LigaSure Use Decreases Intraoperative Blood Loss Volume and Blood Transfusion Volume in Sarcoma Surgery

Intravenous tranexamic acid (TXA) has been administered to reduce intraoperative blood loss in scoliosis surgery. However, the therapeutic effect of TXA on spinal muscular atrophy (SMA) scoliosis surgery is not well demonstrated. Therefore, this study aimed to assess the efficacy of intravenous TXA in SMA scoliosis surgery. From December 1993 to August 2020, 30 SMA patients who underwent scoliosis surgery (posterior fusion with fusion level of thoracic second or third to pelvis) were retrospectively enrolled and divided into the TXA group and non-TXA (control) group, with 15 patients in each group. Survey parameters were the amount of blood loss, blood transfusion, crystalloid transfusion volume, intubation time, and associated pulmonary complications (including pneumonia, pulmonary edema, and pulmonary atelectasis). The TXA group had significantly lesser blood loss than the control group (p = 0.011). Compared with the control group, the TXA group had significantly lower blood transfusion (p < 0.001), crystalloid volume (p = 0.041), and total transfusion volume (p = 0.005). In addition, the TXA group had fewer postoperative pulmonary complications, and patients with pulmonary complications were associated with a higher relative crystalloid volume and relative total transfusion volume (p = 0.003 and 0.022, respectively). In conclusion, TXA can be effective in reducing intraoperative blood loss and crystalloid fluid transfusions during scoliosis surgery in SMA patients, which may aid in reducing postoperative pulmonary complications.

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Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1473-6 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Jia Jiang ◽

Ran Zhou ◽

Bo Li ◽

Fushan Xue

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Orthopedic Surgery ◽

Meta Analysis ◽

Age Groups ◽

Controlled Trials ◽

Intraoperative Blood Loss ◽

Deliberate Hypotension ◽

Transfusion Volume ◽

Quality Evidence

Abstract Background Deliberate hypotension has been shown to reduce the intraoperative bleeding and the need for allogeneic blood transfusion, and improve the surgical field, but there is still controversy on its clinical safety. This systematic review was designed to assess the safety and benefits of deliberate hypotension for orthopedic surgery. Methods The review met the requirements of the PRISMA guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, ISI Web of Science, ScienceDirect, and four Chinese databases (China National Knowledge Infrastructure, Wanfang, vip citation database, and updated version of China Biology Medicine disc from January 1, 2000 to January 1, 2019) were searched. All parallel randomized controlled trials comparing the effects of using deliberate hypotension with not using deliberate hypotension on clinical outcomes of patients undergoing orthopedic surgery were selected. The primary outcome was overall mortality. The secondary outcomes were the intraoperative blood loss, blood transfusion volume, and serious adverse postoperative events. Results A total of 30 studies with 36 comparisons (1454 participants) were included in meta-analysis. Two studies with 120 participants reported overall mortality and the result was zero (low-quality evidence). The use of deliberate hypotension reduced the intraoperative blood loss (mean difference, − 376.7; 95% CI − 428.1 to − 325.3; I2 = 94%; 29 studies, 36 comparisons, and 1398 participants; low-quality evidence) and blood transfusion volume (mean difference, − 242.5; 95% CI − 302.5 to − 182.6; I2 = 95%; 13 studies, 14 comparisons, and 544 participants; low-quality evidence). Six studies with 286 participants reported the occurrence of serious adverse postoperative events and the result was zero (low-quality evidence). Subgroup analyses according to age groups, controlled mean artery pressure levels, types of orthopedic surgeries, different combinations of other blood conservative method, and hypotensive methods mostly did not explain heterogeneity; significant differences were identified in almost all subgroups. Conclusions Based on the available evidence, it is still unclear whether or not deliberate hypotension is a safe technique for orthopedic surgery due to limited studies with very small sample size, though it may decrease the intraoperative blood loss and blood transfusion volume irrespective of age groups, controlled mean artery pressure levels, types of surgeries, hypotensive methods, or different combinations of other blood conservation strategies. Trial registration PROSPERO CRD42016045480.

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

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00374-z ◽

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.

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Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery

Plastic Surgery ◽

10.1177/2292550320925897 ◽

2020 ◽

Vol 28 (2) ◽

pp. 94-104

Author(s):

Liang Sun ◽

Rui Guo ◽

Yi Feng

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Orthognathic Surgery ◽

Operation Time ◽

Controlled Trials ◽

Allogenic Blood Transfusion ◽

Intraoperative Blood Loss ◽

Irrigation Fluid ◽

Allogenic Blood

Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.

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A Comparative Study of the Efficacy of the Modified Sugiura Procedure and the Hassab Procedure for Treatment of Rebleeding after Endoscopic Variceal Ligation Due to Portal Hypertension

The American Surgeon ◽

10.1177/000313481608200619 ◽

2016 ◽

Vol 82 (6) ◽

pp. 557-564 ◽

Cited By ~ 2

Author(s):

Qiang Wang ◽

Xiong Ding

Keyword(s):

Portal Hypertension ◽

Blood Transfusion ◽

Blood Loss ◽

Endoscopic Variceal Ligation ◽

Transfusion Rate ◽

Significant Difference ◽

Sugiura Procedure ◽

Surgical Duration ◽

Blood Loss Volume

Although the modified Sugiura procedure and Hassab procedure have been used for many years, it remains unclear as to which is more effective for the treatment of rebleeding due to portal hypertension (PHT) after endoscopic variceal ligation (EVL). Hence, we conducted a retrospective study to compare the efficacy of these two procedures for treatment of rebleeding due to PHTafter EVL. Of 66 patients diagnosed with PHT and rebleeding after EVL in our institute from January 2007 to January 2014, 31 underwent the modified Sugiura procedure (Group S), whereas 35 underwent the Hassab procedure (Group H). The surgical duration, blood loss volume, blood transfusion rate, postoperative complication rate, postoperative rebleeding rate, postoperative hospital stay, and long-term complication rates were compared between groups. Greater blood loss volume ( P = 0.036), higher blood transfusion rate ( P = 0.002), and longer surgical duration ( P < 0.001) were observed in Group S than in Group H. There was no significant difference in the rate of short-term postoperative rebleeding between the groups ( P = 0.695), although the rate of long-term rebleeding was lower ( P = 0.031) in Group S. Recurrence of esophageal varices in Group S was less frequent in Group H ( P = 0.002), although there was no significant difference between the groups in the rates of recurrence of gastric varices and other long-term complications ( P > 0.05). The modified Sugiura procedure is more effective than the Hassab procedure for the treatment of rebleeding after EVL.

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P42 Predicting bleeding risk during meningioma surgery

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.112 ◽

2019 ◽

Vol 90 (3) ◽

pp. e35.3-e35

Author(s):

A Tsyben ◽

M Surour ◽

K Budohoski ◽

R Kirollos ◽

A Helmy

Keyword(s):

Multivariate Analysis ◽

Blood Transfusion ◽

Blood Loss ◽

Univariate Analysis ◽

Estimate Blood Loss ◽

Bleeding Risk ◽

Intraoperative Blood Loss ◽

Dural Tail ◽

Meningioma Surgery ◽

Tumour Characteristics

ObjectivesSurgical treatment of meningioma is frequently accompanied by significant intraoperative blood loss and the associated risks of blood transfusion. Surgical adjuncts such as pre-operative embolisation and the use of tranexamic acid have attendant risks. An ability to estimate blood loss can appropriately target these interventions.DesignRetrospective studySubjectsPatients following surgery for meningioma between 2015–2018MethodsIntraoperative blood loss, pre- to post-operative haemoglobin difference and blood transfusion were evaluated. Pre-operative imaging included size, shape and location of meningioma, involvement of sinuses and blood vessels, T1 and T2 weighted characteristics, restricted diffusion, peritumoral oedema, dural tail and hyperostosis. Multivariate analysis was used to determine the relationship between meningioma characteristics and blood loss.ResultsTumour diameter and venous sinus opening were significantly related to blood loss on multivariate analysis (p=0.004 and p=0.001 respectively). Furthermore, on univariate analysis additional factors included procedure duration (p<0.0001), pre-operative radiotherapy (p=0.042) and pre-operative platelet count (p=0.03).ConclusionsOnly size of tumour and opening venous sinuses was related to intraoperative bloods loss in this cohort of patients. Further research is required to define tumour characteristics that can be used to identify patients suitable for pre- and intra-operative adjunct therapies.

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Title: Preoperative Endoleak Type in Patients of Aneurysmal Sac Expansion After Endovascular Aneurysm Repair and Intraoperative Blood Loss in Aneurysmorrhaphy: Analysis of a Case Series of 18 Patients

10.21203/rs.3.rs-211359/v1 ◽

2021 ◽

Author(s):

Kazuma Oshida ◽

Kohei Ikeda ◽

Yuka Shibuya ◽

Masayuki Hara ◽

Shoichi Uezono

Keyword(s):

Blood Loss ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Red Blood Cell Transfusion ◽

Preoperative Imaging ◽

Type Ii ◽

Intraoperative Blood Loss ◽

Type Ii Endoleak ◽

Transfusion Volume ◽

Aneurysm Repair

Abstract Purpose EVAR (endovascular aneurysm repair) has become a possible treatment option of abdominal aortic aneurysms, and endoleak is the most common complication after EVAR. The purpose of this study was to determine the difference of intraoperative blood loss in aneurysmorraphy for aneurysmal sac expansion after EVAR according to type of endoleak. Methods Perioperative data of 18 patients underwent aneurysmorrhaphy for aneurysmal sac expansion after EVAR from July 2010 to November 2017 at the Jikei University Hospital are collected. Patients were divided in two group, endoleak type II or type V (endotension) according to preoperative imaging. Patient demographic and quantitative data, including intraoperative blood loss and intraoperative red blood cell transfusion volume, were collected from electronic medical and anesthetic records. Intraoperative blood loss in aneurysmorrhaphy were compared between the two groups. Results In 18 patients, 13 patients were diagnosed type II endoleak, and 5 patients were diagnosed endotension. There were statistically differences in intraoperative blood loss and red cell transfusion volume between type II endoleak and endotension groups (P = 0.0016 and P = 0.018, respectively). Conclusion These results suggest that the type of endoleak after EVAR may be associated with intraoperative blood loss in aneurysmorrhaphy. Pre-operative estimation of intraoperative blood loss depending on endoleak type may be helpful for the decision making of anesthetic management in aneurysmorrhaphy.

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Impact of Intraoperative Blood Loss and Blood Transfusion on the Prognosis of Colorectal Liver Metastasis Following Curative Resection

Anticancer Research ◽

10.21873/anticanres.15377 ◽

2021 ◽

Vol 41 (11) ◽

pp. 5617-5623

Author(s):

SHIBUTANI MASATSUNE ◽

KENJIRO KIMURA ◽

SHINICHIRO KASHIWAGI ◽

WANG EN ◽

YUKI OKAZAKI ◽

...

Keyword(s):

Liver Metastasis ◽

Blood Transfusion ◽

Blood Loss ◽

Colorectal Liver Metastasis ◽

Curative Resection ◽

Intraoperative Blood Loss

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Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000369216 ◽

2015 ◽

Vol 95 (1) ◽

pp. 15-25 ◽

Cited By ~ 10

Author(s):

Kun Wang ◽

Peijin Zhang ◽

Xianlin Xu ◽

Min Fan

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Biomedical Literature ◽

Controlled Trials ◽

Intraoperative Blood Loss ◽

Stone Free Rate ◽

Operative Complications ◽

Free Rate

Objective: To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. Results: Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. Conclusion: Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.

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