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Pang L, Zheng Z, Su P, Xu Z, Chen Y, Liao Z, Jia P, Zhang X, Lv C. Mendelian randomization of stroke risk after total hip and knee replacements. Front Genet 2024; 15:1435124. [PMID: 39055256 PMCID: PMC11270026 DOI: 10.3389/fgene.2024.1435124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objective Previous epidemiological studies have indicated an increased risk of neurovascular diseases in patients following total hip and knee replacements. However, definitive conclusions regarding the increased risk of stroke post-replacement remain elusive. Therefore, we conducted a two-sample Mendelian randomization study to investigate the causal relationship between total hip and knee replacements and stroke. Methods We utilized summary data from publicly available genome-wide association studies (GWAS). Data concerning total hip replacements (THR, N = 319,037) and total knee replacements (TKR, N = 252,041) were sourced from the Genetics of Osteoarthritis (GO) Consortium. Stroke-related data were obtained from the International Stroke Genetics Consortium, encompassing any stroke (AS), any ischemic stroke (AIS), large vessel ischemic stroke (LV-IS), cardioembolic ischemic stroke (CE-IS), and small vessel ischemic stroke (SV-IS). Our primary causal inference method was the inverse variance weighted (IVW) approach, supplemented by weighted median and MR-Egger regression as secondary inference methods. We utilized the MR-PRESSO global test for outlier detection, Cochran's Q statistic to assess heterogeneity, and assessed the multiplicity and stability of our findings using p-values from MR-PRESSO and MR-Egger regressions, and the leave-one-out method, respectively. Results We identified significant genetic associations between THR and both AS (IVW p = 0.0001, OR = 1.08, 95% CI = 1.04-1.12) and AIS (IVW p = 0.0016, OR = 1.07, 95% CI = 1.03-1.12). Significant associations were also observed between TKR and AS (IVW p = 0.0002, OR = 1.08, 95% CI = 1.04-1.12), as well as AIS (IVW p = 0.0005, OR = 1.15, 95% CI = 1.06-1.24). Conclusion Our findings genetically support an increased risk of stroke following total hip and knee replacements. However, further studies are necessary to elucidate the specific mechanisms underlying stroke episodes post-replacement.
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Affiliation(s)
- Liang Pang
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Zhihui Zheng
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Pingping Su
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Zhouhengte Xu
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Yirui Chen
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Zhicheng Liao
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Pengcheng Jia
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Xiuling Zhang
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, China
| | - Cunxian Lv
- Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
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Lele AV, Moreton EO, Sundararajan J, Blacker SN. Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis. Curr Opin Anaesthesiol 2024:00001503-990000000-00203. [PMID: 39011660 DOI: 10.1097/aco.0000000000001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting. RECENT FINDINGS Patients with nonneurological, noncardiac, and nonvascular surgery within three months after stroke have a 153-fold risk, those within 6 months have a 50-fold risk, and those within 12 months have a 20-fold risk of postoperative stroke. There is a 12-fold risk of in-hospital mortality within three months and a three-to-four-fold risk of mortality for more than 12 months after stroke. The risk of stroke and mortality continues to persist years after stroke. Recurrent stroke is common in patients in whom anticoagulation/antiplatelet therapy is discontinued. Stroke and time elapsed after stroke should be included in the preoperative assessment questionnaire, and a stroke-specific risk assessment should be performed before surgical planning is pursued. SUMMARY In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.
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Affiliation(s)
- Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington
| | | | | | - Samuel Neal Blacker
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Wunderlich F, Schröder M, Appelmann P, Wegner E, Goldhofer M, Klonschinski T, Betz U, Drees P, Eckhard L. Simultaneous bilateral TKA in the context of fast track surgery - Do patients meet discharge criteria as anticipated? J Orthop Sci 2024; 29:861-866. [PMID: 37121790 DOI: 10.1016/j.jos.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The efficacy and safety of enhanced recovery after surgery (ERAS) protocols for patients undergoing total knee arthroplasty (TKA) have been generally proven. Previous studies investigating patients undergoing simultaneous bilateral TKA (SBTKA) focused on complications, mortality, and pain and did not examine patients' functional limitations. Therefore, the aim of this study was to investigate to what extent patients undergoing SBTKA are able to meet functional discharge criteria originally designed for their counterparts undergoing unilateral TKA (UTKA) in an ERAS setting. MATERIALS AND METHODS All patients who received primary SBTKA between June 2015 and December 2018 were included in this retrospective analysis. For comparison, UTKA patients were matched 1:1 to SBTKA patients using Propensity Score Matching based on age, gender, and BMI. The times to achieving the rehabilitation checkpoints of walking 150 m, walking a flight of stairs, and 90° knee flexion were evaluated. RESULTS 63 (SBTKA group) and 64 (UTKA group) patients were included. Due to the Propensity-Score-Matching there were no differences regarding age, gender, and BMI. The mean length of stay (LOS) was 9.1 days in the SBTKA and 7.6 days in the UTKA group (p = 0.003). On average, it took SBTKA patients 5.4 days to achieve an uninterrupted walking distance of at least 150 m, while it took UTKA patients 4.1 days (p < 0.001). Mean time to walking a flight of stairs was 6.3 days for SBTKA patients and 4.7 days for UTKA patients (p < 0.001). 90° flexion was achieved after 4.1 days by SBTKA patients and 3.5 days by UTKA patients (p = 0.241). CONCLUSION The vast majority of SBTKA patients were able to achieve functional discharge criteria within their inpatient stay when allowed about 30% extra time. Therefore, functional discharge criteria in ERAS protocols designed for UTKA can be considered appropriate for SBTKA patients. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Markus Schröder
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; Department of General and Visceral Surgery, St. Josef Hospital, Beethovenstr. 20, 65189 Wiesbaden, Germany.
| | - Philipp Appelmann
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; GALENOS Mainz, Helix Medical Excellence Center, Haifa-Allee 24, 55128 Mainz, Germany.
| | - Erik Wegner
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Markus Goldhofer
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; Department of Trauma and Orthopaedic Surgery, Hunsrück Hospital Kreuznacher Diakonie, Holzbacher Str. 1, 55469 Simmern/Hunsrück, Germany.
| | - Thomas Klonschinski
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Lukas Eckhard
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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An X, Zhang Y, Li Z, Song Y, Chen J. Blood Pressure Fluctuation Pattern Associated with 90-Day Ischemic Stroke and Transient Ischemic Attack After Total Knee Arthroplasty-A Retrospective Study. Orthop Surg 2024; 16:383-390. [PMID: 38114302 PMCID: PMC10834200 DOI: 10.1111/os.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE Blood pressure (BP) fluctuation has been demonstrated to be closely associated with stroke. However, at present, no attention is paid to the BP fluctuation following total knee arthroplasty (TKA). The aim of this study is to investigate what is BP fluctuation patterns in stroke and transient ischemic attack (TIA) patients after primary TKA, compare clinical characteristics among different BP fluctuation patterns and determine whether it could predict the occurrence of a 90-day stroke. METHODS A retrospective study was conducted from February 1, 2011 to February 15, 2021. Stroke or TIA patients within 90 days after TKA were included. Data from a hospitalization management system were analyzed, including demographics, smoking status, comorbidities, medications, surgical variables, and 90-day stroke, mortality, and readmission rates. BP fluctuation patterns were defined based on the average BP in the first 3 days after TKA. A logistic regression analysis model was used to identify risk factors for 90-day stroke or TIA following TKA. RESULTS Of the 1687 patients who underwent primary TKA, 4.0% (68/1687) experienced a 90-day stroke or TIA. A total of 63 patients met the inclusion criteria, with an average age of 67.5 years and 55.6% (35/63) female. The number of stroke or TIA patients in each BP fluctuation pattern (T1-T5) was 6 (9.5%), 5 (7.9%), 4 (6.3%), 13 (20.6%), and 35 (55.6%) respectively. Patients with a T5 pattern tended to be older and had a greater reduction in average systolic blood pressure (SBP) 3 days after surgery compared to other patterns. The T5 pattern was associated with a higher occurrence of stroke and a lower occurrence of TIA. Patients with a T5 pattern also had a longer length of stay within 90 days following TKA. After adjusting for confounding factors, average SBP fluctuation ≥40 mmHg and the T5 pattern of BP fluctuation remained risk factors for 90-day stroke or TIA after TKA. CONCLUSION BP fluctuation patterns in the early postoperative period are associated with 90-day stroke and TIA following primary TKA.
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Affiliation(s)
- Xiao An
- PLA General Hospital, Medical College of Chinese PLABeijingChina
- Department of OrthopaedicsHainan Hospital of Chinese PLA General HospitalSanyaHainanChina
| | - Yan Zhang
- Quality Management DepartmentPLA Rocket Force Characteristic Medical CenterBeijingChina
| | - Zhirui Li
- Department of OrthopaedicsHainan Hospital of Chinese PLA General HospitalSanyaHainanChina
| | - Yuxiang Song
- Department of AnesthesiologyThe First Medical Center of Chinese People's Liberation Army (PLA) General HospitalBeijingChina
| | - Jiying Chen
- PLA General Hospital, Medical College of Chinese PLABeijingChina
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Ko K, Kim KH, Ko S, Jo C, Han HS, Lee MC, Ro DH. Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea. Clin Orthop Surg 2023; 15:935-941. [PMID: 38045584 PMCID: PMC10689220 DOI: 10.4055/cios22088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/13/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2023] Open
Abstract
Background Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report mortality trends for major causes of death. Methods A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA. Results The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death. Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3-5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5-3.5) than that in the general population. Conclusions The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.
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Affiliation(s)
- Kyunga Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kee Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sunho Ko
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Changwung Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Mendez E, Puig G, Barquero M, Leon A, Bellafont J, Colomina MJ. Enhanced recovery after surgery: a narrative review on patient blood management recommendations. Minerva Anestesiol 2023; 89:906-913. [PMID: 37307032 DOI: 10.23736/s0375-9393.23.17389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This review aims to analyze and document the presence of patient blood management (PBM) recommendations in enhanced recovery after surgery (ERAS) guidelines. The aim of ERAS programs is to improve outcomes and optimize patient recovery by reducing the stress response to surgery. PBM programs pursue the objective of improving outcomes by boosting and conserving the patient's own blood. From the early development of ERAS, there was little attention paid to the three pillars of perioperative blood management. Preoperative anemia is an important risk factor in perioperative outcomes and should be diagnosed and treated. Bleeding and unnecessary transfusions should be avoided. We analyzed clinical guidelines for scheduled surgery in adults published by the ERAS Society between 2018 and 2022. The guidelines selected were searched for recommendations related to the three pillars of PBM. We selected 15 ERAS guidelines in programmed surgery in adults. Until 2018, none of the ERAS guidelines analyzed included any recommendations related to pillars I and III of PBM. In 2019, recommendations related to the three pillars of PBM were introduced in the ERAS clinical guidelines for colorectal surgery, gynecology/oncology surgery, and lung resection surgery. However, many ERAS guidelines for surgeries with a high risk of bleeding, such as cardiac surgery, contain no clear recommendations on the management of preoperative anemia. This review shows that the ERAS guidelines published to date make very few recommendations related to PBM. The authors emphasize the need to include the most efficient PBM recommendations in ERAS clinical guidelines, given improved outcomes with a good perioperative management of blood transfusion.
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Affiliation(s)
- Esther Mendez
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain -
| | - Guillermo Puig
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Marta Barquero
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Ariadna Leon
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Javier Bellafont
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
- Department of Anesthesiology and Intensive Care, University of Barcelona, Barcelona, Spain
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Yan X, Yan LR, Ma ZG, Jiang M, Gao Y, Pang Y, Wang WW, Qin ZH, Han YT, You XF, Ruan W, Wang Q. Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery. World J Clin Cases 2023; 11:5430-5439. [PMID: 37637679 PMCID: PMC10450377 DOI: 10.12998/wjcc.v11.i23.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication. AIM To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. METHODS A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. RESULTS A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Li-Rong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhi-Gang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang Gao
- Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei-Wei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhao-Hui Qin
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang-Tong Han
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Xiao-Fan You
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei Ruan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Qian Wang
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
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Wadhwa H, Chen MJ, Tigchelaar SS, Bellino MJ, Bishop JA, Gardner MJ. Hypotensive Anesthesia does not reduce Transfusion Rates during and after Acetabular Fracture Surgery. Injury 2021; 52:1783-1787. [PMID: 33832703 DOI: 10.1016/j.injury.2021.03.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/01/2021] [Accepted: 03/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acetabular fracture open reduction and internal fixation (ORIF) is generally associated with high intraoperative blood loss. Hypotensive anesthesia has been shown to decrease blood loss and intraoperative transfusion in total joint arthroplasty and posterior spinal fusion. In this study, we assessed the effect of reduction in intraoperative mean arterial pressures (MAPs) during acetabular fracture surgery on intraoperative blood loss and need for transfusion. METHODS Three hundred and one patients with acetabular fractures who underwent ORIF at an academic Level 1 trauma center were retrospectively reviewed. Patients were separated based on mean intraoperative MAPs (<60 mmHg, 60-70 mmHg, >70 mmHg). Thirteen patients had mean intraoperative MAP <60 mmHg, 95 had MAP 60-70 mmHg, and 193 had MAP >70 mmHg. Rates of intraoperative and postoperative allogeneic blood transfusion were compared. RESULTS Mean intraoperative MAPs were significantly different between groups (p < 0.0001). Time from injury to surgery, estimated blood loss, operative time and intraoperative IV fluids were comparable. The proportion of patients who received blood transfusion and mean units transfused intraoperatively and postoperatively were similar between groups. Mean differences in preoperative and postoperative hemoglobin and hematocrit were also similar. There was no difference in hospital length of stay or perioperative complications between the groups. Multivariate logistic regression analysis demonstrated that body mass index > 30 (p < 0.05) and anterior surgical approach (p < 0.01) were independently associated with intraoperative transfusion and an anterior surgical approach (p < 0.001) was independently associated with postoperative transfusion. CONCLUSION Decreased intraoperative MAP during acetabular fracture surgery does not reduce blood loss or need for transfusion. On the other hand, no increased end-organ ischemia was seen with hypotensive anesthesia. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
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Lee SH, Kim DH, Lee YS. Is there an optimal age for total knee arthroplasty?: A systematic review. Knee Surg Relat Res 2020; 32:60. [PMID: 33198817 PMCID: PMC7667791 DOI: 10.1186/s43019-020-00080-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to elucidate the optimal age for patients undergoing total knee arthroplasty (TKA), to optimize the balance between the benefits and risks by analyzing patient-reported outcome measurements (PROM), revision rate, and mortality according to age. MATERIALS AND METHODS A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data were extracted according to the following: study design, patients enrolled, patient age at the time of surgery, follow-up period, PROM, revision rate, and mortality. RESULTS Thirty-nine articles were included in the final analysis. The results were inconsistent in the PROM analysis, but there was consensus that PROM were good in patients in their 70s . In the revision rate analysis, there was consensus that the revision rate tends to increase in TKA in younger patients, but no significant difference was observed in patients > 70 years of age. In the mortality analysis, there was consensus that the mortality was not significantly different in patients < 80 years of age, but tended to increase with age. CONCLUSION This systematic review shows that the PROM were good when TKA was performed in patients between 70 and 80 years of age; the best PROM could be achieved around 70 years of age, and no significant difference in the revision or mortality rates was observed between 70 and 80 years of age; however, mortality tended to increase with age. Therefore, the early 70s could be recommended as an optimal age to undergo TKA.
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Affiliation(s)
- Seung Hoon Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea.
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10
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Kong X, Yang M, Cao Z, Chen J, Chai W, Wang Y. Tissue adhesive for wound closure in enhanced-recovery total hip arthroplasty: a prospective, randomized and controlled study. BMC Musculoskelet Disord 2020; 21:178. [PMID: 32192465 PMCID: PMC7083038 DOI: 10.1186/s12891-020-03205-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/11/2020] [Indexed: 11/21/2022] Open
Abstract
Background We aimed to present our experience of adopting tissue adhesive as adjunct to standard wound closure in total hip arthroplasty (THA) and evaluate its performance. Methods From September 2019 to November 2019, we prospectively enrolled consecutive patients who underwent simultaneous bilateral THA in this randomized and controlled study. Standard wound closure was applied on one side of hip while additional tissue adhesive was applied on the other side at random. We collected and analyzed patients’ information, including age, gender, body mass index (BMI), diagnosis, postoperative length of stay (LOS), dressing changes, wound evaluation scores, wound-related cost and complications. Results Thirty patients with simultaneous bilateral THA were enrolled in this study. During the hospital stay, the times of dressing change in hips with tissue adhesive was significantly less than that in the other hips (p = 0.000). However, the wound-related cost in hips with tissue adhesive was significantly higher (p = 0.000). According to patients’ feedback at one-month follow-up, wound evaluation of hips with tissue adhesive was significantly better than the other hips (p = 0.004). Seventeen patients preferred tissue adhesive and only five patients preferred standard wound closure. Conclusions Tissue adhesive could significantly reduce wound drainage and increase patients’ satisfaction, which can be an ideal adjunct to standard wound closure in enhanced-recovery THA. Trial registration Chinese Clinical Trial Registry; ChiCTR1900025730; Registered 6 September 2019.
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Affiliation(s)
- Xiangpeng Kong
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China
| | - Minzhi Yang
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.,Nankai University, No.94 Weijin Road, Nankai, Tianjin, China
| | - Zheng Cao
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.,Nankai University, No.94 Weijin Road, Nankai, Tianjin, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China
| | - Wei Chai
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.
| | - Yan Wang
- Department of Orthopaedics, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.
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