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Jovanovic G, Lukic-Sarkanovic M, Lazetic F, Tubic T, Lendak D, Uvelin A. The Effect of Intravenous Tranexamic Acid on Perioperative Blood Loss, Transfusion Requirements, Verticalization, and Ambulation in Total Knee Arthroplasty: A Randomized Double-Blind Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1183. [PMID: 39064612 PMCID: PMC11279079 DOI: 10.3390/medicina60071183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is sometimes associated with significant perioperative bleeding. The aim of this study was to determine the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss in patients undergoing primary TKA. The secondary objectives were to assess the efficacy of TXA in reducing the need for blood transfusion in these patients and to determine its effect on verticalization and ambulation after TKA. Materials and Methods: This study included 96 patients who were randomly assigned to two groups, each containing 48 patients. The study group received intravenous TXA at two time points: immediately after the induction with doses of 15 mg/kg and 10 mg/kg 15 min before the release of the pneumatic tourniquet. The control group received an equivalent volume of 0.9% saline solution via the same route. Results: TXA markedly reduced (Z = -6.512, p < 0.001) the total perioperative blood loss from 892.56 ± 324.46 mL, median 800 mL, interquartile range (IQR) 530 mL in the control group, to 411.96 ± 172.74 mL, median 375 mL, IQR 200 mL, in the TXA group. In the TXA group, only 5 (10.4%) patients received a transfusion, while in the control group, 22 (45.83%) received it (χ2 = 15.536, p = 0.001). Patients in the study group stood (χ2 = 21.162, p < 0.001) and ambulated earlier postoperatively, compared to the control group (χ2 = 26.274, p < 0.001). Patients who received TXA had a better overall postoperative functional recovery. There was a statistically significant difference in all the above results. Conclusions: TXA is an effective drug for reducing the incidence of perioperative bleeding, decreasing transfusion rates, and indirectly improving postoperative functional recovery in patients undergoing primary TKA.
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Affiliation(s)
- Gordana Jovanovic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.L.-S.); (T.T.); (D.L.); (A.U.)
- Clinic for Anesthesia, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Mirka Lukic-Sarkanovic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.L.-S.); (T.T.); (D.L.); (A.U.)
- Clinic for Anesthesia, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Filip Lazetic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia;
| | - Teodora Tubic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.L.-S.); (T.T.); (D.L.); (A.U.)
- Clinic for Anesthesia, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Dajana Lendak
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.L.-S.); (T.T.); (D.L.); (A.U.)
- Clinic for Infectious Disease, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Arsen Uvelin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (M.L.-S.); (T.T.); (D.L.); (A.U.)
- Clinic for Anesthesia, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
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Ashir A, Maya EG, Saiyed SR, Alimohamed TM, Jusabani MA, Abdel KA, Sadiq AM, Ali AM, Mandari FN. Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania. Adv Orthop 2024; 2024:4145592. [PMID: 38827523 PMCID: PMC11142858 DOI: 10.1155/2024/4145592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024] Open
Abstract
Background Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries. Methods This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop. Results A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses. Conclusion With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.
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Affiliation(s)
- Abdel Ashir
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elifuraha G. Maya
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | | | - Kulthum A. Abdel
- Faculty of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Abid M. Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ali Mohamed Ali
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Faiton Ndesanjo Mandari
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Thom ML, Burkhart RJ, Arza RA, Brown MC, Wera GD. Are periprosthetic hip fractures more severe than native hip fractures? A systematic review of outcomes and resource utilization. Arch Orthop Trauma Surg 2024; 144:1117-1127. [PMID: 38156997 DOI: 10.1007/s00402-023-05116-1] [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: 02/15/2023] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is a paucity of data comparing periprosthetic hip fracture (PPHFx) outcomes and resource utilization to native fractures. Many surgeons consider periprosthetic hip fractures to be more severe injuries than native fractures. The aim of this systematic review is to characterize the outcomes of PPHFx and assess their severity relative to native hip fractures (NHFx). METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic review was conducted using Medline, Biosis, and Cinahl. Primary outcomes were time to surgery, length of stay (LOS), cost of management, disposition, complication rates, readmission rates, and mortality. RESULTS 14 articles (13,489 patients) from 2010 to 2018 were included in the study. Study quality was generally low. Patient follow-up ranged from 1 month to 3.2 years. LOS ranged from 5.2 to 38 days. US cost of management was best estimated at $53,669 ± 19,817. Discharge to skilled nursing facilities ranged from 64.5 to 74.5%. Time to surgery ranged from 1.9 to 5.7 days. Readmission rates ranged from 12 to 32%. Per Clavien-Dindo classification, 33.9% suffered minor complications; 14.3% suffered major complications. 1 month and 1 year mortality ranged from 2.9% to 10% and 9.7% to 45%, respectively. CONCLUSION Time to surgery and LOS were longer for PPHFx relative to NHFx. Complications' rates were higher for PPHFx compared to NHFx. There is no evidence for differences in LOS, cost, discharge, readmission rates, or mortality between PPHFx and NHFx. These results may serve as a baseline in future evaluation of PPHFx management.
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Affiliation(s)
- Mitchell L Thom
- Case Western Reserve University, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
- Orthopaedic Surgery, Schulich School of Medicine and Dentistry, London, Canada.
| | - Robert J Burkhart
- Case Western Reserve University, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Ramón A Arza
- Case Western Reserve University, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Marsalis C Brown
- MetroHealth Main Campus Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Glenn D Wera
- Avon Richard E. Jacobs Health Center, 33100 Cleveland Clinic Blvd, Avon, OH, 44011, USA
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Farrow L, Brasnic L, Martin C, Ward K, Adam K, Hall AJ, Clement ND, MacLullich AMJ. A nationwide study of blood transfusion in hip fracture patients. Bone Joint J 2022; 104-B:1266-1272. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0450.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. Methods A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes. Results A total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay. Conclusion Blood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction. Cite this article: Bone Joint J 2022;104-B(11):1266–1272.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Lorena Brasnic
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Caroline Martin
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Kirsty Ward
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Karen Adam
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Andrew J. Hall
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Nick D. Clement
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alasdair M. J. MacLullich
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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