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Casari FA, Navab N, Hruby LA, Kriechling P, Nakamura R, Tori R, de Lourdes Dos Santos Nunes F, Queiroz MC, Fürnstahl P, Farshad M. Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art. Curr Rev Musculoskelet Med 2021; 14:192-203. [PMID: 33544367 PMCID: PMC7990993 DOI: 10.1007/s12178-021-09699-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. RECENT FINDINGS Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.
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Affiliation(s)
- Fabio A Casari
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Nassir Navab
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
- Computer Aided Medical Procedures (CAMP), Johns Hopkins University, Baltimore, MD, USA
| | - Laura A Hruby
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Kriechling
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ricardo Nakamura
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Romero Tori
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo C Queiroz
- Orthopedics and Traumatology Department, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Philipp Fürnstahl
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Balachandar G, Abuzakuk T. Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose. J Orthop Surg (Hong Kong) 2020; 27:2309499019880915. [PMID: 31635527 DOI: 10.1177/2309499019880915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE There is no consensus on the optimum timing of administration of tranexamic acid (TA) in bilateral total knee arthroplasty (TKA). We aimed to determine whether the timing of administration of single-dose intravenous TA (either given preoperatively or intraoperatively) has a significant effect on blood loss reduction. METHODS We compared two cohorts of patients with end-stage arthritis of knees who underwent bilateral TKA and were given single-dose intravenous TA (1 g or 15 mg/kg) at different times during surgery. The retrospective cohort group consisting of 40 patients (preoperative (PO) group) received TA before the skin incision. The prospective cohort consisting of 40 patients (intraoperative (IO) group) received TA 10 min before deflating the tourniquet on the first knee. Primary outcome measures were mean hemoglobin difference, A (between PO and day 1 postoperative hemoglobin), mean hemoglobin difference, B (between PO and lowest postoperative hemoglobin), and rate of allogeneic blood transfusion. Secondary measure was drain blood loss. RESULTS Both cohorts were well matched with respect to age, gender, duration of surgery, and length of hospital stay. The hemoglobin drop in the IO group was significantly lesser than the PO group on the first postoperative day (2 vs. 2.9 g/dL, p < 0.001). Although statistically insignificant, the patients in the IO group received less allogenic transfusion of packed cell units than in the PO group (11/40, 27.5% vs. 14/40, 35% ). Mean hemoglobin difference, B, and secondary drain loss were comparable in both groups. CONCLUSION Single-dose intravenous TA given before the start of surgery is as effective as a dose given during arthroplasty of the first knee in reducing blood loss in bilateral TKA.
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Affiliation(s)
| | - Tarek Abuzakuk
- Department of Orthopaedics, American Hospital, Dubai, United Arab Emirates
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Mercuriali F, Inghilleri G. LA TRASFUSIONE DI SANGUE NELLA CHIRURGIA ONCOLOGICA: RUOLO DELLA ERITROPOIETINA RICOMBINANTE UMANA (rHuEPO). TUMORI JOURNAL 2018; 84:S3-14. [PMID: 10083889 DOI: 10.1177/03008916980846s102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anemia is common in cancer patients. The pathophysiology is multifactorial, however the most common cause is the anemia of chronic diseases (ACD). In 20-50% of cancer patients, anemia restricts physical activity and quality of life and requires transfusion support. The percentage of patients necessitating transfusion dramatically increases when patients require surgery. The traditional belief that blood transfusion is an effective and safe therapy has been challenged by a heightened awareness of the infectious and immunologic risks associated with allogeneic blood administration. In cancer patients transfusion-induced immunomodulation may have the potential to significantly increase postoperative infections and cancer recurrence so that it seems reasonable to minimize allogeneic blood exposure. Several strategies have been adopted to reduce allogeneic transfusion in surgical patients, however to properly select the appropriate blood conservation strategies the blood transfusion requirements for each patient should be defined. Allogeneic blood transfusion in surgery can be reduced by the introduction of autologous blood (AB) programmes and by the use of rHuEPO, alone or in association with AB techniques. AB donation is currently a standard of care for elective surgical patients but its efficacy is limited by anemia that prevents the donation of the optimal number of AB units. rHuEPO has been shown to significantly increase the volume of AB that anemic patients can predeposit or, used perisurgically, to expand the circulating RBCs mass before surgery. Moreover clinical trials employed rHuEPO in anemic cancer patients with various solid tumors both on and off chemotherapy reporting a significantly increase in Hct in more than 50% of the treated patients. Recently different studies have shown the efficacy of rHuEPO in increasing the volume of AB also in patients with ACD and cancer, thus proving to be a useful addition to existing strategies of blood conservation to minimize exposure to allogeneic blood in surgical cancer patients.
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Affiliation(s)
- F Mercuriali
- Servizio di Immunoematologia e Trasfusionale, Istituto Ortopedico Gaetano Pini, Milano
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Scharman CD, Burger D, Shatzel JJ, Kim E, DeLoughery TG. Treatment of individuals who cannot receive blood products for religious or other reasons. Am J Hematol 2017; 92:1370-1381. [PMID: 28815690 DOI: 10.1002/ajh.24889] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/04/2023]
Abstract
By virtue of their religious principles, Jehovah's Witnesses (JWs) generally object to receiving blood products, raising numerous ethical, legal, and medical challenges for providers who care for these patients, especially in the emergent setting. In this review, we discuss several areas relevant to the care of JWs, including the current literature on "bloodless" medical care in the setting of perioperative and intraoperative management, acute blood loss, trauma, pregnancy, and malignancy. We have found that medical and administrative efforts in the form of bloodless medicine and surgery programs can be instrumental in helping to reduce risks of morbidity and mortality in these patients. Planning prior to an anticipated event associated with blood loss or anemia (such as elective surgery, pregnancy, and chemotherapy) is critical. Specifically, bloodless medicine programs should prioritize vigilant early screening and management of anemias, early establishment of patient wishes regarding transfusion, and the incorporation of those wishes into multidisciplinary medical and surgical care. Although there are now a variety of human-based and nonhuman-based products available as transfusion alternatives, the degree and quality of evidence to support their use varies significantly between products and is also largely dependent on the clinical setting.
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Affiliation(s)
- Carlton D. Scharman
- Department of Internal Medicine; Oregon Health and Science University; Portland Oregon
| | - Debora Burger
- Patient Blood Management Program; Oregon Health and Science University; Portland Oregon
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland Oregon
| | - Edward Kim
- School of Medicine; Oregon Health and Science University; Portland Oregon
| | - Thomas G. DeLoughery
- Division of Hematology and Medical Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland Oregon
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Kamath AF, Pagnano MW. Blood Management for Patients Undergoing Total Joint Arthroplasty. JBJS Rev 2016; 1:01874474-201312000-00001. [PMID: 27490505 DOI: 10.2106/jbjs.rvw.m.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Atul F Kamath
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, MN 55905
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The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial. Aesthetic Plast Surg 2016; 40:453-7. [PMID: 27225876 DOI: 10.1007/s00266-016-0653-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/05/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a rich blood flow to the mucosa in the nasal region. In rhinoplasty, surgical procedures are performed in a narrow and confined space. So bleeding during surgery reduces visibility which can complicate the procedure. This study investigated the effects of the patient position on amount of intraoperative bleeding during surgical procedures. PATIENTS AND METHODS This randomized controlled trial was conducted on 71 patients who underwent elective rhinoplasty. The patients were operated on in three groups. Group 1 consisted of 23 patients who were operated on in the supine position; Group 2 included 28 patients who were operated on using a 15° angle reverse Trendelenburg position; Group 3 consisted of 20 patients who were operated on at a 20° angle reverse Trendelenburg position. RESULTS There were statistically significant differences between the groups in regard to surgeon satisfaction and the amount of intraoperative bleeding. The amount of intraoperative bleeding in Group 1 was significantly higher than those of Groups 2 and 3, and surgeon satisfaction was lower. CONCLUSIONS Reverse Trendelenburg position reduces intraoperative bleeding in rhinoplasty patients while facilitating the procedure compared to the supine position. Surgery at a 15° angle reverse Trendelenburg position provides the optimum working conditions by both significantly reducing intraoperative bleeding and allowing for comfortable conditions for the surgeon. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma. J Trauma Acute Care Surg 2016; 80:886-96. [DOI: 10.1097/ta.0000000000001044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suarez JC, Slotkin EM, Szubski CR, Barsoum WK, Patel PD. Prospective, Randomized Trial to Evaluate Efficacy of a Bipolar Sealer in Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty 2015; 30:1953-8. [PMID: 26093486 DOI: 10.1016/j.arth.2015.05.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023] Open
Abstract
Total hip arthroplasty can be associated with substantial blood loss requiring allogenic transfusions. Intraoperative blood loss patterns in DAA differ from other approaches. This study evaluated the hemostatic efficacy of a bipolar sealer in DAA THA on surgical blood loss and transfusion requirements. 118 patients were enrolled in this prospective, randomized, double-blinded trial. Primary outcome measure was transfusion rate, while secondary measures included calculated blood loss. A lower transfusion rate was found in the treatment group (3.5 % vs 16.4%, P=.03). There were differences in Hemoglobin-drop (P=.04), calculated blood loss (P=.02), and hidden blood loss (P=.02), favoring the treatment group. The use of a bipolar sealer decreased intraoperative blood loss and transfusion requirements in the study population.
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Affiliation(s)
- Juan C Suarez
- Cleveland Clinic Florida, Department of Orthopedic Surgery, Weston, Florida
| | - Eric M Slotkin
- Orthopaedic Associates of Reading, Reading Hospital, West Reading, Pennsylvania
| | - Caleb R Szubski
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Wael K Barsoum
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Preetesh D Patel
- Cleveland Clinic Florida, Department of Orthopedic Surgery, Weston, Florida
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Lee C, Freeman R, Edmondson M, Rogers BA. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury 2015; 46:1978-82. [PMID: 26190627 DOI: 10.1016/j.injury.2015.06.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/28/2015] [Indexed: 02/02/2023]
Abstract
Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective lower limb arthroplasty surgery. There are potentially even greater physiological benefits in minimising blood loss in hip fracture surgery, however limited evidence exists for TXA use in hemiarthroplasty surgery. This study investigates the effect of TXA use on postoperative transfusion rates and haemoglobin (Hb) levels specifically following hemiarthroplasty surgery for hip fractures. A retrospective cohort study was conducted for consecutive hip hemiarthroplasties for fractures between June 2013 and October 2014 comparing patients with or without prophylactic TXA before incision. During the study, 305 hemiarthroplasties were performed with 271 cases eligible. TXA was given in 84 (31%) cases, and both patient groups were matched for known confounding factors. Patients given TXA had a lower transfusion rate (6% vs. 19%. p=0.005) and less blood loss (Hb drop>20g/L) on day 1 post surgery (26% vs. 42%; p=0.014). One transfusion was prevented with every 8 patients given prophylactic TXA. There were no differences in the 30 and 90-day mortality rates with TXA use. Tranexamic acid is safe, cost-effective and reduces the need for blood transfusion and should be considered in all patients undergoing hip hemiarthroplasty for fractures.
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Affiliation(s)
- Conrad Lee
- Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK.
| | - Richard Freeman
- Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK
| | - Mark Edmondson
- Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK
| | - Benedict A Rogers
- Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK
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Issues in geriatric orthopedic anesthesia. Int Anesthesiol Clin 2015; 52:126-39. [PMID: 25268869 DOI: 10.1097/aia.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A small group of people belonging to a certain religion, called Jehovah's witness do not accept blood transfusion or blood products, based on biblical readings. When such group of people are in need of health care, their faith and belief is an obstacle for their proper treatment, and poses legal, ethical and medical challenges for attending health care provider. Due to the rapid growth in the membership of this group worldwide, physicians attending hospitals should be prepared to manage such patients. Appropriate management of such patients entails understanding of ethical and legal issues involved, providing meticulous medical management, use of prohaemostatic agents, essential interventions and techniques to reduce blood loss and hence, reduce the risk of subsequent need for blood transfusion. An extensive literature search was performed using search engines such as Google scholar, PubMed, MEDLINE, science journals and textbooks using keywords like ‘Jehovah's witness’, ‘blood haemodilution’, ‘blood salvage’ and ‘blood substitutes’.
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Affiliation(s)
- N Kiran Chand
- Department of Anaesthesiology and Critical Care, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, India
| | - H Bala Subramanya
- Department of Anaesthesiology and Critical Care, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, India
| | - G Venkateswara Rao
- Department of Anaesthesiology and Critical Care, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, India
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Xu Q, Yang Y, Shi P, Zhou J, Dai W, Yao Z, Zhang C. Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty. Biosci Trends 2014; 8:169-75. [DOI: 10.5582/bst.2014.01063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tapia NM, Suliburk J, Mattox KL. The initial trauma center fluid management of penetrating injury: a systematic review. Clin Orthop Relat Res 2013; 471:3961-73. [PMID: 23807449 PMCID: PMC3825889 DOI: 10.1007/s11999-013-3122-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Damage-control resuscitation is the prevailing trauma resuscitation technique that emphasizes early and aggressive transfusion with balanced ratios of red blood cells (RBCs), plasma (FFP), and platelets (Plt) while minimizing crystalloid resuscitation, which is a departure from Advanced Trauma Life Support (ATLS) guidelines. It is unclear whether the newer approach is superior to the approach recommended by ATLS. QUESTIONS/PURPOSES With these recent changes pervading resuscitation protocols, we performed a systematic review to determine if the shift in trauma resuscitation from ATLS guidelines to damage control resuscitation has improved mortality in patients with penetrating injuries. METHODS A systematic search of PubMed, the Cochrane Library, and the Current Controlled Trials Register was performed for studies comparing mortality in massively transfused penetrating trauma patients receiving either balanced ratios of blood transfusion per damage control resuscitation tenets or undergoing an alternate blood volume resuscitation strategy. Studies were deemed appropriate for inclusion if they had a Newcastle-Ottawa Scale score of 6 or greater as well as at least 30% penetrating trauma. Twenty studies that reported on a total of 12,154 patients were included. RESULTS Transfusion ratios varied widely, with 1:1 and 1:2 ratios of FFP:RBC most often defined as high ratios for purposes of comparison with other low ratio groups. Fourteen of 20 studies found significantly lower 30-day mortality when higher transfusion ratios of FFP, RBC, and/or Plt were used; six of 20 studies found mortality to be similar between higher and lower transfusion ratios. CONCLUSIONS Patients with penetrating injuries who require massive transfusion should be transfused early using balanced ratios of RBC, FFP, and Plt. Randomized, controlled trials are needed to determine optimal ratios for transfusion.
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Affiliation(s)
- Nicole M. Tapia
- Baylor College of Medicine, One Baylor Plaza, Suite 404D, Houston, TX 77030 USA
| | - James Suliburk
- Baylor College of Medicine, One Baylor Plaza, Suite 404D, Houston, TX 77030 USA
| | - Kenneth L. Mattox
- Baylor College of Medicine, One Baylor Plaza, Suite 404D, Houston, TX 77030 USA
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Sicras-Mainar A, De Salas-Cansado M, Ruiz-Antorán MB, Cuesta-Peredo D, Lizano-Díez I, Betegón-Nicolas L, Navarro-Artieda R. [Use of health resources and costs associated with the diagnosis and treatment of each episode of deep vein thrombosis and bleeding in patients undergoing orthopaedic surgery for hip or knee]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:341-53. [PMID: 23594888 DOI: 10.1016/j.recot.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the use of healthcare resources and costs associated with the diagnosis and treatment of thrombosis and bleeding patients who have undergone elective hip or knee replacement surgery, in routine clinical practice conditions. PATIENTS AND METHODS This multicentre observational and retrospective study extracted data from the medical records of three Spanish public hospitals (2010). Patients ≥ 40 years who had received prophylaxis-anticoagulation were included. They were randomised into three groups: a) control (no hospital complications), b) bleeding, and c) thrombosis. General variables, use of resources and costs were analysed. STATISTICAL ANALYSIS logistic regression and ANCOVA for model correction, (P<.05) was included. RESULTS A total of 141 patients (control: 60; bleeding: 60; and thrombosis: 21), with a mean age 68.7 (SD: 10.4) years, and 68.1% females were identified. Hip arthroplasty was more frequent (71.6%). The bleeding risk was associated with age (OR=1.1) and thrombosis with COPD (OR=1.8); P<.05). The average length of stay for the thrombosis, bleeding and control groups was 13.9, 11.5 and 7.4 days, respectively; P<.001). The total costs for each group were €10,484.3; €8,766.4 and €6,496.1 respectively; P<.05. All grouped results were comparable between them according to the hospital analysed and the type of replacement. CONCLUSIONS Costs were higher for thrombosis and bleeding patients, respectively. Costs were associated with length of stay and hospital-acquired infections.
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Affiliation(s)
- A Sicras-Mainar
- Dirección de Planificación, Badalona Serveis Assistencials, Badalona, Barcelona, España.
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Use of health resources and costs associated with the diagnosis and treatment of each episode of deep vein thrombosis and bleeding in patients undergoing orthopaedic surgery for hip or knee. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Clement RC, Kamath AF, Derman PB, Garino JP, Lee GC. Bipolar sealing in revision total hip arthroplasty for infection: efficacy and cost analysis. J Arthroplasty 2012; 27:1376-81. [PMID: 22266048 DOI: 10.1016/j.arth.2011.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/11/2011] [Indexed: 02/01/2023] Open
Abstract
Saline-coupled bipolar sealing has shown mixed results in primary arthroplasty. However, this technology has not been studied in infected revision total hip arthroplasty (THA), where morbidity is higher and conventional methods of blood management, such as cell salvage, often cannot be used. This case-matched study of 76 consecutive revision THA for infection included an experimental bipolar sealing group and a control group of conventional electrocautery. Groups were matched for gender, body mass index, American Society of Anesthesiologists classification, and surgery type. Total blood loss, intraoperative blood loss, and perioperative hemoglobin drop were significantly less in the experimental group. In addition, operative time was significantly shorter in the experimental group, which translated into gross savings approximately equal to the cost of the device. The decreases in total blood loss and perioperative hemoglobin decline, along with financial savings, may support the use of bipolar sealing in infected revision THA.
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Affiliation(s)
- R Carter Clement
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Strategies for reducing transfusions in major orthopaedic surgery. BLOOD TRANSFUSION 2011; 9:246-7. [PMID: 21627926 DOI: 10.2450/2011.0003-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hypotensive Resuscitation Strategy Reduces Transfusion Requirements and Severe Postoperative Coagulopathy in Trauma Patients With Hemorrhagic Shock: Preliminary Results of a Randomized Controlled Trial. ACTA ACUST UNITED AC 2011; 70:652-63. [DOI: 10.1097/ta.0b013e31820e77ea] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zeh A, Messer J, Davis J, Vasarhelyi A, Wohlrab D. The Aquamantys system--an alternative to reduce blood loss in primary total hip arthroplasty? J Arthroplasty 2010; 25:1072-7. [PMID: 20097039 DOI: 10.1016/j.arth.2009.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/11/2009] [Accepted: 10/08/2009] [Indexed: 02/01/2023] Open
Abstract
To evaluate the effectiveness of the Bipolar Sealer 6.0-VT (BPS 6.0-VT) (Tissue Link Medical, Inc, Dover, NH) in reducing blood loss compared with a conventional electrocautery (Erbe ICC 350) (Erbe ICC 350 (ERBE Elektromedizin GmbH, Tübingen, Germany). A prospective randomized trial of 105 patients with primary total hip arthroplasty (Erbe ICC 350: 50 patients; BPS 6.0-VT: 55 patients). On the basis of the calculation of the preoperative blood volume the total and postoperative blood loss were calculated. No statistically significant difference could be shown for total intraoperative and postoperative blood loss (group A 1846 mL; group B 1740 mL) (t test). Due to the lack of reduction of blood loss and the high costs of the BPS 6.0-VT, its use is not recommended in primary total hip arthroplasty.
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Affiliation(s)
- Alexander Zeh
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany
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Everts PAM, Devilee RJJ, Brown Mahoney C, Eeftinck-Schattenkerk M, Box HAM, Knape JTA, van Zundert A. Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand 2006; 50:593-9. [PMID: 16643230 DOI: 10.1111/j.1399-6576.2006.001005.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is often associated with a considerable amount of post-operative blood loss, necessitating the transfusion of allogeneic blood, which can add to the complications. Optimization of strategies to reduce the need for blood transfusion is desired. This study was designed to evaluate the efficacy of autologous platelet gel and fibrin sealant in unilateral TKA. METHODS Consecutive patients were operated on and assigned to the study and control groups. Study group patients (n = 85) were operated on according to our standard TKA protocol, with the application of autologous platelet gel and fibrin sealant on the wound tissues at the end of surgery. Eighty patients were operated on according to the same protocol, but without the use of platelet gel and fibrin sealant, and served as the control group. All blood transfusions, occurrence of wound leakage, wound healing disturbances and incidences of post-operative infections were recorded. RESULTS Patients in the treatment group had a significantly higher post-operative haemoglobin level (11.3 vs. 8.9 g/dl, respectively) and a decreased need for allogeneic blood products (0.17 vs. 0.52 units, respectively) than those in the control group (P < 0.001). The incidences of wound leakage and wound healing disturbance were significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. Four patients in the control group, who received blood products, developed wound infection. The hospital stay was decreased by 1.4 +/- 1.5 days for patients in the treatment group (P < 0.001). CONCLUSION Peri-operatively applied platelet gel and fibrin sealant may reduce the incidence of allogeneic blood transfusions and complications associated with TKA.
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Affiliation(s)
- P A M Everts
- Department of Extra Corporeal Blood Management, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
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22
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Utilización de aprotinina como agente hemostático en la prótesis total de cadera. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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López-Anglada E, Paz-Aparicio J, Bertrand D, Gosálbez J, Núñez-Batalla D, Paz-Jiménez J. Influencia de la aprotinina en el sangrado postoperatorio de la artroplastia total de rodilla. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0482-5985(05)74449-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sinardi D, Marino A, Chillemi S, Irrera M, Labruto G, Mondello E. Composition of the blood sampled from surgical drainage after joint arthroplasty: quality of return. Transfusion 2005; 45:202-7. [PMID: 15660828 DOI: 10.1111/j.1537-2995.2004.04180.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The quality of blood obtained with a device for postoperative blood drainage and autotransfusion (Bellovac-ABT, Astra Tech AB) was investigated in 50 patients who underwent total hip replacement (THR) or total knee replacement (TKR) surgeries. STUDY DESIGN AND METHODS The Bellovac-ABT drainage set was inserted and blood collection began after skin closure (THR) or 15 minutes after tourniquet deflation (TKR). A collecting bag stayed in place for less than 6 hours. The product was then returned after sedimentation and discard of supernatant, without anticoagulants. RESULTS Blood returned with the Bellovac-ABT had optimal hemoglobin levels and red blood cell (RBC) counts; the low platelet count reduced the risk of disseminated intravascular coagulation. Inertia of materials maintained acceptable values of C-reactive protein, whereas cytokines and complement split products rose rapidly. Higher concentrations of adenosine triphosphate and 2,3-diphosphoglycerate than in circulating blood suggested a normal RBC metabolism. No adverse reactions were observed in any participants. CONCLUSION Because of its simplicity and safety, the Bellovac-ABT autologous blood transfusion system is recommended in THR or TKR without joint infection or malignancy.
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Affiliation(s)
- Daniele Sinardi
- Anesthetics and ICU Department, Orthopedic Institute of Southern Italy F. Scalabrino, Messina, Italy.
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López-Anglada E, Paz-Aparicio J, Bertrand D, Gosálbez J, Núñez-Batalla D, Paz-Jiménez J. Influencia de la aprotinina en el sangrado postoperatorio de la artroplastia total de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2005. [DOI: 10.1016/s1888-4415(05)76341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Concern about the safety of allogeneic blood transfusion, including the risk of viral infection and immunosuppression, has led to the development of transfusion options in total joint arthroplasty, including intraoperative and postoperative blood salvage, autologous donation, hemodilution, and the use of epoetin alfa. Intraoperative or postoperative blood salvage has been shown not to be cost-effective at our institution except in revision hip arthroplasties because not enough blood is collected. Autologous donation is not helpful. One third of patients undergoing joint arthroplasty have hemoglobin values between 10 and 13 g/dL preoperatively. The most efficient way to decrease allogeneic risk in these patients is epoetin alfa. Epoetin alfa decreases allogeneic risk to 12.9%, which is acceptable. Patients with preoperative hemoglobin >14 g/dL undergoing single total knee or total hip arthroplasty do not need anything because their allogeneic risk is minimal.
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Affiliation(s)
- E Michael Keating
- Center for Hip and Knee Surgery, St. Francis Hospital-Mooresville, Mooresville, Indiana 46158 , USA
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27
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Sprung J, Kindscher JD, Wahr JA, Levy JH, Monk TG, Moritz MW, O'Hara PJ. The use of bovine hemoglobin glutamer-250 (Hemopure) in surgical patients: results of a multicenter, randomized, single-blinded trial. Anesth Analg 2002; 94:799-808, table of contents. [PMID: 11916776 DOI: 10.1097/00000539-200204000-00006] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Hemoglobin-based oxygen carrier-201 (HBOC-201, hemoglobin glutamer-250 [bovine], Hemopure; Biopure Corporation, Cambridge, MA) is polymerized hemoglobin of bovine origin being developed as an oxygen therapeutic. In this study, we evaluated the tolerability of a single intraoperative dose of HBOC-201 in surgical patients. In a single-blinded, multicenter study, 81 patients were randomized to receive either a single infusion of HBOC-201 (55 patients) or an equivalent volume of lactated Ringer's solution (26 patients). Forty-two patients originally assigned to the HBOC-201 group received the entire planned treatment of only one of the following doses: 0.6, 0.9, 1.2, 1.5, 2.0, or 2.5 g/kg of body weight. Thirteen of the 55 patients in the HBOC-201-assigned group did not reach the trigger point for transfusion administration, and they were not included in the analysis. We studied clinical outcomes and compared hematologic findings, blood chemistry values, and blood use in the two treatment groups. There were no patient deaths in this study. No pattern of clinically significant laboratory abnormalities could be attributed to exposure to HBOC-201. In the HBOC-201 group, 2 patients had a transient increased concentration of serum transaminases and 6 had transient skin discoloration. One patient in the HBOC-201 group had mast cell degranulation with hypotension. Postoperatively, methemoglobin plasma concentrations increased in the HBOC-201 group in a dose-dependent manner, reaching maximal values of 3.7% +/- 3.2% (average of all doses given) on postoperative day 3. There was no difference in the mean number of allogeneic blood units transfused in the 2 groups (3.3 +/- 1.8 and 3.7 +/- 4.1 for the lactated Ringer's solution and HBOC-201 groups, respectively) over the course of hospitalization. The intraoperative administration of HBOC-201, up to a maximum of 245 g, was generally well tolerated. There was no relationship between HBOC-201 use and the number of allogeneic blood units transfused over the entire hospitalization course. The administration of HBOC-201 was associated with a delayed (third postoperative day) dose-dependent increase in the plasma methemoglobin concentration. We conclude that the intraoperative use of HBOC-201 was generally well tolerated. IMPLICATIONS The intraoperative use of hemoglobin glutamer-250 (bovine) (HBOC-201, Hemopure was generally well tolerated. The administration of HBOC-201 was associated with a delayed increase in the plasma methemoglobin concentrations.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology and Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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28
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Benoni G, Fredin H, Knebel R, Nilsson P. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. ACTA ORTHOPAEDICA SCANDINAVICA 2001; 72:442-8. [PMID: 11728069 DOI: 10.1080/000164701753532754] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We performed a randomized, double-blind study on the effect of tranexamic acid on blood loss and blood transfusions in 40 primary total hip arthroplasties. Tranexamic acid, 10 mg/kg body weight, or placebo, was given intravenously just before the operation. Blood loss during the operation and postoperatively into the drains was recorded, as also were blood hemoglobin concentrations. Ultrasound examination 1 week postoperatively was done to estimate the blood loss due to remaining hematomas. Total (operation + drain) blood loss was 0.76 (95 CI 0.63-0.89) L in the tranexamic acid group as compared to 1.0 (CI 0.81-1.2) L in the placebo group (p = 0.03). The number of blood transfusions during the day of operation was 2 vs. 10 (p = 0.07) and the total number during the hospital stay was 5 vs. 13 (p = 0.2). 1 patient in each group had a pulmonary embolism.
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Affiliation(s)
- G Benoni
- Department of Orthopaedics, Malmö University Hospital, Sweden.
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29
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Transfusion Therapy. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sculco TP, Gallina J. Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery. Orthopedics 1999; 22:s129-34. [PMID: 9927113 DOI: 10.3928/0147-7447-19990102-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Preoperative autologous donation (PAD) is commonly used for patients undergoing elective total joint arthroplasty; however, PAD is associated with increased overall transfusion rates and may not be cost-effective for all patients. A retrospective analysis was conducted on a series of 1405 patients undergoing unilateral or bilateral total hip or total knee arthroplasty at The Hospital for Special Surgery to determine the effect of PAD on transfusion outcomes. Eighty-three percent of patients predonated blood (1 unit to 3 units). Transfusions occurred in 82% of PAD participants and in only 50% of nondonors. The allogeneic transfusion rates were 8% for PAD participants and 50% for nondonors. Thirty-four percent to 45% of donated autologous units were discarded. Hemoglobin concentrations measured prior to surgery were inversely related to frequency of allogeneic transfusion. These data underscore the importance of hemoglobin levels in blood management planning. This information can be useful for formulating rational, cost-effective blood management guidelines.
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Affiliation(s)
- T P Sculco
- The Hospital for Special Surgery, New York, NY 10021, USA
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Trice ME, Walker RH, D'Lima DD, Morris BA, Colwell CW. Blood loss and transfusion rate in noncemented and cemented/hybrid total hip arthroplasty. Is there a difference? A comparison of 25 matched pairs. Orthopedics 1999; 22:s141-4. [PMID: 9927115 DOI: 10.3928/0147-7447-19990102-07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A common assumption among orthopedic surgeons is that cemented/hybrid total hip arthroplasty (THA) results in lower transfusion requirements than noncemented THA. The hypothesized mechanism to account for transfusion differences is that cement application, after polymerization, decreases perioperative blood loss. To evaluate this theory, a retrospective matched-pair study was performed to quantify perioperative, intraoperative, postoperative blood loss, and transfusion requirements among patients undergoing cemented/hybrid and noncemented THA. Twenty-five THA procedures were either cemented or hybrid and 25 were noncemented. Patients were matched with respect to age, gender, weight, and diagnosis. Six patients in the noncemented group and 10 in the cemented/hybrid group received autologous blood in the Post Anesthesia Care Unit. Among this subgroup, those in the cemented/hybrid group received a significantly greater volume of transfused blood (519.20 mL, versus 291.67 mL in the noncemented group, P < .017). After stratifying patients by gender, additional analysis revealed a greater total blood loss in the male population than in females (1848 mL versus 1464 mL, P < .004). Males also had a greater drain volume (548 mL versus 414 mL, P < .02). The female population utilizing hormone replacement therapy (HRT) was found to have a lesser blood loss (810 mL versus 1209 mL, P < .0107) and received a smaller amount of transfused blood (1164 mL versus 1377 mL) than those who were not on HRT. Other significant findings included a shorter length of stay in the cemented/hybrid group (6.85 versus 7.56 days, P < .012). Based on this matched-pair retrospective analysis of blood requirements, there is no indication that cemented/hybrid and noncemented THA procedures result in different blood requirements. However, differences were found in several areas when the population was stratified by gender. The information obtained from this study is important in its ability to solidify a foundation from which blood management decisions can be made.
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Affiliation(s)
- M E Trice
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA
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Abstract
Innovation in surgical blood management has been fueled by patients' perceptions of the risks associated with allogeneic blood transfusions and by surgeons' attitudes toward the use of allogeneic blood. The challenge is to determine the best blood management strategy to implement in the individual patient, particularly in patients with anemia who are at high risk of allogeneic blood transfusion. An algorithm to estimate safe blood loss based on individual patient parameters has been developed. The algorithm uses patient weight, gender, and preoperative hematocrit level to derive the volume of blood loss that can be tolerated while maintaining a target postoperative hematocrit level. Because the margin of safe blood loss can be anticipated, the most appropriate blood conservation option(s) can be implemented and perioperative blood management can be optimized.
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Affiliation(s)
- C L Nelson
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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34
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Abstract
Due to the increased risks associated with allogenic blood transfusion, blood management in surgical procedures, especially in orthopedic settings, should include reduction of perioperative blood loss. Preoperative nursing assessment will help define patients at increased risk for transfusion. Both nonpharmacologic and pharmacologic techniques can help minimize allogenic transfusion by reducing blood loss. One such method of managing anemia and reducing patient exposure to allogenic transfusion is the perioperative use of recombinant human erythropoietin--erythropoietin alfa--an innovative surgical blood management tool. Increased awareness by perioperative nurses of the use of erythropoietin alfa and patient implications can contribute to the overall blood conservation goal.
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The orthopedic high-risk patient. Acta Anaesthesiol Scand 1997. [DOI: 10.1111/j.1399-6576.1997.tb04902.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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