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Meißner N, Strahl A, Rolvien T, Halder AM, Schrednitzki D. Blood transfusion in elective total hip arthroplasty: can patient-specific parameters predict transfusion? Bone Jt Open 2024; 5:560-564. [PMID: 38971574 PMCID: PMC11227374 DOI: 10.1302/2633-1462.57.bjo-2023-0157.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
Aims Transfusion after primary total hip arthroplasty (THA) has become rare, and identification of causative factors allows preventive measures. The aim of this study was to determine patient-specific factors that increase the risk of needing a blood transfusion. Methods All patients who underwent elective THA were analyzed retrospectively in this single-centre study from 2020 to 2021. A total of 2,892 patients were included. Transfusion-related parameters were evaluated. A multiple logistic regression was performed to determine whether age, BMI, American Society of Anesthesiologists (ASA) grade, sex, or preoperative haemoglobin (Hb) could predict the need for transfusion within the examined patient population. Results The overall transfusion rate was 1.2%. Compared to the group of patients without blood transfusion, the transfused group was on average older (aged 73.8 years (SD 9.7) vs 68.6 years (SD 10.1); p = 0.020) and was mostly female (p = 0.003), but showed no significant differences in terms of BMI (28.3 kg/m2 (SD 5.9) vs 28.7 kg/m2 (SD 5.2); p = 0.720) or ASA grade (2.2 (SD 0.5) vs 2.1 (SD 0.4); p = 0.378). The regression model identified a cutoff Hb level of < 7.6 mmol/l (< 12.2 g/dl), aged > 73 years, and a BMI of 35.4 kg/m² or higher as the three most reliable predictors associated with postoperative transfusion in THA. Conclusion The possibility of transfusion is predictable based on preoperatively available parameters. The proposed thresholds for preoperative Hb level, age, and BMI can help identify patients and take preventive measures if necessary.
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Affiliation(s)
- Nils Meißner
- Department of Orthopaedic Surgery, Sana Hospital Sommerfeld, Kremmen, Germany
| | - André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas M. Halder
- Department of Orthopaedic Surgery, Sana Hospital Sommerfeld, Kremmen, Germany
| | - Daniel Schrednitzki
- Department of Orthopaedic Surgery, Sana Hospital Sommerfeld, Kremmen, Germany
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Park LJ, D'Souza D, Kazi T, Rodriguez F, Griffiths C, McKechnie T, Mertz D, Serrano PE. Comparing cefazolin/ metronidazole, piperacillin-tazobactam, or c efoxitin as surgical antibiotic prophylaxis in patients undergoing pancreaticoduodenectomy: A retrospective cohort study. J Surg Oncol 2024; 129:1413-1419. [PMID: 38664921 DOI: 10.1002/jso.27641] [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] [Received: 02/14/2024] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Preoperative antibiotic options for pancreaticoduodenectomy (PD) include cefoxitin (CX), piperacillin-tazobactam (PT), or combined cefazolin and metronidazole (CM). Recent studies suggest the superiority of PT over CX, but evidence for CM is unclear. OBJECTIVE To explore the impact of preoperative antibiotic selection (CM vs. PT and CX vs. PT) on the development of surgical site infections (SSI). METHODS Consecutive adult patients at one institution who underwent PD from November 2017 to December 2021 and received either CM, PT, or CX preoperatively, were included. The primary outcome was SSI. Secondary outcomes included postoperative infections and clinically significant postoperative pancreatic fistula (POPF). Logistic regression models were used. RESULTS Among 127 patients included in the study, PT, CM, and CX were administered in 46 (36.2%), 44 (34.6%), and 37 (29.4%) patients, respectively. There were 32 (27.1%) SSI, 20 (36.1%) infections, and 21 (22.9%) POPF events. PT use was associated with reduced risk of SSI compared to CX (OR: 0.32, 95% CI: 0.11-0.89, p = 0.03), but there was no difference as compared to CM (OR: 0.75, 95% CI: 0.27-2.13, p = 0.59). There were no differences in secondary outcomes. CONCLUSION PT reduced SSI rates compared to CX but was no different to CM among patients undergoing PD at our center.
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Affiliation(s)
- Lily J Park
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daniel D'Souza
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tania Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Felipe Rodriguez
- NYU Langone Health, New York University, New York, New York, USA
| | - Christopher Griffiths
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Pablo E Serrano
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
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Meißner N, Halder AM, Schrednitzki D. Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study. Arch Orthop Trauma Surg 2023; 143:6447-6451. [PMID: 37036500 PMCID: PMC10088768 DOI: 10.1007/s00402-023-04851-9] [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: 12/25/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Little scientific evidence exists on blood loss and transfusion rates depending on the fixation technique. The hypothesis of this study was that the blood loss and transfusion rate are lower in cemented and hybrid total hip arthroplasty (THA) compared to cementless THA. METHODS We retrospectively compared a total of 1500 patients who received either cementless, cemented, hybrid or reverse hybrid THA. All patients underwent THA in 2021 at a single orthopedic center in Germany. RESULTS The lowest blood loss was found in patients who received a fully cemented THA (695 ± 74 ml). Hybrid THA with a cemented stem showed a blood loss of 845 ± 30 ml and reverse hybrid THA showed the highest blood loss with an average of 994 ± 74 ml. Cementless THA caused an average blood loss of 957 ± 16 ml. There was a significant difference between cementless THA, hybrid THA (cemented stem), and fully cemented THA (p < 0.05). Transfusion rates ranged from 1.3% (cementless THA) to 7.9% (cemented THA) between the groups with a transfusion rate of 2.5% overall. CONCLUSION We found significantly lower blood loss in cemented THA and hybrid THA compared to cementless THA. Although blood loss was lower in cemented and hybrid THA, this did not result in lower transfusion rates. This could be due to other confounders such as age, comorbidities, and preoperative anemia.
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Affiliation(s)
- Nils Meißner
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany.
| | - Andreas M Halder
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
| | - Daniel Schrednitzki
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
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Cao G, Yang X, Yue C, Tan H, Xu H, Huang Z, Quan S, Yang M, Pei F. The effect of body mass index on blood loss and complications in simultaneous bilateral total hip arthroplasty: A multicenter retrospective study. J Orthop Surg (Hong Kong) 2022; 29:23094990211061209. [PMID: 34872412 DOI: 10.1177/23094990211061209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The effect of body mass index (BMI) on blood loss in simultaneous bilateral total hip arthroplasty (SBTHA) was still undetermined. The purpose of the study was to evaluate the blood loss, transfusion and incidence of complications in normal, overweight, and obese patients undergoing SBTHA. METHODS A total of 344 patients following SBTHA were enrolled into this study. The patients were assigned into three groups on the basis of their BMI, including normal (BMI 18.0-24.9 kg/ m2), overweight (BMI 25.0-29.9 kg/ m2), or obese group (BMI ≥ 30.0 kg/ m2). The primary outcome was total blood loss (TBL), and secondary outcomes were intraoperative blood loss, drain volume, ratio of TBL and patient's blood volume (PBV), transfusion rate and volume, hemoglobin and hematocrit drop, length of stay, expenses, and complications. RESULTS The PBV and TBL increased significantly along with the elevated BMI (p < 0.001; p = 0.019, respectively). There was no significant difference in intraoperative blood loss, drain volume, transfusion volume, length of stay, expenses, or incidence of complications among the three groups. In addition, the transfusion rate in normal group was higher than that in overweight (58.3% vs 39.6%, p = 0.001) and obese group (58.3% vs 31.9%, p = 0.001). The maximum hemoglobin drop in obese group was the highest (p = 0.001). CONCLUSION Obesity could increase perioperative blood loss but not increase transfusion risk in the setting of SBTHA. Conversely, obese and overweight patients maybe have lower transfusion need compared with normal patients because of more blood volume. In addition, obesity did not affect the incidence of complications.
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Affiliation(s)
- Guorui Cao
- Department of Knee Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Xiuli Yang
- Department of Orthopaedic Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Chen Yue
- Department of Knee Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Honglue Tan
- Department of Knee Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Songtao Quan
- Department of Knee Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Minglu Yang
- Department of Knee Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, 34753Sichuan University, Chengdu, China
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Magill P, Hill JC, Bryce L, Martin U, Dorman A, Hogg R, Campbell C, Gardner E, McFarland M, Bell J, Benson G, Beverland D. Oral tranexamic acid for an additional 24 hours postoperatively versus a single preoperative intravenous dose for reducing blood loss in total knee arthroplasty: results of a randomized controlled trial (TRAC-24). Bone Joint J 2021; 103-B:1595-1603. [PMID: 34587808 DOI: 10.1302/0301-620x.103b10.bjj-2020-2308.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS In total knee arthroplasty (TKA), blood loss continues internally after surgery is complete. Typically, the total loss over 48 postoperative hours can be around 1,300 ml, with most occurring within the first 24 hours. We hypothesize that the full potential of tranexamic acid (TXA) to decrease TKA blood loss has not yet been harnessed because it is rarely used beyond the intraoperative period, and is usually withheld from 'high-risk' patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease, a patient group who would benefit greatly from a reduced blood loss. METHODS TRAC-24 was a prospective, phase IV, single-centre, open label, parallel group, randomized controlled trial on patients undergoing TKA, including those labelled as high-risk. The primary outcome was indirect calculated blood loss (IBL) at 48 hours. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional 24-hour postoperative oral regime of four 1 g doses, while Group 2 only received the intraoperative dose and Group 3 did not receive any TXA. RESULTS Between July 2016 and July 2018, 552 patients were randomized to either Group 1 (n = 241), Group 2 (n = 243), or Group 3 (n = 68), and 551 were included in the final analysis. The blood loss did differ significantly between the two intervention groups (733.5 ml (SD 384.0) for Group 1 and 859.2 ml (SD 363.6 ml) for Group 2; mean difference -125.8 ml (95% confidence interval -194.0 to -57.5; p < 0.001). No differences in mortality or thromboembolic events were observed in any group. CONCLUSION These data support the hypothesis that in TKA, a TXA regime consisting of IV 1 g perioperatively and four oral 1 g doses over 24 hours postoperatively significantly reduces blood loss beyond that achieved with a single IV 1 g perioperative dose alone. TXA appears safe in patients with history of thromboembolic, cardiovascular, and cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(10):1595-1603.
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Affiliation(s)
- Paul Magill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Leeann Bryce
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Una Martin
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Al Dorman
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Rosemary Hogg
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Christina Campbell
- Northern Ireland Clinical Trials Unit, Royal Victoria Hospital, Belfast, UK
| | - Evie Gardner
- Northern Ireland Clinical Trials Unit, Royal Victoria Hospital, Belfast, UK
| | | | - Jennifer Bell
- Northern Ireland Clinical Trials Unit, Royal Victoria Hospital, Belfast, UK
| | - Gary Benson
- Department of Haematology, Belfast City Hospital, Belfast, UK
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Affiliation(s)
- Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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