1
|
Zang H, Hu A, Xu X, Ren H, Xu L. Development of machine learning models to predict perioperative blood transfusion in hip surgery. BMC Med Inform Decis Mak 2024; 24:158. [PMID: 38840126 PMCID: PMC11155147 DOI: 10.1186/s12911-024-02555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Allogeneic Blood transfusion is common in hip surgery but is associated with increased morbidity. Accurate prediction of transfusion risk is necessary for minimizing blood product waste and preoperative decision-making. The study aimed to develop machine learning models for predicting perioperative blood transfusion in hip surgery and identify significant risk factors. METHODS Data of patients undergoing hip surgery between January 2013 and October 2021 in the Peking Union Medical College Hospital were collected to train and test predictive models. The primary outcome was perioperative red blood cell (RBC) transfusion within 72 h of surgery. Fourteen machine learning algorithms were established to predict blood transfusion risk incorporating patient demographic characteristics, preoperative laboratory tests, and surgical information. Discrimination, calibration, and decision curve analysis were used to evaluate machine learning models. SHapley Additive exPlanations (SHAP) was performed to interpret models. RESULTS In this study, 2431 hip surgeries were included. The Ridge Classifier performed the best with an AUC = 0.85 (95% CI, 0.81 to 0.88) and a Brier score = 0.21. Patient-related risk factors included lower preoperative hemoglobin, American Society of Anesthesiologists (ASA) Physical Status > 2, anemia, lower preoperative fibrinogen, and lower preoperative albumin. Surgery-related risk factors included longer operation time, total hip arthroplasty, and autotransfusion. CONCLUSIONS The machine learning model developed in this study achieved high predictive performance using available variables for perioperative blood transfusion in hip surgery. The predictors identified could be helpful for risk stratification, preoperative optimization, and outcomes improvement.
Collapse
Affiliation(s)
- Han Zang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Ai Hu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Xuanqi Xu
- Key Laboratory of High Confidence Software Technologies (Peking University), Ministry of Education, Beijing, 100084, China
- School of Computer Science, Peking University, Beijing, 100084, China
| | - He Ren
- Beijing HealSci Technology Co., Ltd., Beijing, 100176, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
2
|
Tomos G, Saussine C, Gaillard V, Lang H, Tricard T. [Short-term functional outcomes of laparoscopic robotic-assisted cystectomy (RAC) with ileal conduit urinary diversion (ICUD) for lower urinary tract dysfunction (LUTD): A single-center retrospective study]. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102639. [PMID: 38636808 DOI: 10.1016/j.fjurol.2024.102639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To assess the short-term functional outcomes and morbidity of robotic-assisted cystectomy (RAC) and intracorporeal urinary diversion (ICUD) in patients with lower urinary tract dysfunction (LUTD). METHODS All consecutive patients who underwent RAC+ICUD for LUTD in a tertiary hospital center, between July 2018 and May 2021 were retrospectively included. Medical records were systematically reviewed and patient, perioperative and postoperative data were collected. A good short-term functional outcome was defined by the combination of a satisfying urostomy equipment (absence of urine leakage and easy appliance of the urostomy bag), the absence of pelvicaliceal system dilatation on sonography, and the absence of renal function decrease at the 2months post-operative consultation. Intraoperative parameters and post-operative complications were collected to assess morbidity. RESULTS Thirty-five patients were included. Eight (22.8%) patients needed intraoperative conversion to laparotomy. Twenty-five patients (92,5%) met criteria for a good functional outcome 2months post-operatively. The median operative time was 346min (86.5-407.5). The median blood loss was 100mL (100-290) and 5 patients (18.5%) required blood transfusion. The median times to return of bowel function was 3 days (2-4) and the median length of hospital stay was 10 days (10-18). Peri-operative complications were reported in 16 patients (59.2%): 6 (22.2%) minor complications Clavien ≤ II and 10 (37%) major complications Clavien ≥ III. There was no significative decrease of the renal function (mean preoperative creatininemia of 61.2μmol/L (50.5-74.5) vs 64.5μmol/L (47-85.25) postoperatively) CONCLUSION: RAC+ICUD in LUTD can provide good short-term functional outcomes while limiting blood transfusion, time to return of bowel function and the length of hospital stay. These results should be confirmed by larger prospective study. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Georgios Tomos
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France.
| | - Christian Saussine
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Victor Gaillard
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Hervé Lang
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Thibault Tricard
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| |
Collapse
|
3
|
Schootman M, Li C, Ying J, Orcutt ST, Laryea J. Maximizing Readmission Reduction in Colon Cancer Patients. J Surg Res 2024; 295:587-596. [PMID: 38096772 PMCID: PMC10922981 DOI: 10.1016/j.jss.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Multiple studies have identified risk factors for readmission in colon cancer patients. We need to determine which risk factors, when modified, produce the greatest decrease in readmission for patients so that limited resources can be used most effectively by implementing targeted evidence-based performance improvements. We determined the potential impact of various modifiable risk factors on reducing 30-d readmission in colon cancer patients. METHODS We used a cohort design with the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program data to track colon cancer patients for 30 d following surgery. Colon cancer patients who received colectomies and were discharged alive were included. Readmission (to the same or another hospital) for any reason within 30 d of the resection was the outcome measure. Modifiable risk factors were the use of minimally invasive surgery (MIS) versus open colectomy, mechanical bowel preparation, preoperative antibiotic use, functional status, smoking, complications (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke, infections, anastomotic leakage, prolonged postoperative ileus, extensive blood loss, and sepsis), serum albumin, and hematocrit. RESULTS 111,691 patients with colon cancer were included in the analysis. About half of the patients were male, most were aged 75 or older, and were discharged home. Overall, 11,138 patients (10.0%) were readmitted within 30 d of surgery. In adjusted analysis, the reduction in readmission would be largest by preventing both prolonged ileus and by switching open colectomies to MIS (28.0% relative reduction) followed by preventing anastomotic leaks (6.2% relative reduction). Improving other modifiable risk factors would have a more limited impact. CONCLUSIONS The focus of readmission reduction should be on preventing prolonged ileus, increasing the use of MIS, and preventing anastomotic leaks.
Collapse
Affiliation(s)
- Mario Schootman
- Division of Community Health and Research, Department of Internal Medicine, College of Medicine, The University of Arkansas for Medical Sciences, Springdale, Arkansas; Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jun Ying
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sonia T Orcutt
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Surgical Oncology, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan Laryea
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Colorectal Surgery, Department of Surgery, College of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
4
|
Link H, Kerkmann M, Holtmann L, Detzner M. Anemia diagnosis and therapy in malignant diseases: implementation of guidelines-a representative study. Support Care Cancer 2024; 32:113. [PMID: 38240843 PMCID: PMC10799088 DOI: 10.1007/s00520-023-08267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Anemia in cancer should be diagnosed and treated according to guideline recommendations. The implementation of ESMO and German guidelines and their effect on anemia correction was analyzed. METHODS This retrospective epidemiological study, representative for Germany, analyzed data on anemia management of cancer patients with anemia ≥ grade 2. The Guideline Adherence Score (GLAD) for diagnosis (GLAD-D) and therapy (GLAD-T) was defined as follows: 2 points for complete, 1 point for partial, 0 point for no adherence. RESULTS Data were analyzed for 1046 patients. Hb levels at diagnosis of anemia were 8-10 g/dL in 899 (85.9%) patients, 7-8 g/dL in 92 (8.7%), and < 7 g/dL (5.0%) in 52. Transferrin saturation was determined in 19% of patients. Four hundred fifty-six patients received RBC (43.6%), 198 (18.9%) iron replacement, 106 (10.1%) ESA, and 60 (5.7%) vitamin B12 replacement. 60.6% of patients receiving iron replacement were treated intravenously and 39.4% were treated orally. Two hundred eighty-eight (36.6%) of 785 patients receiving transfusions had no guideline-directed indication. GLAD-D was 2 in 310 patients (29.6%), 1 in 168 (16.1%), and 0 in 568 (54.3%). GLAD-T was 2 in 270 patients (25.8%), 1 in 320 patients (30.6%), and 0 in 456 patients (43.6%). Higher GLAD-D significantly correlated with higher GLAD-T (τB = 0.176, p < 0.001). GLAD-T 2 was significantly associated with greater Hb increase than GLAD-T 0/1 (p < 0.001) at 28 days (10.2 vs. 9.7 g/dL) and at 2 months (10.4 vs. 9.9 g/dL). CONCLUSIONS Anemia assessment is inadequate, transfusion rates too high, and iron and ESA therapy too infrequent. TRIAL REGISTRATION ClinicalTrials.gov, NCT05190263, date: 2022-01-13.
Collapse
Affiliation(s)
- Hartmut Link
- Internal Medicine, Hematology and Medical Oncology, D-67661, Kaiserslautern, Germany.
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany.
| | - Markus Kerkmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Laura Holtmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Markus Detzner
- AIO-Studien-gGmbH, Kuno-Fischer-Straße 8, D-14057, Berlin, Germany
| |
Collapse
|
5
|
Koepke EJ, Orr CH, Blitz J. Systems of Care Delivery and Optimization in the Preoperative Arena. Anesthesiol Clin 2023; 41:833-845. [PMID: 37838387 DOI: 10.1016/j.anclin.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Key elements of an effective preoperative process include the following: history-taking, risk assessment, shared decision making, effective interdisciplinary communication, preoperative optimization of modifiable conditions, longitudinal care coordination, contribution to population health aims, and collection of outcomes-driven metrics. Perioperative medicine tenets can be applied by health systems of all sizes and demographics to improve quality and safety.
Collapse
Affiliation(s)
- Elena J Koepke
- Department of Anesthesiology, Critical Care, and Pain Medicine, McGovern Medical School at UTHealth Houston, 6431 Fannin Street, MSB 5.176, Houston, TX 77030, USA
| | - Cheryl Hilty Orr
- Department of Surgery, Perioperative Surgical Home, Barton Memorial Hospital, 2209 South Avenue, Suite C, South Lake Tahoe, CA 96150, USA
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710, USA.
| |
Collapse
|
6
|
Guinn N, Tanaka K, Erdoes G, Kwak J, Henderson R, Mazzeffi M, Fabbro M, Raphael J. The Year in Coagulation and Transfusion: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2023; 37:2435-2449. [PMID: 37690951 DOI: 10.1053/j.jvca.2023.08.132] [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: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
This is an annual review to cover highlights in transfusion and coagulation in patients undergoing cardiovascular surgery. The goal of this article is to provide readers with a focused summary of the most important transfusion and coagulation topics published in 2022. This includes a discussion covering the management of anemia and red blood cell transfusion, the management of factor Xa inhibitors, updates in coagulation testing, updates in the use of factor concentrates, advances in platelet therapy, advances in anticoagulation management of patients on extracorporeal membrane oxygenation and other forms of mechanical circulatory support, and advances in the diagnosis and management of heparin-induced thrombocytopenia.
Collapse
Affiliation(s)
- Nicole Guinn
- Chief of Neuroanesthesiology, Otolaryngology and Offsite Anesthesia Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Jenny Kwak
- Division of Cardiac Anesthesia, Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, IL
| | - Reney Henderson
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Maryland School of Medicine, Baltimore, MD
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, FL
| | - Jacob Raphael
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA.
| |
Collapse
|
7
|
Shah A, Acheson A, Sinclair R. Perioperative iron deficiency anaemia. BJA Educ 2023; 23:372-381. [PMID: 37720558 PMCID: PMC10501883 DOI: 10.1016/j.bjae.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- A. Shah
- University of Oxford, Oxford, UK
| | - A. Acheson
- University of Nottingham, Nottingham, UK
| | - R.C.F. Sinclair
- Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| |
Collapse
|
8
|
Duarte GDC, Ribeiro GN, Moschen M, Toledo RSM, Bordin JO, Langhi DM. Targeting patient blood management's first pillar: A multicentric retrospective study on preoperative anemia. Hematol Transfus Cell Ther 2023; 45:338-341. [PMID: 35882618 PMCID: PMC10499570 DOI: 10.1016/j.htct.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/04/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Anemia is a common issue in surgical patients and has been associated with worse clinical outcomes, such as a higher probability of transfusions and longer hospital stay. Therefore, Patient Blood Management programs are actively aiming to achieve early identification and treatment of anemia, previous to the surgery. METHODS AND MATERIALS In this study, preoperative hemoglobin within the Blood Order Schedule (BOS) at 16 blood centers in several Brazilian regions were retrospectively evaluated. Data regarding hemoglobin, age, gender and Brazilian regions were further analyzed. RESULTS From the 20,201 BOSs evaluated, the mean age was 55.65 ± 23.52 years old, with an overall prevalence of preoperative anemia of 60.9%. Women had a lower mean preoperative hemoglobin (11.74 ± 2.84 for women and 12.27 ± 3.06 for men) and higher prevalence of anemia than men (66% of females and 52.2% of males). The individuals over 65 years old and under 18 were the most affected by preoperative anemia. All regions had a high prevalence of preoperative anemia, without any direct association with the Human Development Index. CONCLUSION In summary, upon evaluating the BOS, our study showed a high prevalence of preoperative anemia in all Brazilian regions, regardless of the gender and age group, but that women and individuals less than 18 or over 65 years old have an even higher prevalence of preoperative anemia. This information can identify the institutions in which preoperative anemia is a critical issue and in which new strategies, such as preoperative screening clinics, might be helpful.
Collapse
|
9
|
Terada R, Stewart K, Hansen S, Shettar SS, Butt A, Vallurupalli S, Martin M, Tanaka K. Temporal changes and predictors of perioperative blood transfusion in elective spine surgery: a retrospective analysis of a large surgical database. Br J Anaesth 2023; 130:421-429. [PMID: 36586804 DOI: 10.1016/j.bja.2022.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Allogeneic blood transfusion used to be common in spine surgery. Patient blood management has been widely adopted, and it is important to reassess transfusion predictors in contemporary practice. METHODS A retrospective study of inpatient spine surgery was performed using National Surgical Quality Improvement Program (NSQIP) data from 2011 to 2019. The primary outcome was perioperative transfusion within 72 h of surgery. Multivariable logistic regression and recursive partitioning were used to assess up to 15 variables including patient and surgical data, surgical specialty (orthopaedic surgery vs neurosurgery), and year of surgery. RESULTS The study population included 251 971 US surgical patients; 6.9% of these patients received perioperative blood transfusion. Perioperative transfusions declined over time with the steepest decline from 2011 to 2015. The greatest reduction was seen among orthopaedic cases where the transfusion rate declined from 16.0% to 8.7% between 2011 and 2015. Eight variables were predictive factors in a reduced model: operative time, preoperative haemoglobin, vertebral level, number of vertebral levels, older age, surgeon specialty, arthrodesis, and year of surgery (area under the curve [AUC]=0.880; 95% confidence interval [CI], 0.878-0.883). Overall, longer operative time (>144 min) and greater numbers of vertebral levels had greater associations with transfusion than surgical specialty after adjustments. Prevalence of anaemia (15%) has not substantially declined. CONCLUSIONS Perioperative blood transfusion rate in spine surgery has declined over the past decade. The extent and duration of surgery and preoperative haemoglobin level remain important factors associated with increased odds for perioperative blood transfusion.
Collapse
Affiliation(s)
- Rui Terada
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Kenneth Stewart
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA; Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Sandra Hansen
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Shashank S Shettar
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Amir Butt
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Santaram Vallurupalli
- Department of Orthopedic Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Michael Martin
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Kenichi Tanaka
- Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
| |
Collapse
|
10
|
Kiyatkin ME, Mladinov D, Jarzebowski ML, Warner MA. Patient Blood Management, Anemia, and Transfusion Optimization Across Surgical Specialties. Anesthesiol Clin 2023; 41:161-174. [PMID: 36871997 PMCID: PMC10066799 DOI: 10.1016/j.anclin.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Patient blood management (PBM) is a systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood and minimizing allogenic transfusion need and risk. According to the PBM approach, the goals of perioperative anemia management include early diagnosis, targeted treatment, blood conservation, restrictive transfusion except in cases of acute and massive hemorrhage, and ongoing quality assurance and research efforts to advance overall blood health.
Collapse
Affiliation(s)
- Michael E Kiyatkin
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Domagoj Mladinov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Mary L Jarzebowski
- Department of Anesthesiology, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, 200 1st Street, Rochester, MN 55905, USA
| |
Collapse
|
11
|
Gloff MS, Mazzeffi M, Eaton M. Preoperative Anemia Treatment in Cardiac Surgery: Past Due and Time to Act. J Cardiothorac Vasc Anesth 2023; 37:276-278. [PMID: 36379832 DOI: 10.1053/j.jvca.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Marjorie S Gloff
- University of Rochester, Department of Anesthesiology, Rochester, NY
| | - Michael Mazzeffi
- University of Virginia Health, Department of Anesthesiology, Charlottesville, VA.
| | - Michael Eaton
- University of Rochester, Department of Anesthesiology, Rochester, NY
| |
Collapse
|
12
|
Applebaum JC, Kim EK, Rush M, Shah DK. Safety of Same-Day Discharge Versus Hospital Admission in Minimally Invasive Myomectomy. J Minim Invasive Gynecol 2023; 30:382-388. [PMID: 36708763 DOI: 10.1016/j.jmig.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To compare postoperative complication rates between same-day discharge patients and patients admitted to hospital after minimally invasive myomectomy, stratified by patient demographics and perioperative variables including myoma burden. DESIGN Retrospective cohort study. Setting Hospitals participating in the National Surgical Quality Improvement Program database from January 2015 to December 2019. PATIENTS Female patients aged ≥18 years undergoing minimally invasive myomectomy. INTERVENTIONS Patients were categorized into either the same-day discharge or admitted patient cohort. Univariate comparisons of demographics, perioperative variables, and 30-day postoperative complications were performed. Multivariate logistic regression was used to 1) identify demographic and perioperative factors associated with admission, and 2) compare postoperative complication rates of same-day discharge patients with those of admitted patients while adjusting for demographic and perioperative factors. MEASUREMENTS AND MAIN RESULTS Eight thousand one hundred patients were recruited during the study period. The overall rate of same-day discharge was 57.2% in 2015 and 65.0% in 2019. The same-day discharge rate was 64.6% for patients with a smaller myoma burden (1-4 fibroids and ≤250 grams, Current Procedural Terminology 58545) and 56.8% for larger myoma burden (≥5 fibroids or >250 grams, Current Procedural Terminology 58546). Age, race, American Society of Anesthesiologists classification III or IV, preoperative hematocrit <36%, hypertension, diabetes, bleeding disorder, and increasing operative time were associated with admission to hospital. After adjusting for these variables, composite postoperative complication rates were similar between admitted patients and patients who were discharged the same day regardless of myoma burden (adjusted OR [aOR], 0.66; 95% confidence interval [CI] 0.18-2.47 for low myoma burden and aOR, 0.91; 95% CI 0.18-4.63 for high myoma burden). Admitted patients with both low (aOR, 9.1; 95% CI 2.27-37.04) and high (aOR, 8.24; 95% CI 1.59-42.49) myoma burdens were significantly more likely to receive a blood transfusion compared to same-day discharge patients. CONCLUSION Same-day discharge after minimally invasive myomectomy, regardless of myoma burden, is associated with low complication rates. Our findings may aid in shared decision making on discharge planning.
Collapse
Affiliation(s)
- Jeremy C Applebaum
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Drs. Applebaum and Rush), Philadelphia, Pennsylvania.
| | - Edward K Kim
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Dr. Kim), Philadelphia, Pennsylvania
| | - Margaret Rush
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Drs. Applebaum and Rush), Philadelphia, Pennsylvania
| | - Divya K Shah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Dr. Shah), Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients. Anesth Analg 2022; 135:532-544. [PMID: 35977363 DOI: 10.1213/ane.0000000000006148] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Preoperative anemia is common in patients presenting for cardiac surgery, with a prevalence of approximately 1 in 4, and has been associated with worse outcomes including increased risk of blood transfusion, kidney injury, stroke, infection, and death. Iron deficiency, a major cause of anemia, has also been shown to have an association with worse outcomes in patients undergoing cardiac surgery, even in the absence of anemia. Although recent guidelines have supported diagnosing and treating anemia and iron deficiency before elective surgery, details on when and how to screen and treat remain unclear. The Eighth Perioperative Quality Initiative (POQI 8) consensus conference, in conjunction with the Enhanced Recovery after Surgery-Cardiac Surgery Society, brought together an international, multidisciplinary team of experts to review and evaluate the literature on screening, diagnosing, and managing preoperative anemia and iron deficiency in patients undergoing cardiac surgery, and to provide evidence-based recommendations in accordance with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria for evaluating biomedical literature.
Collapse
|