tourniquet in total knee replacement (TKR), but there is nothing published on what the effects of not using a tourniquet on unicondylar knee replacements (UKR) may be in terms of blood loss.Methods: A retrospective case series of 36 consecutive UKR from our institution were analysed. All procedures were carried out without a tourniquet and also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, administration of periarticular local anaesthetic and adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.Results: Most patients (61.1%) experienced an estimated intra-operative blood loss of less than100 mls. There was a mean haemoglobin drop of 16.1 g/l (range 1–26, SD ±5.9), with a mean post operatively haemoglobin level of 125.1 g/l (range 107-142, SD ±8.7). No patients required a blood transfusion.Conclusions: A low level of blood loss is encountered when UKR is undertaken without a tourniquet and with our standard interventions to reduce bleeding. The level of post-operative haemoglobin and absence of requirement for blood transfusion suggests that this operation can be undertaken without the need for a group and save. It is our hope that surgeons will be encouraged to perform this procedure without a tourniquet and benefit from the cost-saving opportunity of not performing a group and save.

Download Full-text

Preoperative Particle and Glue Embolization of Meningiomas: Indications, Results, and Lessons Learned from 117 Consecutive Patients

Operative Neurosurgery ◽

10.1227/neu.0000000000000187 ◽

2013 ◽

Vol 73 (2) ◽

pp. ons244-ons252 ◽

Cited By ~ 8

Author(s):

Anouk Borg ◽

Jinendra Ekanayake ◽

Richard Mair ◽

Thomas Smedley ◽

Stefan Brew ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Transfusion Requirement ◽

Lessons Learned ◽

Direct Result ◽

Embolic Agent ◽

Operative Blood Loss ◽

Indirect Measure ◽

Blood Transfusion Requirement ◽

Transfusion Requirements

Abstract BACKGROUND: Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. OBJECTIVE: To evaluate the safety of presurgical embolization of meningiomas and its impact on subsequent transfusion requirement with respect to the extent of embolization and technique used. METHODS: One hundred seventeen consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma before surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed. RESULTS: Mean blood transfusion requirement during surgery was 0.8 units per case (range, 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographically devascularized (P = .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral hemorrhage in 2, sixth cranial nerve palsy in 1, and scalp necrosis requiring reconstructive surgery in 1 patient. CONCLUSION: The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that preoperative meningioma embolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.

Download Full-text

The Efficacy of Tranexamic Acid in Cardiac Surgery Requiring Cardio-Pulmonary Bypass (CPB) to Reduce Post-Operative Blood Loss and Requirement of Allogenic Blood Transfusion

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2019.6.8.39 ◽

2019 ◽

Vol 6 (8) ◽

Author(s):

Abhijeet Shitole ◽

Sharanagouda Patil ◽

Shilpi Sharma ◽

Anand Vagarali ◽

Samrat Madnaik ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Allogenic Blood Transfusion ◽

Operative Blood Loss ◽

Allogenic Blood ◽

Cardio Pulmonary Bypass ◽

Pulmonary Bypass

Download Full-text

Strategies for Reducing Blood Transfusions in Hepatic Resection

HPB Surgery ◽

10.1155/1994/98027 ◽

1994 ◽

Vol 8 (1) ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

T. Matsumata ◽

H. Itasaka ◽

K. Shirabe ◽

M. Shimada ◽

K. Yanaga ◽

...

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Blood Transfusion ◽

Blood Loss ◽

Hepatic Resection ◽

Prothrombin Time ◽

Laboratory Data ◽

Blood Transfusions ◽

Operative Blood Loss ◽

The Difference

A comparison of 60 blood transfused and 71 nonblood transfused hepatic resection patients was done to evaluate strategies for reducing blood transfusions during hepatic surgery. There were no significant differences between the two groups with regard to preoperative laboratory data, except for prothrombin time and hematocrit value. The mean operative blood loss was 1990 ml and 760 ml in the blood transfused and nonblood transfused groups, respectively. A multivariate analysis suggested that the patient’s body weight, preoperative prothrombin time, and operative blood loss independently predicted the need for intraoperative blood transfusion. Major postoperative complications developed more frequently in the blood transfused group than in the nonblood transfused group (31.7 vs. 11.3%, p<0.005). These results suggest that the difference in operative blood loss between the two groups was related to the prolonged prothrombin time and a susceptibility for blood transfusion was found to exist particularly in patients with a lower hematocrit value as well as a lower body weight. Thus, the improvement of these preoperative laboratory data combined with avoiding the use of the hematocrit value as a determining factor for intraoperative transfusion could correspond to a reduction in operative blood loss, while curtailing the demands on blood bank facilities, and lowering the risk of postoperative complications.

Download Full-text

Preoperative Aspirin Use and Outcomes in Off-pump Coronary Artery Bypass Grafting Surgery

Bangladesh Heart Journal ◽

10.3329/bhj.v33i1.37019 ◽

2018 ◽

Vol 33 (1) ◽

pp. 16-21

Author(s):

Md Rezaul Karim ◽

Tawfiq Ahmed ◽

Rownak Khurshid ◽

Shahriar Moinuddin ◽

Md Kamrul Hasan

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Artery Bypass ◽

Perioperative Period ◽

Operative Blood Loss ◽

Off Pump ◽

Transfusion Requirements ◽

Increased Risk ◽

Pump Cabg ◽

Group B

Introduction: Aspirin, the most widely used platelet function inhibitor extremely effective at blocking the production of thromboxane in platelets, rendering the platelets incapable of functioning normally, and thus preventing thrombosis. The practice of empirically discontinuing aspirin preoperatively should be abandoned because evidence strongly supports continued use of aspirin in patients for secondary prevention of CAD, CVD, or PVD when undergoing surgery.Methods and Materials: This Observational study was conducted at Department of Cardiac Surgery, NICVD, Dhaka, who underwent off pump CABG (OPCAB), divided in two groups, Group A: 24 patients who stopped and Group B: 24 patients who are continuing aspirin throughout the perioperative period. Post operative blood loss, requirement of blood transfusion, post-operative MI, ICU stay, Total hospital stay (days) and early post-operative complication (Stroke, New arrhythmia in ECG, 30 days mortality) were recorded and included in the study.Results: The key finding of the present study is that preoperatively continued aspirin use was not associated with increased risk of post-operative blood loss, blood transfusion requirements and need for re exploration after OPCAB.Conclusions: Preoperative aspirin therapy should be continued till off-pump CABG without interruption.Bangladesh Heart Journal 2018; 33(1) : 16-21

Download Full-text

Pre-Operative Oral Iron Supplementation Reduces Blood Transfusion in Colorectal Surgery – A Prospective, Randomised, Controlled Trial

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x183364 ◽

2007 ◽

Vol 89 (4) ◽

pp. 418-421 ◽

Cited By ~ 68

Author(s):

PG Lidder ◽

G Sanders ◽

E Whitehead ◽

WJ Douie ◽

N Mellor ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Colorectal Surgery ◽

Blood Transfusion ◽

Blood Loss ◽

Controlled Trial ◽

Ferrous Sulphate ◽

Haemoglobin Concentration ◽

Treated Group ◽

Operative Blood Loss ◽

Randomised Controlled

INTRODUCTION Allogeneic blood transfusion confers a risk to the recipient. Recent trials in colorectal surgery have shown that the most significant factors predicting blood transfusion are pre-operative haemoglobin, operative blood loss and presence of a transfusion protocol. We report a randomised, controlled trial of oral ferrous sulphate 200 mg TDS for 2 weeks' pre-operatively versus no iron therapy. PATIENTS AND METHODS Patients diagnosed with colorectal cancer were recruited from out-patient clinic and haematological parameters assessed. Randomisation was co-ordinated via a telephone randomisation centre. RESULTS Of the 49 patients recruited, 45 underwent colorectal resection. There were no differences between those patients not receiving iron (n = 23) and the iron-supplemented group (n = 22) for haemoglobin at recruitment, operative blood loss, operation duration or length of hospital stay. At admission to hospital, the iron-supplemented group had a higher haemoglobin than the non-iron treated group (mean haemoglobin concentration 13.1 g/dl [range, 9.6–17 g/dl] versus 11.8 g/dl [range, 7.8–14.7 g/dl]; P = 0.040; 95% CI 0.26–0.97) and were less likely to require operative blood transfusion (mean 0 U [range, 0–4 U] versus 2 U [range, 0–11 U] transfused; P = 0.031; 95% CI 0.13–2.59). This represented a cost reduction of 66% (47 U of blood = £4700 versus oral FeSO4 at £30 + 15 U blood at £1500). At admission, ferritin in the iron-treated group had risen significantly from 40 μg/l (range, 15–222 μg/l) to 73 μg/l (range, 27–386 μg/l; P = 0.0036; 95% CI 46.53–10.57). CONCLUSIONS Oral ferrous sulphate given pre-operatively in patients undergoing colorectal surgery offers a simple, inexpensive method of reducing blood transfusions.

Download Full-text