scholarly journals Efficacy of Intraoperative Blood Salvage in Cerebral Aneurysm Surgery

2021 ◽  
Vol 10 (24) ◽  
pp. 5734
Author(s):  
Bedjan Behmanesh ◽  
Florian Gessler ◽  
Elisabeth Adam ◽  
Ulrich Strouhal ◽  
Sae-Yeon Won ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Cell ◽  
Cerebral Aneurysm ◽  
Red Blood Cell ◽  
Cerebral Aneurysms ◽  
Cell Salvage ◽  
Aneurysm Surgery ◽  
Allogenic Blood ◽  
Intraoperative Cell Salvage ◽  
Unruptured Cerebral Aneurysm

Background. The use and effectiveness of intraoperative cell salvage has been analyzed in many surgical specialties. Until now, no data exist evaluating the efficacy of intraoperative cell salvage in cerebral aneurysm surgery. Aim. To evaluate the efficacy and cost effectiveness of intraoperative cell salvage in cerebral aneurysm surgery. Methods. Data were collected retrospectively for all the patients who underwent cerebral aneurysm surgery at our institution between 2013 and 2019. Routinely, we apply blood salvage through autotransfusion. The cases were divided into a ruptured cerebral aneurysm group and a unruptured cerebral aneurysm group. Results. A total of 241 patients underwent cerebral aneurysm clipping. Of all the cerebral aneurysms, 116 were ruptured and 125 were unruptured and clipped electively. Age, location of the aneurysm, postoperative red blood cell count, intraoperative blood loss, and number of allogenic blood cell transfusions were statistically significantly different between the groups. The autotransfusion of salvaged blood could only be facilitated in eight cases with ruptured cerebral aneurysms and in none with unruptured cerebral aneurysms clipped electively (p < 0.01). Additionally, 35 patients with ruptured cerebral aneurysms and one patient with unruptured cerebral aneurysm required allogenic red blood cell transfusion after surgery, and 71 vs. 2 units of blood were transfused (p < 0.0001). In terms of cost effectiveness, a total of EUR 45,189 in 241 patients was spent to run the autotransfusion system, while EUR 13,797 was spent for allogenic blood transfusion. Conclusions. The use of cell salvage in patients with unruptured cerebral aneurysm, undergoing elective surgery, is not effective.

scholarly journals Verbal Memory Functions in Patients after the Ruptured and Unruptured Cerebral Aneurysm Surgery

2020 ◽  
Vol 57 (1) ◽  
pp. 81-92
Author(s):  
Ljiljana Pačić-Turk ◽  
Valerija Hauptfeld ◽  
Lana Maljković ◽  
Ivo Somek ◽  
Larissa Kalaus
Keyword(s):  
Cerebral Aneurysm ◽  
Verbal Memory ◽  
Verbal Learning ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Brain Aneurysm ◽  
Memory Functions ◽  
Unruptured Cerebral Aneurysm ◽  
Significant Difference

A cerebral aneurysm is a bulge in the wall of a brain blood vessel with a risk to rupture. It occurs in about 2% of the population, somewhat more often in women. Most aneurysms are located in the anterior circulation area. Aneurysm rupture is relatively rare and accounts for 5% of all cerebrovascular brain incidents. Ruptured and asymptomatic/unruptured aneurysms are often treated surgically at the Department of Neurosurgery, Medical School University of Zagreb. The study included 134 patients after cerebral aneurysm surgery during the last 10 years, and neuropsychological testing was performed on average 77 days after surgery. The average age was 52 years and they completed an average of 12 years of education. In the group of patients included in this study, 40.3% of them were operated after ruptured, and 59.7% for unruptured cerebral aneurysm. Most aneurysms were located in the middle cerebral and anterior communicating arteries. With regard to lateralization, there was an equal number of aneurysms located in the right and left hemisphere and bilaterally (on the anterior communicating artery). As part of regular neuropsychological assessment, tests of verbal learning and memory (numerical, logical and mechanical memory) were applied. The aims of the study were to find out whether patients operated for ruptured cerebral aneurysms show greater verbal memory impairments than patients operated for unruptured cerebral aneurysms and whether there was the significant effect of lateralization of aneurysm (to check the interaction effect of both rupture and lateralization on those functions). The results obtained show that, even though there are no statistically significant differences between groups of patients that underwent surgery for ruptured and unruptured brain aneurysm, patients show a trend of somewhat better results on most of the verbal memory functions after surgery for unruptured brain aneurysm. The results show statistically significant difference between groups of patients that underwent surgery for ACoA aneurysm and those with right lateralized cerebral aneurysms on most of the trails on AVLT test. Also, patients with operated ACoA aneurysm have significantly worse scores in learning process (AVLT 3 and AVLT 4) and especially on short-term and long-term verbal memory than the patients who were operated for left or right lateralized aneurysm.

scholarly journals Cost-effectiveness of prospective red blood cell antigen matching to prevent alloimmunization among sickle cell patients

Transfusion ◽  
2013 ◽  
Vol 54 (1) ◽  
pp. 86-97 ◽  
Author(s):  
Seema Kacker ◽  
Paul M. Ness ◽  
William J. Savage ◽  
Kevin D. Frick ◽  
R. Sue Shirey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Cell ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Cell Antigen

scholarly journals The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery

2017 ◽  
Vol 17 (7) ◽  
pp. 977-982 ◽  
Author(s):  
Mahmoud Elmalky ◽  
Naveed Yasin ◽  
Ricardo Rodrigues-Pinto ◽  
John Stephenson ◽  
Craig Carroll ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Tumor Surgery ◽  
Cell Salvage ◽  
Spine Tumor ◽  
Intraoperative Cell Salvage ◽  
Metastatic Spine Tumor ◽  
Spine Tumor Surgery

scholarly journals Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes

2015 ◽  
Vol 8 (9) ◽  
pp. 977-981 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
George Bovis ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Postoperative Mortality ◽  
Fee For Service ◽  
Aneurysm Clipping ◽  
Unruptured Cerebral Aneurysm ◽  
Procedural Volume ◽  
Unruptured Cerebral Aneurysms

BackgroundIt is often questioned if one physician can conduct both open and endovascular techniques successfully and safely.ObjectiveTo investigate the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm clipping.MethodsWe performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent surgical clipping for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding we used propensity score conditioning, and controlled for clustering at the physician level.ResultsDuring the study, 3247 patients underwent clipping for unruptured cerebral aneurysms, and met the inclusion criteria. Of these, 766 (23.6%) underwent treatment by hybrid neurosurgeons, and 2481 (76.4%) by proceduralists, who performed only clipping. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR=0.81; 95% CI 0.51 to 1.28), discharge to rehabilitation (OR=0.95; 95% CI 0.72 to 1.25), length of stay (adjusted difference 0.85 days; 95% CI −0.31 to 2.00), or 30-day readmission rate (OR=1.05; 95% CI 0.80 to 1.39). Higher procedural volume was independently associated with improved outcomes.ConclusionsIn a cohort of Medicare patients with unruptured aneurysms, we did not demonstrate a difference in mortality, discharge to rehabilitation, or readmission rate between hybrid neurosurgeons and surgeons performing only clipping.

Size is the Most Important Predictor of Aneurysm Rupture Among Multiple Cerebral Aneurysms: Post Hoc Subgroup Analysis of Unruptured Cerebral Aneurysm Study Japan

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 864-869 ◽  
Author(s):  
Masaaki Shojima ◽  
Akio Morita ◽  
Hirofumi Nakatomi ◽  
Shinjiro Tominari
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Ruptured Aneurysm ◽  
Clinical Value ◽  
Total Cohort ◽  
Unruptured Cerebral Aneurysm ◽  
Specific Factors ◽  
Unruptured Cerebral Aneurysms ◽  
Post Hoc

Abstract BACKGROUND Multiple cerebral aneurysms are encountered in approximately 15% to 35% of patients harboring unruptured cerebral aneurysms. It would be of clinical value to determine which of them is most likely to rupture. OBJECTIVE To characterize features of the ruptured aneurysm relative to other concomitant fellow aneurysms in patients with multiple cerebral aneurysms. METHODS From a total of 5720 patients who were prospectively registered in the Unruptured Cerebral Aneurysm Study in Japan, a subgroup of patients with multiple cerebral aneurysms who developed subarachnoid hemorrhage was extracted for this post hoc analysis. Intrapatient comparisons of each aneurysm were carried out using aneurysm-specific factors such as size, location, and shape to identify predictors of rupture among the fellow aneurysms in a patient with multiple cerebral aneurysms. RESULTS Twenty-five patients with 62 aneurysms were identified from the total cohort of 5720 patients. With the distinctiveness in size, which means the aneurysm was the single largest among the multiple aneurysms, the ruptured aneurysm in each case was discriminated from the other coexisting aneurysms with a sensitivity of 0.76 and specificity of 0.86. CONCLUSION Our results suggest that the largest aneurysm is likely to rupture among coexisting aneurysms in a patient with multiple cerebral aneurysms.

scholarly journals The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms

2017 ◽  
Vol 126 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
Nicos Labropoulos ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Unruptured Cerebral Aneurysm ◽  
Hospital Referral ◽  
Unruptured Cerebral Aneurysms ◽  
The Impact ◽  
Aneurysm Coiling

OBJECTIVE The impact of combined practices on the outcomes of unruptured cerebral aneurysm coiling remains an issue of debate. The authors investigated the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm coiling. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent endovascular coiling for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding, the authors used propensity score conditioning, with mixed effects to account for clustering at the hospital referral region level. RESULTS During the study period, there were 11,716 patients who underwent endovascular coiling for unruptured cerebral aneurysms and met the inclusion criteria. Of these, 1186 (10.1%) underwent treatment performed by hybrid neurosurgeons, and 10,530 (89.9%) by proceduralists who performed only endovascular coiling. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR 0.84; 95% CI 0.58–1.23), discharge to rehabilitation (OR 1.0; 95% CI 0.66–1.51), 30-day readmission rate (OR 1.07; 95% CI 0.83–1.38), and length of stay (adjusted difference, 0.41; 95% CI −0.26 to 1.09). Higher procedural volume was independently associated with improved outcomes. CONCLUSIONS In a cohort of Medicare patients, the authors did not demonstrate a difference in mortality, discharge to rehabilitation, readmission rate, and LOS between hybrid neurosurgeons and proceduralists performing only endovascular coiling.

scholarly journals Luspatercept (Reblozyl)

2021 ◽  
Vol 1 (8) ◽  
Author(s):  
Reimbursement Team
Keyword(s):  
Cost Effectiveness ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Subcutaneous Injection ◽  
Drug Class ◽  
Clinical Effectiveness ◽  
Adult Patients ◽  
Red Blood Cell Transfusion ◽  
Beta Thalassemia ◽  
Clinician Perspectives

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses luspatercept (Reblozyl), 25 mg/vial, 75 mg/vial, powder for solution for subcutaneous injection. Indication: For the treatment of adult patients with red blood cell transfusion-dependent anemia associated with beta-thalassemia.

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