151
|
Chojnowski K, Janus A, Bliźniewska K, Robak M, Treliński J. Long-lasting extreme anemia during the therapy of acute lymphoblastic leukemia in a Jehovah's Witness patient. Transfusion 2016; 56:2438-2442. [PMID: 27385671 DOI: 10.1111/trf.13703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The treatment of patients with acute leukemia, who due to their religious beliefs refuse to accept blood transfusion, is a great challenge for hematologists. CASE REPORT We present a case of acute pre-T-lymphoblastic leukemia in a Jehovah's Witness who did not accept blood transfusion during chemotherapy. Standard induction and consolidation chemotherapy was used (according to the PALG ALL-6 regiment). RESULTS During consolidation cycles, darbepoietin alfa, intravenous iron, and total parenteral nutrition was administered. Extreme (Hb < 5 g/dL), long-lasting (41 days) anemia was observed with the lowest Hb concentration amounting to 1.3 g/dL (lasting 7 days). CONCLUSION We believe this to be the lowest Hb value observed, particularly one that persisted for such a long period of time and resulted in the patient surviving without consequences. The patient remains in complete remission for more than 2 years after diagnosis.
Collapse
Affiliation(s)
| | - Agnieszka Janus
- Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland
| | | | - Marta Robak
- Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland
| | - Jacek Treliński
- Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland.
| |
Collapse
|
152
|
Frew N, Alexander D, Hood J, Acornley A. Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty. Ann R Coll Surg Engl 2016; 98:380-6. [PMID: 27055406 PMCID: PMC5209967 DOI: 10.1308/rcsann.2016.0139] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Preoperative anaemia remains undertreated in the UK despite advice from national agencies to implement blood conservation measures. A local retrospective audit of 717 primary hip/knee replacements in 2008-2009 revealed 25% of patients were anaemic preoperatively. These patients experienced significantly increased transfusion requirements and length of stay. We report the results of a simple and pragmatic blood management protocol in a district general hospital. Methods Since 2010 patients at our institution who are found to be anaemic when listed for hip/knee replacement have been offered iron supplementation and/or erythropoietin depending on haemoglobin and ferritin levels. In this study, postoperative blood transfusions, length of stay and readmissions were assessed retrospectively for all patients undergoing elective primary hip/knee replacement in 2014 and compared with the baseline findings. Results During the 12-month study period, 406 patients were eligible for inclusion and none were excluded. Eighty-nine patients (22%) were anaemic preoperatively and sixty-five received treatment. The transfusion rate fell from the baseline levels of 23.0% and 6.7% to 4.3% and 0.5% for hip and knee replacements respectively (p<0.001). The median length of stay reduced from 6 to 3 days (p<0.001) for both hip and knee replacements. The rate for readmissions within 90 days fell from 13.5% to 8.9% (p<0.05). Conclusions Preoperative anaemia is common in patients listed for hip/knee replacement and it is associated strongly with increased blood transfusion. The introduction of a blood management protocol has led to significant reductions in transfusion and length of stay, sustained over a four-year period. This suggests that improved patient outcomes, conservation of blood stocks and cost savings can be achieved.
Collapse
Affiliation(s)
- N Frew
- Airedale NHS Foundation Trust , UK
| | | | - J Hood
- Airedale NHS Foundation Trust , UK
| | | |
Collapse
|
153
|
Schoettker P, Marcucci CE, Casso G, Heim C. Revisiting transfusion safety and alternatives to transfusion. Presse Med 2016; 45:e331-40. [DOI: 10.1016/j.lpm.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
154
|
Calcaterra D, Renfro LA, Shander A. Navigating the Fine Line Between the Bad and Worse: The Issue Is Not the Number, and the Message Is Not "All or Nothing". J Cardiothorac Vasc Anesth 2016; 30:1159-62. [PMID: 27640892 DOI: 10.1053/j.jvca.2016.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Domenico Calcaterra
- Division of Cardiac Surgery, Hennepin County Medical Center and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Leslie A Renfro
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Aryeh Shander
- Department of Anesthesiology, Englewood Hospital & Medical Center, Englewood, NJ
| |
Collapse
|
155
|
Drayton BA, Patterson JA, Nippita TA, Ford JB. Red blood cell transfusion after postpartum haemorrhage and breastmilk feeding at discharge: A population‐based study. Aust N Z J Obstet Gynaecol 2016; 56:591-598. [DOI: 10.1111/ajo.12485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/03/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Bradley A. Drayton
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St LeonardsNew South Wales Australia
- Biostatistics Training Program New South Wales Ministry of Health North SydneyNew South Wales Australia
| | - Jillian A. Patterson
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St LeonardsNew South Wales Australia
- Sydney Medical School Northern University of Sydney St Leonards New South WalesAustralia
| | - Tanya A. Nippita
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St LeonardsNew South Wales Australia
- Sydney Medical School Northern University of Sydney St Leonards New South WalesAustralia
- Department of Obstetrics and Gynaecology Royal North Shore Hospital St Leonards New South Wales Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St LeonardsNew South Wales Australia
- Sydney Medical School Northern University of Sydney St Leonards New South WalesAustralia
| |
Collapse
|
156
|
Roque-Castellano C, Marchena-Gómez J, Fariña-Castro R, Acosta-Mérida MA, Armas-Ojeda MD, Sánchez-Guédez MI. Perioperative Blood Transfusion is Associated with an Increased Mortality in Older Surgical Patients. World J Surg 2016; 40:1795-801. [DOI: 10.1007/s00268-016-3521-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
157
|
The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:157-64. [DOI: 10.1097/imi.0000000000000280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Limiting blood transfusion in cardiac operations is a well-meaning goal of perioperative care. Potential benefits include decreasing morbidity and limiting procedural costs. It is difficult to identify transfusion as the cause of adverse outcomes. The need for transfusion may identify a sicker patient population at greater risk for a worse outcome that may or may not be related to the transfusion. We reviewed the indications for and adverse effects of blood transfusion in patients undergoing cardiac procedures to provide a balanced approach to management of blood resources in this population. We reviewed current literature, including systematic reviews and practice guidelines, to synthesize a practice management plan in patients having cardiac operations. Several prospective randomized studies and large population cohort studies compared a postoperative restrictive transfusion policy to a more liberal policy and found very little difference in outcomes but decreased costs with a restrictive policy. Evidence-based practice guidelines and implementation standards provide robust intervention plans that can limit harmful effects of transfusion and provide safe and effective procedure outcomes. A restrictive transfusion policy seems to be safe and effective but does not necessarily provide better outcome in most patient cohorts. The implications of these findings suggest that many discretionary transfusions could be avoided. A subset of high-risk patients could undoubtedly benefit from a more liberal transfusion policy, but the definition of high risk is ill defined.
Collapse
|
158
|
Gunn T, Paone G, Emery RW, Ferraris VA. The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tyler Gunn
- Department of Surgery, University of Kentucky, Lexington, KY USA
| | - Gaetano Paone
- Cardiac Surgery, Henry Ford Hospital, Detroit, MI USA
| | | | - Victor A. Ferraris
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY USA
| |
Collapse
|
159
|
Chen L, Lv L, Long C, Lou S. Effects of circuit albumin coating on coagulation and inflammatory response for patients receiving aortic arch replacement: a randomized controlled trial. Perfusion 2016; 31:576-83. [PMID: 27117175 DOI: 10.1177/0267659116645662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether human serum albumin coating before cardiopulmonary bypass (CPB) could improve platelet function and hemostasis and mitigate the inflammatory response among patients receiving aortic arch replacement with deep hypothermic circulatory arrest (DHCA). METHODS Sixty patients were included and randomized into two groups: the Control Group (CG, receiving 40 g human albumin 5 minutes after the initiation of CPB) and the Study Group (SG, circulating the prime with 40 g albumin for 5 minutes before CPB). Rapid thromboelastography, complete blood count, coagulation tests and cytokines (IL-1, IL-6, IL-10, TNF-α and PAF) were measured at two intervals: after anesthesia induction and before CPB (T1) and 10 minutes after heparin reversal before any blood product transfusion (T2). RESULTS Compared with T1, the fibrinogen and MA levels in both groups reduced significantly after heparin reversal and fell within the normal range for most patients. The platelet count reduction (ΔPLT) in the Study Group was significantly less than in the Control Group (p=0.031). Despite the inflammatory factor levels increasing after CPB (p<0.001), no differences were found between the Control Group and the Study Group. Fewer red blood cells were given in the Study Group, but this was not significant (p=0.05). CONCLUSION Most patients receiving aortic arch replacement with DHCA have normal platelet function and fibrinogen levels after heparin reversal. Albumin coating before CPB may mitigate the platelet count reduction, but not platelet dysfunction. There is a trend that the patients treated with albumin coating received less red blood cell transfusions.
Collapse
Affiliation(s)
- Liang Chen
- Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lin Lv
- Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cun Long
- Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Song Lou
- Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and the Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| |
Collapse
|
160
|
Abstract
Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks.
Collapse
Affiliation(s)
- Aryeh Shander
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
| | - Gregg P Lobel
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
| | - Mazyar Javidroozi
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
| |
Collapse
|
161
|
Mayson E, Shand AW, Ford JB. Single‐unit transfusions in the obstetric setting: a qualitative study. Transfusion 2016; 56:1716-22. [DOI: 10.1111/trf.13603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Eleni Mayson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
| | - Antonia W. Shand
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
- Department of ObstetricsRoyal Hospital for WomenSydney Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
| |
Collapse
|
162
|
Maempel JF, Wickramasinghe NR, Clement ND, Brenkel IJ, Walmsley PJ. The pre-operative levels of haemoglobin in the blood can be used to predict the risk of allogenic blood transfusion after total knee arthroplasty. Bone Joint J 2016; 98-B:490-7. [DOI: 10.1302/0301-620x.98b4.36245] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 11/03/2015] [Indexed: 12/22/2022]
Abstract
Aims The pre-operative level of haemoglobin is the strongest predictor of the peri-operative requirement for blood transfusion after total knee arthroplasty (TKA). There are, however, no studies reporting a value that could be considered to be appropriate pre-operatively. This study aimed to identify threshold pre-operative levels of haemoglobin that would predict the requirement for blood transfusion in patients who undergo TKA. Patients and Methods Analysis of receiver operator characteristic (ROC) curves of 2284 consecutive patients undergoing unilateral TKA was used to determine gender specific thresholds predicting peri-operative transfusion with the highest combined sensitivity and specificity (area under ROC curve 0.79 for males; 0.78 for females). Results Threshold levels of 13.75 g/dl for males and 12.75 g/dl for females were identified. The rates of transfusion in males and females, respectively above these levels were 3.37% and 7.11%, while below these levels, they were 16.13% and 28.17%. Pre-operative anaemia increased the rate of transfusion by 6.38 times in males and 6.27 times in females. Blood transfusion was associated with an increased incidence of early post-operative confusion (odds ratio (OR) = 3.44), cardiac arrhythmia (OR = 5.90), urinary catheterisation (OR = 1.60), the incidence of deep infection (OR = 4.03) and mortality (OR = 2.35) one year post-operatively, and increased length of stay (eight days vs six days, p < 0.001). Conclusion Uncorrected low pre-operative levels of haemoglobin put patients at potentially modifiable risk and attempts should be made to correct this before TKA. Target thresholds for the levels of haemoglobin pre-operatively in males and females are proposed. Take home message: Low pre-operative haemoglobin levels put patients at unnecessary risk and should be corrected prior to surgery. Cite this article: Bone Joint J 2016;98-B:490–7.
Collapse
Affiliation(s)
- J. F. Maempel
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Edinburgh EH16 4SA, UK
| | | | - N. D. Clement
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Edinburgh EH16 4SA, UK
| | - I. J. Brenkel
- Victoria Hospital, Hayfield
Road, Kirkcaldy KY2 5AH, UK
| | | |
Collapse
|
163
|
Shander A, Isbister J, Gombotz H. Patient blood management: the global view. Transfusion 2016; 56 Suppl 1:S94-102. [DOI: 10.1111/trf.13529] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
- Department of Anesthesiology, Department of Medicine, Department of Surgery; Mount Sinai School of Medicine; New York New York
| | - James Isbister
- Sydney Medical School, University of Sydney, Northern Clinical School, Royal North Shore Hospital; Sydney NSW Australia
| | - Hans Gombotz
- Department of Anesthesiology and Intensive Care; General Hospital Linz; Linz Austria
| |
Collapse
|
164
|
Klein AA, Collier TJ, Brar MS, Evans C, Hallward G, Fletcher SN, Richards T. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia 2016; 71:627-35. [DOI: 10.1111/anae.13423] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
Affiliation(s)
- A. A. Klein
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - T. J. Collier
- Department of Medical Statistics; London School of Hygiene and Tropical Medicine; London UK
| | - M. S. Brar
- Department of Surgery; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - C. Evans
- Department of Anaesthesia; University Hospital of Wales; Cardiff UK
| | - G. Hallward
- Department of Anaesthesia; Guy's and St Thomas' Hospitals; London UK
| | - S. N. Fletcher
- Department of Anaesthesia and Critical Care; St George's Hospital; London UK
| | - T. Richards
- Division of Surgery and Interventional Science; University College Hospital; London UK
| | | |
Collapse
|
165
|
Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebø LM, Carli F. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 2016; 60:289-334. [PMID: 26514824 PMCID: PMC5061107 DOI: 10.1111/aas.12651] [Citation(s) in RCA: 375] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
Background The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme. Methods Studies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature. Results This consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations. Conclusions Based on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.
Collapse
Affiliation(s)
- A. Feldheiser
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - O. Aziz
- St. Mark's Hospital Harrow Middlesex UK
| | - G. Baldini
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - B. P. B. W. Cox
- Department of Anesthesiology and Pain Therapy University Hospital Maastricht (azM) Maastricht The Netherlands
| | - K. C. H. Fearon
- University of Edinburgh The Royal Infirmary Clinical Surgery Edinburgh UK
| | - L. S. Feldman
- Department of Surgery McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - T. J. Gan
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - R. H. Kennedy
- St. Mark's Hospital/Imperial College Harrow, Middlesex/London UK
| | - O. Ljungqvist
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - D. N. Lobo
- Gastrointestinal Surgery National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit Nottingham University Hospitals and University of Nottingham Queen's Medical Centre Nottingham UK
| | - T. Miller
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - F. F. Radtke
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - T. Ruiz Garces
- Anestesiologa y Reanimacin Hospital Clinico Lozano Blesa Universidad de Zaragoza Zaragoza Spain
| | - T. Schricker
- Department of Anesthesia McGill University Health Centre Royal Victoria Hospital Montreal Quebec Canada
| | - M. J. Scott
- Royal Surrey County Hospital NHS Foundation Trust University of Surrey Surrey UK
| | - J. K. Thacker
- Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - L. M. Ytrebø
- Department of Anaesthesiology University Hospital of North Norway Tromso Norway
| | - F. Carli
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| |
Collapse
|
166
|
Colomina MJ, Guilabert P. [Transfusion according to haemoglobin levels or therapeutic objectives]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:65-68. [PMID: 26626434 DOI: 10.1016/j.redar.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - P Guilabert
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| |
Collapse
|
167
|
Erpicum M, Dardenne N, Hans G, Larbuisson R, Defraigne JO. Prediction of the post-dilution hematocrit during cardiopulmonary bypass. Are new formulas needed? Perfusion 2015; 31:458-64. [PMID: 26685001 DOI: 10.1177/0267659115623357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead to large errors. We aimed to improve the accuracy of these formulas by a better estimation of the dilution volume and the patient circulatory blood volume. METHODS We compared the estimation accuracy of two formulas, using fixed (formula A) versus estimated (formula D) dilution volume and patient circulatory blood volume for 100 cardiac interventions. The difference between predicted and measured HctT1 was considered as "good" if less than 0.5%, "moderate" between 0.5 and 2% and "poor" if higher than 2%. The influence of the body mass index (BMI) on patient blood volume estimation was explored by categorized groups' comparison. RESULTS The mean difference between predicted and measured HctT1 differed significantly between formulas A and D. Formula A didn't differ from HctT1 (p=0.19, IC95% [-0.89-0.18]), but a significant and higher underestimation was observed in the BMI⩽25 group compared to the other BMI groups (p<0.001). Formula D overestimated HctT1 (p<0.001, IC95% [1.01-1.93]) without a difference between the BMI groups. No difference was observed in their overall proportions of good (11 vs 10%), moderate (44 vs 46%) and poor predictions (47 vs 44%) (p=0.117). CONCLUSIONS Formulas used for post-dilution hematocrit prediction lead to major estimation errors and a risk of inadequate transfusion practices. Estimations performed by experienced clinicians could not minimize these biases in all clinical cases as significant errors remain, with potential clinical impact. No estimation formula should be used as a hard tool for transfusing patients, but rather as a guide to predicting the probability of transfusion requirement.
Collapse
Affiliation(s)
- Marie Erpicum
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium
| | - Nadia Dardenne
- Support Unit in Epidemiology and Biostatistics, University of Liege, Liege, Belgium
| | - Grégory Hans
- Department of Anaesthesiology, University Hospital of Liege, Liege, Belgium
| | - Robert Larbuisson
- Department of Anaesthesiology, University Hospital of Liege, Liege, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium
| |
Collapse
|
168
|
Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015; 102:1314-24. [PMID: 26349842 DOI: 10.1002/bjs.9861] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/26/2015] [Accepted: 04/20/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Numerous published studies have explored associations between anaemia and adverse outcomes after surgery. However, there are no evidence syntheses describing the impact of preoperative anaemia on postoperative outcomes. METHODS A systematic review and meta-analysis of observational studies exploring associations between preoperative anaemia and postoperative outcomes was performed. Studies investigating trauma, burns, transplant, paediatric and obstetric populations were excluded. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes were acute kidney injury, stroke and myocardial infarction. Predefined analyses were performed for the cardiac and non-cardiac surgery subgroups. A post hoc analysis was undertaken to evaluate the relationship between anaemia and infection. Data are presented as odds ratios (ORs) with 95 per cent c.i. RESULTS From 8973 records, 24 eligible studies including 949 445 patients were identified. Some 371 594 patients (39·1 per cent) were anaemic. Anaemia was associated with increased mortality (OR 2·90, 2·30 to 3·68; I(2) = 97 per cent; P < 0·001), acute kidney injury (OR 3·75, 2·95 to 4·76; I(2) = 60 per cent; P < 0·001) and infection (OR 1·93, 1·17 to 3·18; I(2) = 99 per cent; P = 0·01). Among cardiac surgical patients, anaemia was associated with stroke (OR 1·28, 1·06 to 1·55; I(2) = 0 per cent; P = 0·009) but not myocardial infarction (OR 1·11, 0·68 to 1·82; I(2) = 13 per cent; P = 0·67). Anaemia was associated with an increased incidence of red cell transfusion (OR 5·04, 4·12 to 6·17; I(2) = 96 per cent; P < 0·001). Similar findings were observed in the cardiac and non-cardiac subgroups. CONCLUSION Preoperative anaemia is associated with poor outcomes after surgery, although heterogeneity between studies was significant. It remains unclear whether anaemia is an independent risk factor for poor outcome or simply a marker of underlying chronic disease. However, red cell transfusion is much more frequent amongst anaemic patients.
Collapse
Affiliation(s)
- A J Fowler
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Ahmad
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M K Phull
- Departments of Anaesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Allard
- Departments of Haematology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R M Pearse
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
169
|
Jericó C, Bretón I, García Ruiz de Gordejuela A, de Oliveira AC, Rubio MÁ, Tinahones FJ, Vidal J, Vilarrasa N. [Diagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery]. ACTA ACUST UNITED AC 2015; 63:32-42. [PMID: 26611153 DOI: 10.1016/j.endonu.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.
Collapse
Affiliation(s)
- Carlos Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Barcelona, España. Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org).
| | - Irene Bretón
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Gregorio Marañón, Madrid, España
| | - Amador García Ruiz de Gordejuela
- Unidad de Cirugía Bariátrica y Metabólica. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Francisco J Tinahones
- Servicio de Endocrinología, Hospital Virgen de la Victoria, Málaga, España; CIBEROBN Instituto de Salud Carlos III, Madrid, España
| | - Josep Vidal
- Unidad de obesidad, Hospital Clínic Universitari, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, España
| | - Nuria Vilarrasa
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Bellvitge-IDIBELL, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
| |
Collapse
|
170
|
Baker JE, Pavenski K, Pirani RA, White A, Kataoka M, Waddell JP, Ho A, Schemitsch EH, Lo N, Bogoch ER, Pronovost A, Luke K, Howell A, Nassis A, Tsui AKY, Tanzini RM, Pulendrarajah R, Mazer CD, Freedman J, Hare GMT. Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation. Can J Anaesth 2015; 62:1179-87. [PMID: 26335903 DOI: 10.1007/s12630-015-0460-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 08/13/2015] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Tranexamic acid (TXA) therapy can reduce red blood cell (RBC) transfusion; however, this therapy remains underutilized in many surgical patient populations. We assessed whether implementation of a protocol to facilitate universal administration of TXA in patients undergoing total hip or knee arthroplasty would reduce the incidence of RBC transfusion without increasing adverse clinical outcomes. METHODS We implemented a quality of care policy to provide universal administration of intravenous TXA at a dose of 20 mg·kg(-1) iv to all eligible patients undergoing total hip or knee arthroplasty from October 21, 2013 to April 30, 2014. We compared data from an equal number of patients before and after protocol implementation (n = 422 per group). The primary outcome was RBC transfusion with secondary outcomes including postoperative hemoglobin concentration (Hb) and length of hospital stay. Adverse events were identified from the electronic medical records. Data were analyzed by a Chi square test and adjusted logistic and linear regression analysis. RESULTS Implementation of the protocol resulted in an increase in TXA utilization from 45.8% to 95.3% [change 49.5%; 95% confidence interval (CI), 44.1 to 54.5; P < 0.001]. This change was associated with a reduction in the rate of RBC transfusion from 8.8% to 5.2%, (change -3.6%; 95% CI, -0.1 to -7.0; P = 0.043). Pre- and post-protocol mean [standard deviation (SD)] Hb values were similar, including the nadir Hb prior to RBC transfusion [72 (8) g·L(-1) vs 70 (8) g·L(-1), respectively; mean difference -1 g·L(-1); 95% CI, -3 to 5; P = 0.569]. Length of stay was not altered, and no increase in adverse events was observed. CONCLUSIONS Implementation of a perioperative TXA protocol was associated with both an increase in TXA use and a reduction in RBC transfusion following hip or knee arthroplasty. Adverse events and length of hospital stay were not influenced by the protocol.
Collapse
Affiliation(s)
- James E Baker
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Katerina Pavenski
- St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada.,Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Razak A Pirani
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Alexander White
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Mark Kataoka
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - James P Waddell
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexander Ho
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nick Lo
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Earl R Bogoch
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Antoine Pronovost
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - Katherine Luke
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Ontario Transfusion Coordinators (ONTraC), Toronto, ON, Canada
| | - Alanna Howell
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Ontario Transfusion Coordinators (ONTraC), Toronto, ON, Canada
| | - Anna Nassis
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Ontario Transfusion Coordinators (ONTraC), Toronto, ON, Canada
| | - Albert K Y Tsui
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Rosa Maria Tanzini
- Department of Pharmacy, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Robisa Pulendrarajah
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - John Freedman
- St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada.,Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Gregory M T Hare
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, ON, Canada. .,Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| |
Collapse
|
171
|
Ferraris VA, Hochstetler M, Martin JT, Mahan A, Saha SP. Blood transfusion and adverse surgical outcomes: The good and the bad. Surgery 2015; 158:608-17. [DOI: 10.1016/j.surg.2015.02.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/15/2015] [Accepted: 02/27/2015] [Indexed: 01/09/2023]
|
172
|
Kim K, Seo H, Chin JH, Son HJ, Hwang JH, Kim YK. Preoperative hypoalbuminemia and anemia as predictors of transfusion in radical nephrectomy for renal cell carcinoma: a retrospective study. BMC Anesthesiol 2015. [PMID: 26194797 PMCID: PMC4509698 DOI: 10.1186/s12871-015-0089-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The only curative therapy for renal cell carcinoma is the complete removal of malignant tissue. Surgical bleeding during radical nephrectomy may require blood transfusion. Blood transfusion, however, is associated with postoperative morbidity and mortality. This study investigated predictive factors of transfusion requirement in patients undergoing radical nephrectomy, as well as the effects of transfusion on postoperative outcomes. Methods This study retrospectively enrolled 526 patients who underwent open radical nephrectomy for renal cell carcinoma between 2010 and 2012. Univariate and multivariate logistic regression analyses were used to determine independent predictive factors of a requirement for packed red blood cell (PRBC) transfusion. Postoperative outcomes included an admission to the intensive care unit (ICU) and lengths of ICU and hospital stay. Results Of the 526 patients, 93 (17.7 %) required PRBC transfusion, with these patients requiring a mean 5.5 units. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) was observed in 75 (14.3 %) patients, and preoperative anemia (hemoglobin <12.0 g/dL) in 121 (23.0 %). Multivariate logistic regression analysis showed that preoperative hypoalbuminemia, preoperative anemia, and a high cancer stage were independent factors significantly associated with PRBC transfusion in open radical nephrectomy. The transfused group had higher incidence of ICU admission and longer lengths of ICU and hospital stay than the non-transfused group. Conclusions Preoperative hypoalbuminemia and anemia are important predictors of PRBC transfusion during radical nephrectomy for renal cell carcinoma. Furthermore, transfusion is associated with poor postoperative outcomes.
Collapse
Affiliation(s)
- Kyungmi Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Hyo-Jung Son
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Jai-Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| |
Collapse
|
173
|
Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S, Shander A, Richards T, Pavía J, Kehlet H, Acheson A, Evans C, Raobaikady R, Javidroozi M, Auerbach M. ‘Fit to fly’: overcoming barriers to preoperative haemoglobin optimization in surgical patients †. Br J Anaesth 2015; 115:15-24. [DOI: 10.1093/bja/aev165] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
174
|
Lako S, Dedej T, Nurka T, Ostreni V, Demiraj A, Xhaxho R, Prifti E. Hematological Changes in Patients Undergoing Coronary Artery Bypass Surgery: a Prospective Study. Med Arch 2015; 69:181-6. [PMID: 26261388 PMCID: PMC4500299 DOI: 10.5455/medarh.2015.69.181-186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/24/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives: Removal of pro inflammatory stimuli after CABG, wound closure and the regenerative ability of the bone marrow will ensure a gradual recovery of hematological parameters. The aim of this study was to assess the hematological changes after CABG. Materials and Methods: A prospective cohort study included 164 consecutive patients undergoing on pump CABG surgery between January 2012 and January 2013. Patients with primary hematologic disease, emergent or urgent CABG and off-pump CABG were not included. A time line protocol was employed. Results: All patients survived surgery. Average values of erythrocytes, hemoglobin and hematocrit declined, to reach lower values on day 3 after surgery (-33.6 %, -33.1 %, -32.6 % versus preoperative value, p<0.001) and then gradually increased to reach normal values after one month and the preoperative values after three months. The average values of leukocytes and neutrophils increased rapidly to achieve the highest value on day 2, while the average value of lymphocytes decreased quickly to achieve lower value on day 1 after surgery (+74.7 %, +127.1 %, -52.4 % respectively from the preoperative value, p<0.001). The average platelet count decreased to the lowest value on day 2 after surgery (-26.4 % from the preoperative value, p<0.001), after which gradually increased up to +100.8 % of preoperative value on day 14 (p<0.001) and then gradually decreased to reach normal values on day 21 and preoperative values after three months. Conclusions: Average values of the three peripheral blood cells parameters undergo important changes after CABG, but not life threatening, and regain normal and preoperative values after 1-3 months after surgery.
Collapse
Affiliation(s)
- Sotir Lako
- Department of Internal Medicine, American Hospital, Tirana, Albania
| | - Teuta Dedej
- Division of Hematology and Laboratory Medicine, University Hospital Center of Tirana, Albania
| | - Tatjana Nurka
- Division of Hematology and Laboratory Medicine, University Hospital Center of Tirana, Albania
| | - Vera Ostreni
- Division of Hematology and Laboratory Medicine, University Hospital Center of Tirana, Albania
| | - Aurel Demiraj
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Roland Xhaxho
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| |
Collapse
|
175
|
Prevention of Bleeding in Orthognathic Surgery--A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Oral Maxillofac Surg 2015; 74:139-50. [PMID: 26073131 DOI: 10.1016/j.joms.2015.05.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of the present study was to evaluate the efficacy of hemostatic adjuncts on intraoperative blood loss (IOB) in orthognathic surgery (OS) detected by randomized controlled trials (RCTs) of the highest quality. MATERIALS AND METHODS A search of the Medline, Cochrane, Embase, and Web of Science databases was performed in January 2015, and the risk of bias was assessed using the Jadad and Delphi scales. The predictor variable was the hemostatic measures, and the main outcome variable was the total IOB volume. The secondary outcome variables were the hemoglobin and hematocrit and operating time. This review is registered at PROSPERO (CRD42014014840). RESULTS Eleven trials were included for review. The individual trials demonstrated the effects on IOB from hypotensive anesthetic regimens, the use of aprotinin, and the herbal medicine Yunnan Baiyao. Six studies of tranexamic acid (TXA), with 288 patients, were suitable for a meta-analysis of continuous data. TXA reduced IOB by an average of 171 mL (95% confidence interval [CI] -230 to -112; P < .00001). Its topical use yielded similarly significant results (mean difference -197, 95% CI -319 to -76; P < .001). A subgroup analysis showed a decreased operating time in the TXA groups by an average of 15 minutes (mean difference -14.78, 95% CI -22.21 to -7.35; P < .0001). CONCLUSIONS Efficient hemostatic adjuncts exist for OS. Our meta-analysis showed that TXA significantly reduces IOB by an average of one third, regardless of whether it was given intravenously (IV) or applied topically. Additional RCTs are needed to confirm the effect of topical TXA in OS, and larger studies of intravenous administration are needed before any routine recommendations. No hemostatic effect of hypotensive anesthesia was found, mainly owing to imprecise descriptions of the blinding procedures. Transparent and uniform trial reporting is thus encouraged in future studies.
Collapse
|
176
|
Jørgensen CC, Jans Ø, Kehlet H. Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty. Vox Sang 2015; 109:62-70. [PMID: 25975629 DOI: 10.1111/vox.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/04/2015] [Accepted: 01/10/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. STUDY DESIGN AND METHODS A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. RESULTS Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). CONCLUSION Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation.
Collapse
Affiliation(s)
- C C Jørgensen
- Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.,The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark
| | - Ø Jans
- Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.,The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark
| | - H Kehlet
- The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark
| | | |
Collapse
|
177
|
Grant S, Hickey G, Wisely N, Carlson E, Hartley R, Pichel A, Atkinson D, McCollum C. Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair †. Br J Anaesth 2015; 114:430-6. [DOI: 10.1093/bja/aeu383] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
178
|
Oge T, Kilic CH, Kilic GS. Economic impact of blood transfusions: balancing cost and benefits. Eurasian J Med 2015; 46:47-9. [PMID: 25610294 DOI: 10.5152/eajm.2014.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/17/2013] [Indexed: 12/31/2022] Open
Abstract
Blood transfusions may be lifesaving, but they inherit their own risks. Risk of transfusion to benefit is a delicate balance. In addition, blood product transfusions purchases are one of the largest line items among the hospital and laboratory charges. In this review, we aimed to discuss the transfusion strategies and share our transfusion protocol as well as the steps for hospitals to build-up a blood management program while all these factors weight in. Moreover, we evaluate the financial burden to the health care system.
Collapse
Affiliation(s)
- Tufan Oge
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA ; Department of Obstetrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gokhan Sami Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
| |
Collapse
|
179
|
Boral LI, Bernard A, Hjorth T, Davenport D, Zhang D, MacIvor DC. How do I implement a more restrictive transfusion trigger of hemoglobin level of 7 g/dL at my hospital? Transfusion 2015; 55:937-45. [DOI: 10.1111/trf.12982] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Leonard I. Boral
- Department of Pathology and Laboratory Medicine; UK College of Medicine; Lexington Kentucky
| | - Andrew Bernard
- Department of Surgery; UK College of Medicine; Lexington Kentucky
| | - Todd Hjorth
- Finance Department; UK Healthcare; University of Kentucky; Lexington Kentucky
| | - Daniel Davenport
- Department of Surgery; UK College of Medicine; Lexington Kentucky
| | - Daoping Zhang
- Department of Pathology and Laboratory Medicine; UK College of Medicine; Lexington Kentucky
| | - Duncan C. MacIvor
- Department of Pathology and Laboratory Medicine; UK College of Medicine; Lexington Kentucky
| |
Collapse
|
180
|
Szelkowski LA, Puri NK, Singh R, Massimiano PS. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg 2015; 52:531-69. [DOI: 10.1067/j.cpsurg.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
181
|
Timler D, Klepaczka J, Kasielska-Trojan A, Bogusiak K. Analysis of complications after blood components’ transfusions. POLISH JOURNAL OF SURGERY 2015; 87:166-73. [DOI: 10.1515/pjs-2015-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 11/15/2022]
Abstract
AbstractComplications after blood components still constitute an important clinical problem and serve as limitation of liberal-transfusion strategy.The aim of the study was to present the 5-year incidence of early blood transfusions complications and to assess their relation to the type of the transfused blood components.Material and methods. 58,505 transfusions of blood components performed in the years 2006-2010 were retrospectively analyzed. Data concerning the amount of the transfused blood components and the numbers of adverse transfusion reactions reported to the Regional Blood Donation and Treatment Center (RBDTC) was collected.Results. 95 adverse transfusion reactions were reportedto RBDTC 0.16% of alldonations (95/58 505) - 58 after PRBC transfusions, 28 after platelet concentrate transfusions and 9 after FFP transfusion. Febrile nonhemolytic and allergic reactions constitute respectively 36.8% and 30.5% of all complications.Conclusion. Nonhemolyticand allergic reactions are the most common complications of blood components transfusion and they are more common after platelet concentrate transfusions in comparison to PRBC and FFP donations.
Collapse
|
182
|
Iyer SS, Shah J. Red blood cell transfusion strategies and Maximum surgical blood ordering schedule. Indian J Anaesth 2014; 58:581-9. [PMID: 25535420 PMCID: PMC4260304 DOI: 10.4103/0019-5049.144660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Blood transfusion is one of the practices that is in vogue because it expands blood volume and purportedly improves the oxygen carrying capacity. Despite this supposed physiological benefit, paradoxically, both anaemia and transfusion are independently associated with organ injury and increased morbidity. Historically, transfusion was used to maintain blood haemoglobin concentration above 10 g/dL and a haematocrit above 30%. There is now a greater emphasis on interventions to reduce the use of transfusion as it is a scarce and expensive resource with many serious adverse effects. Institutional maximum surgical blood ordering schedule algorithm developed with data analysis and consensus of surgeons, anaesthesiologists and blood banks can reduce the overuse of blood. A PubMed search was performed with search words/combination of words 'erythrocyte transfusion, adverse effects, economics, mortality, therapy, therapeutic use and utilisation'. Search yielded a total of 1541 articles that were screened for clinical relevance for the purpose of this review.
Collapse
Affiliation(s)
- Shivakumar S Iyer
- Department of Critical Care, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
| |
Collapse
|
183
|
Affiliation(s)
- Jv Divatia
- Section Editor (Critical Care), IJA, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. E-mail:
| |
Collapse
|
184
|
Joubert J, Joubert S, Raubenheimer J, Louw V. The long-term effects of training interventions on transfusion practice: A follow-up audit of red cell concentrate utilisation at Kimberley Hospital, South Africa. Transfus Apher Sci 2014; 51:25-32. [DOI: 10.1016/j.transci.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
185
|
De Backer O, Arnous S, Lønborg J, Brooks M, Biasco L, Jönsson A, Franzen OW, Søndergaard L. Recovery from anemia in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation--prevalence, predictors and clinical outcome. PLoS One 2014; 9:e114038. [PMID: 25437191 PMCID: PMC4250195 DOI: 10.1371/journal.pone.0114038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/03/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome – including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI on baseline anemia. Methods A total of 253 patients who survived at least 1 year following TAVI were included in this study. The prevalence, predictors and clinical outcome of hemoglobin (Hb)-recovery were assessed. Results The prevalence of baseline anemia was 49% (n = 124) – recovery from anemia occurred in 40% of the anemic patients (n = 49) at 1 year after TAVI with an increase in mean Hb-level of 1.35 g/dL from baseline. This increase was not related to an improvement in renal function. At multivariate analysis, a high peak gradient (OR 4.82, P = 0.003) was shown to be an independent predictor for Hb-recovery, while blood transfusion (OR 0.31, P = 0.038) and chronic kidney disease (CKD, OR 0.33, P = 0.043) were identified as negative predictors at, respectively, one and two years after TAVI. When compared to patients without baseline anemia, those anemic patients with Hb-recovery had a similar functional improvement (OR 0.98, P = 0.975), whereas those without Hb-recovery had a significantly lower likelihood of functional improvement with ≧2 NYHA classes (OR 0.49, P = 0.034) and a higher likelihood of re-hospitalization within the first year after TAVI (OR 1.91, P = 0.024). Conclusion Recovery from anemia occurs in 40% of anemic patients at 1 year after TAVI – mainly in those with a high gradient and without CKD. Blood transfusion was found to have a transient adverse effect on this Hb-recovery. Finally, anemic patients without Hb-recovery experience less functional improvement and have a higher re-hospitalization rate within the first year after TAVI.
Collapse
Affiliation(s)
- Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
- * E-mail:
| | - Samer Arnous
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Matthew Brooks
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Luigi Biasco
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Anders Jönsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Olaf W. Franzen
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Sjælland, Denmark
| |
Collapse
|
186
|
Shah A, Stanworth SJ, McKechnie S. Evidence and triggers for the transfusion of blood and blood products. Anaesthesia 2014; 70 Suppl 1:10-9, e3-5. [DOI: 10.1111/anae.12893] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 01/28/2023]
Affiliation(s)
- A. Shah
- Adult Intensive Care Unit; John Radcliffe Hospital; Oxford UK
| | - S. J. Stanworth
- Department of Haematology; John Radcliffe Hospital; Oxford UK
| | - S. McKechnie
- Department of Anaesthesia and Intensive Care; John Radcliffe Hospital; Oxford UK
| |
Collapse
|
187
|
Replacing the Transfusion of 1-2 Units of Blood with Plasma Expanders that Increase Oxygen Delivery Capacity: Evidence from Experimental Studies. J Funct Biomater 2014; 5:232-45. [PMID: 25350267 PMCID: PMC4285404 DOI: 10.3390/jfb5040232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/17/2014] [Accepted: 10/15/2014] [Indexed: 12/14/2022] Open
Abstract
At least a third of the blood supply in the world is used to transfuse 1–2 units of packed red blood cells for each intervention and most clinical trials of blood substitutes have been carried out at this level of oxygen carrying capacity (OCC) restoration. However, the increase of oxygenation achieved is marginal or none at all for molecular hemoglobin (Hb) products, due to their lingering vasoactivity. This has provided the impetus for the development of “oxygen therapeutics” using Hb-based molecules that have high oxygen affinity and target delivery of oxygen to anoxic areas. However it is still unclear how these oxygen carriers counteract or mitigate the functional effects of anemia due to obstruction, vasoconstriction and under-perfusion. Indeed, they are administered as a low dosage/low volume therapeutic Hb (subsequently further diluted in the circulatory pool) and hence induce extremely small OCC changes. Hyperviscous plasma expanders provide an alternative to oxygen therapeutics by increasing the oxygen delivery capacity (ODC); in anemia they induce supra-perfusion and increase tissue perfusion (flow) by as much as 50%. Polyethylene glycol conjugate albumin (PEG-Alb) accomplishes this by enhancing the shear thinning behavior of diluted blood, which increases microvascular endothelial shear stress, causes vasodilation and lowering peripheral vascular resistance thus facilitating cardiac function. Induction of supra-perfusion takes advantage of the fact that ODC is the product of OCC and blood flow and hence can be maintained by increasing either or both. Animal studies suggest that this approach may save a considerable fraction of the blood supply. It has an additional benefit of enhancing tissue clearance of toxic metabolites.
Collapse
|
188
|
Butler C, Tay J, Doree C, Brunskill SJ, Trivella M, Fergusson DA, Tinmouth A, Murphy MF. Restrictive versus liberal red blood cell transfusion strategies for patients with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
189
|
Salisbury AC, Reid KJ, Marso SP, Amin AP, Alexander KP, Wang TY, Spertus JA, Kosiborod M. Blood Transfusion During Acute Myocardial Infarction. J Am Coll Cardiol 2014; 64:811-9. [DOI: 10.1016/j.jacc.2014.05.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 01/20/2023]
|
190
|
Clevenger B, Mallett SV. Preoperative assessment of coagulation and bleeding risk. Br J Hosp Med (Lond) 2014; 75 Suppl 5:C71-4. [PMID: 25075413 DOI: 10.12968/hmed.2014.75.sup5.c71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
191
|
Muñoz M, Gómez-Ramírez S, Liumbruno GM, Grazzini G. Intravenous iron and safety: is the end of the debate on the horizon? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:287-9. [PMID: 25074522 PMCID: PMC4111804 DOI: 10.2450/2014.0144-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Manuel Muñoz
- Transfusion Medicine, University of Málaga, Málaga, Spain
| | | | | | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| |
Collapse
|
192
|
Shander A, Goodnough LT, Javidroozi M, Auerbach M, Carson J, Ershler WB, Ghiglione M, Glaspy J, Lew I. Iron Deficiency Anemia—Bridging the Knowledge and Practice Gap. Transfus Med Rev 2014; 28:156-66. [DOI: 10.1016/j.tmrv.2014.05.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/24/2014] [Accepted: 05/09/2014] [Indexed: 12/18/2022]
|
193
|
Choi DK, Kim WJ, Chin JH, Lee EH, Don Hahm K, Yeon Sim J, Cheol Choi I. Intraoperative Renal Regional Oxygen Desaturation Can Be a Predictor for Acute Kidney Injury after Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:564-71. [DOI: 10.1053/j.jvca.2013.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Indexed: 01/09/2023]
|
194
|
|
195
|
Gombotz H, Rehak PH, Shander A, Hofmann A. The second Austrian benchmark study for blood use in elective surgery: results and practice change. Transfusion 2014; 54:2646-57. [DOI: 10.1111/trf.12687] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Hans Gombotz
- Department of Anesthesiology and Intensive Care; General Hospital Linz; Linz Austria
| | - Peter H. Rehak
- Department of Surgery; Medical University of Graz; Graz Austria
| | - Aryeh Shander
- Mount Sinai School of Medicine; New York New York
- Department of Anesthesiology and Critical Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Axel Hofmann
- School of Surgery; Faculty of Medicine Dentistry and Health Sciences; University of Western Australia; Perth Australia
- Centre for Population Health Research; Curtin Health Innovation Research Institute; Curtin University; Perth Australia
- Institute of Anaesthesiology; University Hospital and University of Zurich; Zurich Switzerland
| |
Collapse
|
196
|
Hogervorst E, Rosseel P, van der Bom J, Bentala M, Brand A, van der Meer N, van de Watering L. Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion 2014; 54:2696-704. [DOI: 10.1111/trf.12654] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Esther Hogervorst
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
| | | | - Johanna van der Bom
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden the Netherlands
| | | | - Anneke Brand
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
| | | | - Leo van de Watering
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
| |
Collapse
|
197
|
Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks. Anesthesiology 2014; 120:551-63. [PMID: 24534855 DOI: 10.1097/aln.0000000000000120] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Much controversy remains on the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. The aim of the study is to characterize cases of IFs, identify risk factors, and study the role of PNB and anesthesia technique in IF risk in total knee arthroplasty patients. METHODS The authors selected total knee arthroplasty patients from the national Premier Perspective database (Premier Inc., Charlotte, NC; 2006-2010; n = 191,570, >400 acute care hospitals). The primary outcome was IF. Patient- and healthcare system-related characteristics, anesthesia technique, and presence of PNB were determined for IF and non-IF patients. Independent risk factors for IFs were determined by using conventional and multilevel logistic regression. RESULTS Overall, IF incidence was 1.6% (n = 3,042). Distribution of anesthesia technique was 10.9% neuraxial, 12.9% combined neuraxial/general, and 76.2% general anesthesia. PNB was used in 12.1%. Patients suffering IFs were older (average age, 68.9 vs. 66.3 yr), had higher comorbidity burden (average Deyo index, 0.77 vs. 0.66), and had more major complications, including 30-day mortality (0.8 vs. 0.1%; all P < 0.001). Use of neuraxial anesthesia (IF incidence, 1.3%; n = 280) had lower adjusted odds of IF compared with adjusted odds of IF with the use of general anesthesia alone (IF incidence, 1.6%; n = 2,393): odds ratio, 0.70 (95% CI, 0.56-0.87). PNB was not significantly associated with IF (odds ratio, 0.85 [CI, 0.71-1.03]). CONCLUSIONS This study identifies several risk factors for IF in total knee arthroplasty patients. Contrary to common concerns, no association was found between PNB and IF. Further studies should determine the role of anesthesia practices in the context of fall-prevention programs.
Collapse
|
198
|
Shander A. The obligation to stop hemorrhage is a basic tenet of care for any clinician. Introduction. J Cardiothorac Vasc Anesth 2014; 27:S1-2. [PMID: 23910531 DOI: 10.1053/j.jvca.2013.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aryeh Shander
- Anesthesia and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| |
Collapse
|
199
|
Shander A, Javidroozi M, Naqvi S, Aregbeyen O, Çaylan M, Demir S, Juhl A. An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME). Transfusion 2014; 54:2688-95; quiz 2687. [DOI: 10.1111/trf.12565] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/25/2013] [Accepted: 12/07/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Aryeh Shander
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Mazyar Javidroozi
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Sajjad Naqvi
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Oshuare Aregbeyen
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Mustafa Çaylan
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Selma Demir
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Anna Juhl
- Departments of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| |
Collapse
|
200
|
Gombotz H, Hofmann A. [Patient Blood Management : three pillar strategy to improve outcome through avoidance of allogeneic blood products]. Anaesthesist 2014; 62:519-27. [PMID: 23836145 DOI: 10.1007/s00101-013-2199-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Blood transfusions are commonly viewed as life-saving interventions; however, current evidence shows that blood transfusions are associated with a significant increase of morbidity and mortality in a dose-dependent relationship. Not only explanatory models of basic research but also the results from randomized controlled trials suggest a causal relationship between blood transfusion and adverse outcome. Therefore, it can be claimed that the current state of science debunks the long held belief in the so-called life-saving blood transfusion by exposing the potential for promoting disease and death. Adherence to the precautionary principle and also the fact that blood transfusions are more costly than previously assumed require novel approaches in the treatment of anemia and bleeding. Patient Blood Management (PBM) allows transfusion rates to be dramatically reduced through correcting anemia by stimulating erythropoiesis, minimization of perioperative blood loss and harnessing and optimizing the physiological tolerance of anemia. A resolution of the World Health Assembly has endorsed PBM and therefore morbidity and mortality should be significantly reduced by lowering of the currently high blood utilization rate of allogeneic blood products in Austria, Germany and Switzerland.
Collapse
Affiliation(s)
- H Gombotz
- Abteilung für Anästhesiologie und Intensivmedizin, Allgemeines Krankenhaus der Stadt Linz, Krankenhausstr. 9, 4020, Linz, Österreich.
| | | |
Collapse
|