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Müller F, Proske A, Füchtmeier B, Wulbrand C. Are Process Changes Measurable? An Analysis of 4136 Proximal Femur Fractures over 16 Year. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38621696 DOI: 10.1055/a-2276-6440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Prozessänderungen im perioperativen Setting werden selten analysiert, weil ihre Ergebnisse nicht unmittelbar fassbar sind und es einer hohen Fallzahl bedarf. Primäres Ziel war es, Prozessänderungen retrospektiv anhand proximaler Femurfrakturen (PF) zu evaluieren und deren Effekt mit verschiedenen Zielkriterien zu überprüfen. Sekundäres Ziel war die Definition möglicher Qualitätskriterien für die Versorgung von PF.Retrospektive Analyse der Datenbank eines Level-1-Traumazentrums zu PF. Eingeschlossen wurden alle osteosynthetisch und endoprothetisch versorgten PF im Behandlungszeitraum vom 01.01.2006 bis 31.12.2021. Der Zeitraum von 16 Jahren wurde für die Statistik trichotom aufgeteilt und die ersten 6 Jahre als Ausgangsbasis verwendet. Insgesamt 10 Prozessänderungen wurden in den folgenden 10 Jahren vorgenommen. Die Auswirkungen dieser Änderungen wurden anhand 1. der operativen Revisionsrate, 2. der Infektionsrate, 3. der perioperativen Transfusionsrate sowie 4. der 1-Jahres-Letalität überprüft.Insgesamt 4163 PF wurden analysiert. Hinsichtlich der Zielkriterien zeigten die Änderungen der ersten 5 Jahre (2012-2016; intramedulläres Verfahren für Osteosynthesen sowie Einwegabdeckung und Einwegkittel) den stärksten Effekt mit einer erstmaligen Senkung der operativen Revisionsrate unter 10% auf Dauer. Weitere Prozessoptimierungen der letzten 5 Jahre (2017-2021) erbrachten ebenfalls messbare Verbesserungen (Senkung der Infektions- und Transfusionsrate). Die 1-Jahres-Letalität blieb unverändert, auch während der COVID-19-Pandemie.Prozessänderungen bei PF führen nicht unmittelbar zu objektiv messbaren Verbesserungen. Rückblickend erscheint der Paradigmenwechsel von extra- auf intramedulläre Osteosynthese den höchsten Effekt erzielt zu haben, wenngleich über die letzten 10 Jahre eine schrittweise Besserung aller Zielkriterien eintrat - mit Ausnahme der Letalität. Als objektive Qualitätskontrolle sollte eine 1-Jahres-Revisionsrate unter 10% angestrebt sein.
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Affiliation(s)
- Franz Müller
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Andreas Proske
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Bernd Füchtmeier
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Christian Wulbrand
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
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Wilharm A, Wutschke I, Schenk P, Hofmann GO. Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome. Geriatr Orthop Surg Rehabil 2023; 14:21514593221147817. [PMID: 36654888 PMCID: PMC9841876 DOI: 10.1177/21514593221147817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/24/2022] [Accepted: 11/21/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction: Implantation of a dual-head hip prosthesis to treat medial femoral neck fractures is often associated with significant blood loss. In elective endoprosthetics procedures, it has already been demonstrated that administration of tranexamic acid (TXA) reduces blood loss and need for postoperative transfusions, as well as reducing the frequency of postoperative complications. The aim of this study is to show whether the administration of TXA also leads to a reduction in perioperative blood loss and haemorrhage-associated complications when applied as part of treatment of femoral neck fractures using a dual-head prosthesis. Methods: In a single-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 93 patients who had suffered from femoral neck fractures. This group was compared to a comparison group of 65 patients who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, frequency of transfusion, and frequency of specific complications occurring. Results: The transfusion rate in the TXA group was 6% lower, whereby the volume of blood transfused was 26.7% lower than in the nonTXA group. However, neither result was significant. The calculated perioperative blood loss remained the same. Similarly, the incidence of postoperative renal failure was not significantly lower in the TXA group, at 6.5%, as compared to the nonTXA group (7.7%). A higher rate of complications or deaths as a result of TXA administration was not observed. The tranexamic acid effect seems to be related to the dose. Conclusion: Preoperative administration of TXA during implantation of a dual-head prosthesis for treatment of a femoral neck fracture does not lead to an increased complication rate. The study revealed a trend towards fewer transfusions required, but a significant reduction in blood loss could not be demonstrated. There should be further investigation of other factors influencing blood loss, in particular the dosing regimen followed for perioperative administration of TXA. Level of Evidence: Level 4: retrospective case-control study.
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Affiliation(s)
- Arne Wilharm
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany,Arne Wilharm, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, Jena 07747, Germany.
| | - Isabell Wutschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Philipp Schenk
- Department of Research Executive, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Gunther Olaf Hofmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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Stojadinovic IB, Ristic BM, Knezevic DR, Milenkovic ZS, Prodanovic NS, Zornic NR, Milosevic JB. The effect of tranexamic acid on the reduction of intraoperative and postoperative blood loss and thromboembolic risk in patients with hip fracture. Open Med (Wars) 2022; 17:857-862. [PMID: 35582194 PMCID: PMC9055253 DOI: 10.1515/med-2022-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/24/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
The aim of this study is to determine whether the use of tranexamic acid (TXA) in patients with hip fracture reduces intraoperative and postoperative blood loss, and on the other hand, whether it increases thromboembolic risk. The study was performed on patients with hip fracture for a period of one year. Patients were divided into two groups (1:1): the first group receiving TXA and the second group receiving placebo. The amount of blood aspiration during the surgery was measured as well as drainage in the postoperative period of 24 h. The occurrence of deep vein thrombosis (DVT) was monitored before and after the surgery by ultrasound of the lower extremities. The amount of total blood loss was two times lower in patients who received TXA (291.8 ± 65.5 mL of blood vs 634.7 ± 150.5 mL of blood). Among the patients who developed DVT, one patient was from the group that did not receive TXA, and two patients were from the group that received TXA. The use of TXA in patients with hip fracture significantly reduces intraoperative and postoperative blood loss, without a significant thromboembolic risk.
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Affiliation(s)
- Ivan B. Stojadinovic
- Department of Spinal Surgery, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Branko M. Ristic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica St. 69, Kragujevac, 34000, Serbia
- Department of Traumatology, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Dragan R. Knezevic
- Vascular Surgery Department, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Zoran S. Milenkovic
- Department of Traumatology, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Nikola S. Prodanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica St. 69, Kragujevac, 34000, Serbia
- Department of Alloartoplastic Surgery, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Nenad R. Zornic
- Department of Anesthesia and Intensive Care, University Clinical Center Kragujevac, Kragujevac, 34000, Serbia
| | - Jelena B. Milosevic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, 34000, Serbia
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Oguayo C, Helal A, Dawkins J, Bhimani A, Nimmons SJB, Jones AL, Rizkalla JM. Relation of tranexamic acid therapy to length of stay in the hip fracture population. Proc AMIA Symp 2022; 35:301-304. [DOI: 10.1080/08998280.2022.2028347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Chris Oguayo
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - Asad Helal
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - Jonathan Dawkins
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - Aamir Bhimani
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | | | - Alan L. Jones
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
| | - James M. Rizkalla
- Department of Orthopedics, Baylor University Medical Center, Dallas, Texas
- Coptic Medical Association of North America (CMANA) Research Institute, Dallas, Texas
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