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Güllüev M, Yücel A, Demirci B, Kaplan D, Özdemir LE. The relationship between posttonsillectomy bleeding to hemogram and coagulation parameters. Eur Arch Otorhinolaryngol 2024; 281:2569-2574. [PMID: 38315176 DOI: 10.1007/s00405-024-08487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Tonsillectomy is a common surgery performed for indications such as chronic tonsilitis, tonsil hypertrophy and obsructive sleep apnea. Although posttonsillectomy bleeding (PTB) is rare and can be controlled with simple interventions in many patients, it is one of the most feared complications of tonsillectomy surgery. In our study, we investigated the effects of changes in hemogram and coagulation values and seasonal effects on PTB. METHODS Pediatric and adult patients who underwent tonsillectomy with cold knife method between August 2020 and August 2023 in our clinic were retrospectively reviewed. Demographic data, hemogram and coagulation values of the patients in the control and study groups were recorded and the differences between the two groups in terms of these parameters were evaluated. RESULTS Our study included 991 patients aged 1-51 years. The rate of PTB was calculated as 2.82%. No patient with primary PTB was found. The duration of bleeding development was 7.03 days. Age, WBC and neutrophil values were statistically significantly higher in the study group. There were no significant differences between two groups in terms of gender, season and other hemogram and coagulation parameters. CONCLUSIONS Age, high WBC and neutrophil levels were determined as possible risk factors for PTB. Seasonal and gender distribution, aPTT and INR values were similar in the two groups. In order to prevent and predict bleeding, detailed infection investigation should be performed and the risk of bleeding should be considered to increase with increasing age.
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Affiliation(s)
- Mustafa Güllüev
- Department of Otorhinolaryngology, Develi State Hospital, Kayseri, 38100, Turkey.
| | - Abitter Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Berat Demirci
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Duygu Kaplan
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Latif Emre Özdemir
- Department of Otorhinolaryngology, University of Health Sciences, Konya City Hospital, Konya, Turkey
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Kobori I, Soga K, Tamano M. Bile duct cannulation with a balloon catheter and hemostasis when identification of the papilla is difficult due to clots from bleeding after endoscopic sphincterotomy. Dig Endosc 2024; 36:642-643. [PMID: 38462916 DOI: 10.1111/den.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
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Affiliation(s)
- Ikuhiro Kobori
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Koichi Soga
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masaya Tamano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Paramo R, Cheng T, Malik A, Fan J, Barmettler A. Effect of Tranexamic Acid on Intra- and Postoperative Bleeding in Eyelid Surgery: A Prospective, Randomized, Multicenter, Double-Masked, Control Trial. Ophthalmic Plast Reconstr Surg 2024; 40:331-335. [PMID: 38624153 DOI: 10.1097/iop.0000000000002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE Pilot studies suggest that waiting 15 minutes after a subcutaneous tranexamic acid injection is associated with decreased intraoperative bleeding and postoperative ecchymosis in eyelid surgery. The outcomes of commencing eyelid surgery immediately after injection without a waiting period remain unexplored. METHODS This prospective, randomized, multicenter, double-masked, controlled study examined bilateral symmetric upper and/or lower lid blepharoplasty or ptosis repair. Patients received tranexamic acid in 1 eyelid and control in the contralateral eyelid. The surgeon recorded the side with more intraoperative bleeding. Two masked graders evaluated periocular ecchymosis at postoperative day 0 and postoperative week 1 (POW 1) with a 5-point scale. At POW 1, patients reported subjective grading of bruising as increased on 1 side or similar on both sides. Results were analyzed with Wilcoxon signed-rank and sign tests. RESULTS Of 130 patients, there was less eyelid ecchymosis on the tranexamic side at postoperative day 0 ( p = 0.001) and POW 1 ( p < 0.001). By surgery type, the 69 levator advancement surgeries had significantly less ecchymosis at postoperative day 0 ( p < 0.001) and POW 1 ( p = 0.001), while upper eyelid blepharoplasty, combined upper and lower lid blepharoplasty, and conjunctivomullerectomy trended toward significance. Of 68 patients reporting a POW 1 grading, 69% reported less bruising on the tranexamic side ( p < 0.001). Intraoperative bleeding was not significantly different between sides ( p = 0.930). CONCLUSIONS Without a postinjection waiting period, subcutaneous tranexamic acid for eyelid surgery significantly decreased postoperative ecchymosis on postoperative day 0 and POW 1 but did not affect intraoperative bleeding. Subcutaneous tranexamic acid was not associated with any complications.
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Affiliation(s)
- Ricky Paramo
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York, U.S.A
| | - Tiffany Cheng
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York, U.S.A
| | - Amina Malik
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - James Fan
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Anne Barmettler
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York, U.S.A
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Lu Z, Qin C, Zhang M, Li T. Postoperative delayed massive bleeding in gastric cancer: a case report. J Med Case Rep 2024; 18:218. [PMID: 38658989 PMCID: PMC11044427 DOI: 10.1186/s13256-024-04531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Postoperative delayed bleeding of gastric cancer is a complication of radical gastrectomy with low incidence rate and high mortality. CASE PRESENTATION This case report presents the case of a 63-year-old female patient of Mongolian ethnicity who was diagnosed with gastric malignancy during a routine medical examination and underwent Billroth's I gastric resection in our department. However, on the 24th day after the surgery, she was readmitted due to sudden onset of hematemesis. Gastroscopy, abdominal CT, and digital subtraction angiography revealed postoperative anastomotic fistula, rupture of the duodenal artery, and bleeding from the abdominal aorta. The patient underwent three surgical interventions and two arterial embolizations. The patient's condition stabilized, and she was discharged successfully. CONCLUSION Currently, there are no specific guidelines for the diagnosis and treatment of pseudoaneurysms in the abdominal cavity resulting from gastric cancer surgery. Early digital subtraction angiography examination should be performed to assist in formulating treatment plans. Early diagnosis and treatment contribute to an improved overall success rate of rescue interventions.
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Affiliation(s)
- Zhongting Lu
- Graduate School, Ningxia Medical University, Ningxia, China
| | - Chenhui Qin
- The General Hospital of Taiyuan Central Hospital, Shanxi, China
| | - Mingxuan Zhang
- Graduate School, Ningxia Medical University, Ningxia, China
| | - Tao Li
- Department of Surgical Oncology, Tumor Hospital, The General Hospital of Ningxia Medical University, Ningxia, China.
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Iyer M, Shah R, Zheng W, Ziada KM, Khot U, Krishnaswamy A, Kapadia SR, Reed GW. Aetiology and predictors of major bleeding events in patients with heart failure with reduced ejection fraction undergoing percutaneous coronary intervention. Open Heart 2024; 11:e002572. [PMID: 38663889 PMCID: PMC11043724 DOI: 10.1136/openhrt-2023-002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES We sought to determine the relationship between the degree of left ventricular ejection fraction (LVEF) impairment and the frequency and type of bleeding events after percutaneous coronary intervention (PCI). DESIGN This was an observational retrospective cohort analysis. Patients who underwent PCI from 2009 to 2017 were identified from our institutional National Cardiovascular Disease Registry (NCDR) CathPCI database. Patients were stratified by pre-PCI LVEF: preserved (≥50%), mildly reduced (41%-49%) and reduced (≤40%) LVEF. PRIMARY OUTCOME MEASURES The outcome was major bleeding, defined by NCDR criteria. Events were classified based on bleeding aetiology and analysed by multivariable logistic regression. RESULTS Among 13 537 PCIs, there were 817 bleeding events (6%). The rate of bleeding due to any cause, blood transfusion, gastrointestinal bleeding and coronary artery perforation or tamponade each increased in a stepwise fashion comparing preserved, mildly reduced and reduced LVEF reduction (p<0.05 for all comparisons). However, there were no differences in bleeding due to asymptomatic drops in haemoglobin, access site haematoma or retroperitoneal bleeding. After multivariable adjustment, mildly reduced and reduced LVEF remained independent predictors of bleeding events (OR 1.36, 95% CI 1.06 to 1.74, p<0.05 and OR 1.73, 95% CI 1.45 to 2.06, p<0.0001). CONCLUSIONS The degree of LV dysfunction is an independent predictor of post-PCI major bleeding events. Patients with mildly reduced or reduced LVEF are at greatest risk of post-PCI bleeding, driven by an increased need for blood transfusion, major GI bleeding events and coronary artery perforation or tamponade. Pre-PCI LV dysfunction does not predict asymptomatic declines in haemoglobin, access site haematoma or retroperitoneal bleeding.
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Affiliation(s)
- Meghana Iyer
- Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio, USA
| | - Rohan Shah
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Weili Zheng
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Umesh Khot
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Wang J, Hou J, Feng K, Wu H, Liu Q, Zhou Z, Li H, Luo L, Fu G, Shang L, Chen G, Huang S, Wu Z. Development and validation of a postoperative bleeding complications prediction model in infective endocarditis. Int J Cardiol 2024; 396:131432. [PMID: 37827281 DOI: 10.1016/j.ijcard.2023.131432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/23/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Bleeding complications are one of the most serious postoperative complications after cardiac surgery and are associated with high mortality, especially in patients with infective endocarditis (IE). Our objectives were to identify the risk factors and develop a prediction model for postoperative bleeding complications in IE patients. METHODS The clinical data of IE patients treated from October 2013 to January 2022 were reviewed. Multivariate logistic regression analysis was used to evaluate independent risk factors for postoperative bleeding complications and develop a prediction model accordingly. The prediction model was verified in a temporal validation cohort. The performance of the model was evaluated in terms of its discrimination power, calibration, precision, and clinical utility. RESULTS A total of 423 consecutive patients with IE who underwent surgery were included in the final analysis, including 315 and 108 patients in the training cohort and validation cohort, respectively. Four variables were selected for developing a prediction model, including platelet counts, systolic blood pressure, heart failure and vegetations on the mitral and aortic valves. In the training cohort, the model exhibited excellent discrimination power (AUC = 0.883), calibration (Hosmer-Lemeshow test, P = 0.803), and precision (Brier score = 0.037). In addition, the model also demonstrated good discrimination power (AUC = 0.805), calibration (Hosmer-Lemeshow test, P = 0.413), and precision (Brier score = 0.067) in the validation cohort. CONCLUSIONS We developed and validated a promising risk model with good discrimination power, calibration, and precision for predicting postoperative bleeding complications in IE patients.
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Affiliation(s)
- Junjie Wang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Hou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kangni Feng
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huawei Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Quan Liu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huayang Li
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Luo
- Department of Cardiac Surgery, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Guangguo Fu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liqun Shang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangxian Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Cardiothoracic Surgery ICU, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Meng R, Wang W, Zhai Z, Zuo C. Machine learning algorithm to predict postoperative bleeding complications after lateral decubitus percutaneous nephrolithotomy. Medicine (Baltimore) 2024; 103:e37050. [PMID: 38277513 PMCID: PMC10817089 DOI: 10.1097/md.0000000000037050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
Bleeding is a serious complication following percutaneous nephrolithotomy (PCNL). This study establishes a predictive model based on machine learning algorithms to forecast the occurrence of postoperative bleeding complications in patients with renal and upper ureteral stones undergoing lateral decubitus PCNL. We retrospectively collected data from 356 patients with renal stones and upper ureteral stones who underwent lateral decubitus PCNL in the Department of Urology at Peking University First Hospital-Miyun Hospital, between January 2015 and August 2022. Among them, 290 patients had complete baseline data. The data was randomly divided into a training group (n = 232) and a test group (n = 58) in an 8:2 ratio. Predictive models were constructed using Logistic Regression, Random Forest, and Extreme Gradient Boosting (XGBoost). The performance of each model was evaluated using Accuracy, Precision, F1-Score, Receiver Operating Characteristic curves, and Area Under the Curve (AUC). Among the 290 patients, 35 (12.07%) experienced postoperative bleeding complications after lateral decubitus PCNL. Using postoperative bleeding as the outcome, the Logistic model achieved an accuracy of 73.2%, AUC of 0.605, and F1 score of 0.732. The Random Forest model achieved an accuracy of 74.5%, AUC of 0.679, and F1 score of 0.732. The XGBoost model achieved an accuracy of 68.3%, AUC of 0.513, and F1 score of 0.644. The predictive model for postoperative bleeding after lateral decubitus PCNL, established based on machine learning algorithms, is reasonably accurate. It can be utilized to predict postoperative stone residue and recurrence, aiding urologists in making appropriate treatment decisions.
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Affiliation(s)
- Rui Meng
- Department of Urology, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Weining Wang
- Department of Urology, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Zhipeng Zhai
- Department of Urology, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Chao Zuo
- Department of Urology, Peking University First Hospital - Miyun Hospital, Beijing, China
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Brar AS, Behera UC, Karande S, Kanakagiri A, Sugumar S, Rani PK, Vignesh TP, Manayath G, Salian R, Giridhar A, Indurkhya S, Bhattacharjee H, Raman R, Sivaprasad S. Late postoperative vitreous cavity hemorrhage after vitrectomy for proliferative diabetic retinopathy-observation versus intervention. Indian J Ophthalmol 2024; 72:S22-S26. [PMID: 38131537 PMCID: PMC10833151 DOI: 10.4103/ijo.ijo_311_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the outcome of intervention versus observation for vitreous cavity hemorrhage occurring after a 2-month period of blood-free cavity (late postoperative vitreous cavity hemorrhage-POVCH) in eyes operated by vitrectomy for complications of proliferative diabetic retinopathy (PDR). METHODS This study was a 10-year retrospective, observational, multi-center study involving eight major vitreoretinal surgical centers across India from January 2010 to December 2019. The primary objective of the study was to assess the visual and clinical outcomes of various management approaches for late POVCH. The key secondary objective was to determine the best management option that prevented recurrence. Patients with follow-up of less than 6 months of POVCH management were excluded. RESULTS The occurrence of late POVCH was studied in 261 eyes. The median time to occurrence was 7 months (range: 2-87) postvitrectomy/silicone oil removal. The majority (58%) experienced a single, nonrecurring POVCH event. Visual acuity outcome was independent of all management approaches (P = 0.179; mean follow-up 20.7 ± 14.1 months). With watchful observation, spontaneous resolution was noted in 83% (60/72 eyes) of eyes in 81.5 days (interquartile range, 169.75). Silicone oil injection was most effective in preventing recurrence (P < 0.001). CONCLUSION The current treatment practice of late POVCH management in PDR suggests that watchful observation for at least 3 months could be as efficacious as any surgical intervention.
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Affiliation(s)
- Anand S Brar
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Umesh C Behera
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Sayali Karande
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Akhila Kanakagiri
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Shalini Sugumar
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Padmaja K Rani
- Srimati Kanuri Santhamma Center for Vitreo-retinal Diseases, Anant Bajaj Retina Institute, LV Prasad Eye Institute (Kallam Anji Reddy Campus), Hyderabad, Telangana, India
| | - T P Vignesh
- Vitreo-retina Department, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - George Manayath
- Vitreo-retina Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Romit Salian
- Vitreo-retina Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | | | - Swati Indurkhya
- Vitreo-retina Department, Giridhar Eye Institute, Cochin, Kerala, India
| | - Harsha Bhattacharjee
- Department of Anterior and Posterior Segment, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Hsu JL, Chen KA, Butler LR, Bahraini A, Kapadia MR, Gomez SM, Farrell TM. Application of machine learning to predict postoperative gastrointestinal bleed in bariatric surgery. Surg Endosc 2023; 37:7121-7127. [PMID: 37311893 DOI: 10.1007/s00464-023-10156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Postoperative gastrointestinal bleeding (GIB) is a rare but serious complication of bariatric surgery. The recent rise in extended venous thromboembolism regimens as well as outpatient bariatric surgery may increase the risk of postoperative GIB or lead to delay in diagnosis. This study seeks to use machine learning (ML) to create a model that predicts postoperative GIB to aid surgeon decision-making and improve patient counseling for postoperative bleeds. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used to train and validate three types of ML methods: random forest (RF), gradient boosting (XGB), and deep neural networks (NN), and compare them with logistic regression (LR) regarding postoperative GIB. The dataset was split using fivefold cross-validation into training and validation sets, in an 80/20 ratio. The performance of the models was assessed using area under the receiver operating characteristic curve (AUROC) and compared with the DeLong test. Variables with the strongest effect were identified using Shapley additive explanations (SHAP). RESULTS The study included 159,959 patients. Postoperative GIB was identified in 632 (0.4%) patients. The three ML methods, RF (AUROC 0.764), XGB (AUROC 0.746), and NN (AUROC 0.741) all outperformed LR (AUROC 0.709). The best ML method, RF, was able to predict postoperative GIB with a specificity and sensitivity of 70.0% and 75.4%, respectively. Using DeLong testing, the difference between RF and LR was determined to be significant with p < 0.01. Type of bariatric surgery, pre-op hematocrit, age, duration of procedure, and pre-op creatinine were the 5 most important features identified by ML retrospectively. CONCLUSIONS We have developed a ML model that outperformed LR in predicting postoperative GIB. Using ML models for risk prediction can be a helpful tool for both surgeons and patients undergoing bariatric procedures but more interpretable models are needed.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack CB#7050, Chapel Hill, NC, 27599, USA.
| | - Kevin A Chen
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack CB#7050, Chapel Hill, NC, 27599, USA
| | - Logan R Butler
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anoosh Bahraini
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack CB#7050, Chapel Hill, NC, 27599, USA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack CB#7050, Chapel Hill, NC, 27599, USA
| | - Shawn M Gomez
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack CB#7050, Chapel Hill, NC, 27599, USA
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Kataria S, Juneja D, Singh O. Approach to thromboelastography-based transfusion in cirrhosis: An alternative perspective on coagulation disorders. World J Gastroenterol 2023; 29:1460-1474. [PMID: 36998429 PMCID: PMC10044856 DOI: 10.3748/wjg.v29.i9.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023] Open
Abstract
Viscoelastic tests, specifically thromboelastography and rotational thromboelastometry, are increasingly being used in the management of postoperative bleeding in surgical intensive care units (ICUs). However, life-threatening bleeds may complicate the clinical course of many patients admitted to medical ICUs, especially those with underlying liver dysfunction. Patients with cirrhosis have multiple coagulation abnormalities that can lead to bleeding or thrombotic complications. Compared to conventional coagulation tests, a comprehensive depiction of the coagulation process and point-of-care availability are advantages favoring these devices, which may aid physicians in making a rapid diagnosis and instituting early interventions. These tests may help predict bleeding and rationalize the use of blood products in these patients.
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Affiliation(s)
- Sahil Kataria
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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Dyas AR, Zhuang Y, Meguid RA, Henderson WG, Madsen HJ, Bronsert MR, Colborn KL. Development and validation of a model for surveillance of postoperative bleeding complications using structured electronic health records data. Surgery 2022; 172:1728-1732. [PMID: 36150923 PMCID: PMC10204070 DOI: 10.1016/j.surg.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/01/2022] [Accepted: 08/22/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Postoperative bleeding complications surveillance is done primarily through manual chart review. The purpose of this study was to develop and validate a detection model for postoperative bleeding complications using structured electronic health records data. METHODS Patients who underwent operations at 1 of 5 hospitals within our local health system between 2013 and 2019 and whose complications were reported by the American College of Surgeons National Surgical Quality Improvement Program were included. Electronic health records data were linked to American College of Surgeons National Surgical Quality Improvement Program data using personal health identifiers. Electronic health records predictors included diagnosis codes mapped to PheCodes, procedure names, and medications within 30 days after surgery. We defined bleeding events as the transfusion of red blood cell components within 30 days after surgery. The knockoff filter and the lasso were used to develop a model in a training set of operations from January 2013 to March 2017. Performance of each model was tested in a held-out data set of patients who underwent operations from March 2017 to October 2019. RESULTS A total of 30,639 patients were included; 1,112 patients (3.6%) had a bleeding event. Eight predictor variables were selected by the knockoff filter. When applied to the test set, specificity was 94%, sensitivity was 94%, area under the curve was 0.97, and accuracy was 93%. Calibration was consistent in lower predicted risk patients, whereas the model slightly overpredicted risk in high-risk patients. CONCLUSION We created a parsimonious, accurate model for identifying patients with bleeding complications. This model can be used to augment manual chart review for surveillance and reporting of perioperative bleeding complications, enabling inclusion of all surgeries in quality improvement efforts.
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Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO.
| | - Yaxu Zhuang
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Helen J Madsen
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Kathryn L Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
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12
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Maccabe TA, Robertson HF, Skipworth J, Rees J, Roberts K, Pathak S. A systematic review of post-pancreatectomy haemorrhage management stratified according to ISGPS grading. HPB (Oxford) 2022; 24:1110-1118. [PMID: 35101359 DOI: 10.1016/j.hpb.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Morbidity and mortality from post-pancreatectomy haemorrhage (PPH) remains high. The International Study Group of Pancreatic Surgery (ISGPS) published guidelines to standardise definitions of PPH severity, management and reporting. This study aimed to i) identify the number of studies reporting PPH using ISGPS guidelines (Grade A, B or C) and ii) describe treatment modality success by grade. METHODS A systematic literature review was performed, identifying studies reporting PPH by ISGPS Grade and their subsequent management. RESULTS Of 62 studies reporting on PPH management, 17 (27.4%) stratified by ISGPS guidelines and included 608 incidences of PPH: 48 Grade A, 274 Grade B (62 early, 166 late, 46 unspecified) and 286 Grade C. 96% of Grade A PPH were treated conservatively. Of 62 early Grade B, 54.8% were managed conservatively and 37.1% surgically. Late Grade B were managed non-operatively in 25.3% (42/166), with successful endoscopy in 90.9% (10/11) and angiography in 90.3% (28/31). In Grade C, endoscopic treatment was successful in 64.4% (29/45) and angiography in 90.8% (108/119). Surgical intervention was required in 43.5% early Grade B, 7.8% late Grade B and 33.2% Grade C. CONCLUSION PPH grading is underreported and despite guidelines, inconsistencies remain when using definitions and reporting of outcomes.
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Affiliation(s)
- Thomas A Maccabe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK.
| | - Harry F Robertson
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - James Skipworth
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - Jonathan Rees
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - Keith Roberts
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK; Department of Pancreatic Surgery, University Hospitals Birmingham, UK
| | - Samir Pathak
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
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13
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Alekyan BG, Varava AB, Lusnikov VP, Davydenko PI, Chevina AA, Goev AA, Kriger AG, Revishvili AS. Endovascular treatment of delayed arterial bleeding after pancreatic surgery: single-center experience. Khirurgiia (Mosk) 2022:5-15. [PMID: 35289543 DOI: 10.17116/hirurgia20220315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate technical aspects and clinical results of transcatheter arterial embolization (TAE) for delayed postoperative arterial bleeding after pancreatic surgery. MATERIAL AND METHODS There were 821 pancreatectomies between 2012 and 2020. Delayed bleeding occurred in 106 (12.9%) patients; 74 patients were included in the study. Previous pancreatic head resection was carried out in 75.7% of cases, pancreatic body resection - in 17.6% of cases, pancreatic tail resection - in 6.8% of patients. Primary endpoint was technical success of TAE, secondary endpoints - complications after TAE, as well as recurrent bleeding after embolization. RESULTS Angiography of celiac-mesenteric arterial system was performed in 74 patients (91 procedures). The most common sources of bleeding were gastroduodenal and superior mesenteric arteries (35.7%), jejunal arteries (13.1%), common hepatic artery (11.9%). Combination of embolization agents was applied for TAE (metal coils and non-calibrated PVA particles, 48.6%). In 11 (14.9%) patients, we applied stent-grafts. Technical success rate was 100%. Recurrent bleeding occurred in 13 (17.6%) patients. In-hospital mortality was 12.2% (n=9). CONCLUSION TAE is an effective treatment procedure in patients with arrosive bleeding. This method is characterized by high technical efficiency and low in-hospital mortality, but it does not affect recurrence of bleeding.
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Affiliation(s)
- B G Alekyan
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Varava
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V P Lusnikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - P I Davydenko
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A A Chevina
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A A Goev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A Sh Revishvili
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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14
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Konanur A, McCoy JL, Shaffer A, Kitsko D, Maguire R, Padia R. Detecting coagulopathy in pediatric patients with post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol 2021; 147:110807. [PMID: 34192615 DOI: 10.1016/j.ijporl.2021.110807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-tonsillectomy hemorrhage (PTH) is a serious complication after a tonsillectomy. Utility of lab work at presentation for PTH was low. This study aims to determine the frequency and type of labs drawn at emergency department (ED) presentation and assess the incidence of uncovering a previously unidentified coagulopathy. METHODS A retrospective chart review was performed on pediatric patients who were seen in the ED after tonsillectomy at a tertiary care children's hospital from 2017 to 2019. Exclusion criteria were the following: no tonsillar bleed, history of known coagulopathy, treated by outside provider, ≥18 years old. Lab work included complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), and von Willebrand factor (VWF). RESULTS 364/723 (50.3%) patients met inclusion criteria. 179/364 (49.2%) patients were male and 309/364 (84.9%) patients were Caucasian. Average age at surgery was 8.12 years (SD = 4.0) and average post-operative day at presentation was 6 days (SD = 2.1). Operative control of bleed was performed in 68/364 (18.7%) patients. 334/364 (91.8%) patients had labs drawn in the ED. 64/334 (19.1%) patients were anemic (hemoglobin (Hgb) < 11), 46/334 (13.8%) patients had thrombocytosis (platelets>450,000), 10/334 (3.0%) had elevated PTT and 8/334 (2.4%) had elevated PT. Hematology was consulted in 14/364 (3.8%) patients of whom 6/14 were diagnosed with von Willebrand disease and 1/14 with factor VII deficiency. Aminocaproic acid was used in 8/364 (2.2%) patients due to elevated PTT in 3/8 and multiple episodes of bleeding in 5/8.3/364 (0.8%) patients needed a blood transfusion. No difference was found in incidence of abnormal lab work in patients who did and did not need operative control of bleed (p = .125). Of the 334 patients who had ED labs drawn, 7 (2.1%) had an uncovered coagulopathy. CONCLUSION Uncovering incidental coagulopathies is rare in patients who present with PTH. Though anemia was the most common abnormality noted, only a small percentage required transfusion, with all having abnormal vital signs. Thrombocytosis was the next common abnormality, and this can be seen in an inflammatory state. Developing algorithms is necessary to better guide appropriate lab work in patients who present with PTH and to provide optimal value of care to patients.
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Affiliation(s)
- Anisha Konanur
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amber Shaffer
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Dennis Kitsko
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond Maguire
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Reema Padia
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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15
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Wang Y, Xie J, Pei F. Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty: A STROBE compliant article. Medicine (Baltimore) 2021; 100:e26058. [PMID: 34011123 PMCID: PMC8136990 DOI: 10.1097/md.0000000000026058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy.Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Venous blood sample at different time points (preoperative, intraoperative, postoperative 6 hours, 12 hours, 24 hours, 48 hours) were drawn to test D-dimer, fibrin (-ogen) degradation products (FDP) and TEG.The TEG parameters associated with coagulation (R, K, α, MA, and CI) and fibrinolysis (estimate percent lysis and Ly30) were all in normal range although had a higher level than preoperative time (P < .05). The postoperative levels of D-dimer and FDP were higher than preoperative level (P < .05). The dynamics of D-dimer and FDP presented a bimodal pattern, which peaked at 6 hours postoperatively, then remained and decreased until 24 hours, but would rebound at 48 hours postoperatively with smaller amplitude. Moreover, FDP6h (P = .028), D-Dimer6h (P = .044), FDP12h (P = .009), D-dimer12h (P = .007), and FDP48h (P = .016) were all correlated with total blood loss on POD3.FDP and D-dimer were effective and practical markers for prediction of acute postoperative fibrinolytic activity, which peaked at 6 hours after end of surgery and would maintain for at least 24 hours.
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Affiliation(s)
- Yan Wang
- Core Facility of West China Hospital
| | - Jinwei Xie
- Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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16
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Billings KR, Stake C, Arzu J, Lavin J. Outcomes of a Postoperative Data-Extraction Questionnaire After Adenotonsillectomy in Children. Laryngoscope 2021; 131:E2821-E2826. [PMID: 34014559 DOI: 10.1002/lary.29626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate outcomes of a postoperative telephone questionnaire for children who underwent adenotonsillectomy (T&A). To determine whether episodes of postoperative hemorrhage were not captured until the call, and whether this impacted knowledge of physician rates of hemorrhage. STUDY DESIGN Retrospective database analysis. METHODS Retrospective analysis of outcomes of an 11-question data extraction tool utilized at a tertiary care children's hospital for follow-up in T&A patients <18 years of age over a 2-year period. Sub-analysis of positive responses to the question asking about incidence of postoperative hemorrhage. RESULTS During the study period, 1,068/3,142 (34.0%) parents responded to the phone call. Median age was 6.0 years (interquartile range [IQR] 4.0-8.2), and 566 (53.0%) were male. Ninety (8.4%) noted that the child was still snoring, but only 9 (0.84%) reported signs of obstructed breathing. A total of 402 (37.6%) reported a voice change after surgery. Most children (n = 885, 82.9%) did not receive opioid analgesics, and 252 (23.6%) received acetaminophen/ibuprofen 7 days postoperatively. Return visits to the emergency department were reported in 149 patients; primarily for hemorrhage in 46 (30.8%). In 7 (15.2%) patients, the hemorrhage event was not recorded until the call. The majority-of respondents (n = 1,031, 96.5%) were satisfied with the outcome of the procedure. CONCLUSIONS The postoperative T&A tool provided a means of gathering information on success and satisfaction with surgical outcomes. Children were able to be managed primarily with acetaminophen and ibuprofen. Most complications were captured in the electronic record, although some episodes of hemorrhage were not noted until the call, emphasizing the importance of follow-up. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Kathleen R Billings
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Christine Stake
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Styopushkin S, Chaikovskyi V, Chernylovskyi V, Sokolenkо R, Bondarenko D. POSTOPERATIVE HEMORRHAGE AS A COMPLICATION OF A PARTIAL NEPHRECTOMY: FREQUENCY, FEATURES AND MANAGEMENT. Georgian Med News 2021:12-20. [PMID: 34103423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective - to study the character of possible postoperative complications and to define the reason and frequency of postoperative hemorrhage as a complication of partial nephrectomy. From January 2008 to December 2019 were performed 175 partial nephrectomy (PN) by a single surgeon in a high volume center. 41 operations were laparoscopic partial nephrectomy (LPN), 134 - open partial nephrectomy (OPN). In 152 cases kidney cancer was detected. Physical status, tumor volume, R.E.N.A.L. score, operative access, warm ischemia time (WIT), postoperative bleeding and its severity and treatment options were assessed in both groups of patients. Based on our study, R.E.N.A.L score may be a good tool in prognosis of a delay postoperative bleeding after nephron sparing surgery and this is statistically significant. On the other hand, single R.E.N.A.L score characteristics can't be reliable predictors of a delay bleeding. It is possible that a lack of cases with a significant postoperative bleeding in current study (6 of 175 cases) have some statistical restrictions. From our point of view, for better prognosis of delay bleeding, aside from hephrometric system it is important to take into account a proximity of a segmental arteries to a resection border, presens of any type of a coagulopathy and a preoperative antithrombotic therapy, obesity. High R.E.N.A.L score index is connected with a risk of significant postoperative bleeding, but this type of bleeding is rare after any nephron sparing surgery. Postoperative selective angioembolization is a method of choice and, in most cases, effective to stop kidney bleeding and nephron preservation.
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Abstract
RATIONALE Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery. PATIENT CONCERNS A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years. DIAGNOSIS The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery. INTERVENTION Portal venous angioplasty using balloon dilation and stent implantation was performed. OUTCOMES After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up. LESSONS Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.
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Affiliation(s)
- Yang Tai
- Department of Gastroenterology
- Laboratory of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Bo Wei
- Department of Gastroenterology
| | - Hao Wu
- Department of Gastroenterology
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Chen Y, Duan J. Diagnostic Value of Peripheral Blood miR-148a-3p in Patients with Liver Injury After Hepatectomy Under General Anesthesia with Propofol. Clin Lab 2020; 66. [PMID: 32162885 DOI: 10.7754/clin.lab.2019.190814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current study aims to evaluate the correlation between peripheral blood miR-148a-3p level in patients with liver injury after hepatectomy under general anesthesia with propofol, thereby evaluating whether circulating miR-148a-3p can be used as a biomarker of liver injury after hepatectomy. METHODS One hundred one patients who underwent hepatectomy at the Fourth Hospital of Xi'an were selected. On the first day after operation, peripheral blood was taken to determine the level of miR-148a-3p in peripheral blood. The correlation between circulating miR-148a-3p and liver injury after operation was analyzed using Pearson's correlation assay. RESULTS First, our data showed that the level of miR-148a-3p was increased in the peripheral blood of patients after hepatectomy. The amount of bleeding was significantly correlated with the increase of ALT, AST, and miR-148a-3p. Moreover, the level of miR-148a-3p was significantly correlated with alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Further analysis showed that intraoperative propofol dosage was correlated with ALT, AST, and miR-148a-3p after hepatectomy. CONCLUSIONS MiR-148a-3p may be sensitive to ischemic and traumatic liver injury and may be a marker of liver injury after hepatectomy under general anesthesia with propofol.
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Casonato A, Galletta E, Cella G, Barbon G, Daidone V. Acquired von Willebrand Syndrome Hiding Inherited von Willebrand Disease Can Explain Severe Bleeding in Patients With Aortic Stenosis. Arterioscler Thromb Vasc Biol 2020; 40:2187-2194. [PMID: 32640909 DOI: 10.1161/atvbaha.120.314656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aortic stenosis may be complicated by an acquired von Willebrand syndrome that rarely causes significant bleeding, raising the question of why it does so in a few cases. To seek an explanation, we studied 5 severe bleeder aortic stenosis patients in a cohort of 49 patients, using the flowchart for inherited von Willebrand disease. Approach and Results: All 5 patients were lacking in large and intermediate VWF (von Willebrand factor) multimers, 3 had reduced plasma and platelet VWF levels, and none showed PFA100 closure. Two patients (those with most multimers missing) also had a short VWF half-life. Genetic analyses on the 3 patients with reduced platelet VWF levels revealed that one carried both the c.1164C>G and the c.7880G>A mutations, and another carried the c.3390C>T mutation, while the third had one of the 2 VWF alleles relatively less expressed than the other (25% versus 75%). No genetic alterations emerged in the other 2 patients. Successful replacement of the stenotic aortic valve, performed in the 2 patients with VWF mutations, did not correct their abnormal VWF multimer picture-unlike what happened in the aortic stenosis patients without bleeding symptoms. CONCLUSIONS Our findings suggest that acquired von Willebrand syndrome can develop in patients with hitherto-undiagnosed inherited von Willebrand disease. Since von Willebrand disease is the most common bleeding disorder, this possibility should be considered in aortic stenosis patients-especially those with a more severe bleeding history and more disrupted VWF laboratory patterns-because they risk hemorrhage during aortic valve replacement.
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Affiliation(s)
- Alessandra Casonato
- From the Department of Medicine, First Chair of Internal Medicine (A.C., E.G., G.B., V.D.), University of Padua Medical School, Italy
| | - Eva Galletta
- From the Department of Medicine, First Chair of Internal Medicine (A.C., E.G., G.B., V.D.), University of Padua Medical School, Italy
| | - Giuseppe Cella
- Department of Cardiac, Thoracic and Vascular Sciences (G.C.), University of Padua Medical School, Italy
| | - Giovanni Barbon
- From the Department of Medicine, First Chair of Internal Medicine (A.C., E.G., G.B., V.D.), University of Padua Medical School, Italy
| | - Viviana Daidone
- From the Department of Medicine, First Chair of Internal Medicine (A.C., E.G., G.B., V.D.), University of Padua Medical School, Italy
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Abstract
OBJECTIVE This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy. METHODS Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient's estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy. RESULTS The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy. CONCLUSIONS HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients' postoperative rehabilitation.
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Affiliation(s)
- Miaomiao Ye
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junhan Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linzhi Yan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Abstract
This study aimed to identify the correlation of contradiction between DAPT score and PRECISE-DAPT score with the severity of coronary lesion in acute coronary syndromes (ACS).In total, 458 patients with ACS after a percutaneous coronary intervention (PCI) who had tolerated 1-year uneventful dual antiplatelet therapy (DAPT) were enrolled and divided into groups based on the Gensini score, number of stenosed vessels, and left main (LM) disease. Both DAPT score and PRECISE-DAPT score were calculated and the proportion of patients receiving conflicting recommendations from each score was compared among the groups.DAPT score as well as the proportion of patients with DAPT score ≥2 were associated with the Gensini score and the number of stenosed vessels. Similarly, PRECISE-DAPT score as well as the proportion of patients with PRECISE-DAPT score ≥25 were associated with the Gensini score and the number of stenosed vessels. The proportion of patients with DAPT score ≥2 along with PRECISE-DAPT score ≥25 were associated with Gensini score, but they had no significant association with the number of stenosed vessels (P = .006 and P = .075, respectively). None of those aforementioned items were associated with LM disease.The inconsistencies of DAPT scores and PRECISE-DAPT scores are frequent and associated with the severity of coronary disease, represented by the Gensini score. Appropriate clinical decisions should be individualized.
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Affiliation(s)
- Sisi Bi
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Yue Zhao
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Qingling Peng
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Wenxue Liu
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Guogang Zhang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Chenglong Zhang
- Department of Cardiology, Xiangya Hospital of Central South University
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Abstract
BACKGROUND Accurate prediction of operative transfusions is essential for resource allocation and identifying patients at risk of postoperative adverse events. This research examines the efficacy of using artificial neural networks (ANNs) to predict transfusions for all inpatient operations. METHODS Over 1.6 million surgical cases over a two year period from the NSQIP-PUF database are used. Data from 2014 (750937 records) are used for model development and data from 2015 (885502 records) are used for model validation. ANN and regression models are developed to predict perioperative transfusions for surgical patients. RESULTS Various ANN models and logistic regression, using four variable sets, are compared. The best performing ANN models with respect to both sensitivity and area under the receiver operator characteristic curve outperformed all of the regression models (p < .001) and achieved a performance of 70-80% specificity with a corresponding 75-62% sensitivity. CONCLUSION ANNs can predict >75% of the patients who will require transfusion and 70% of those who will not. Increasing specificity to 80% still enables a sensitivity of almost 67%. The unique contribution of this research is the utilization of a single ANN model to predict transfusions across a broad range of surgical procedures.
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Affiliation(s)
- Steven Walczak
- School of Information, Florida Center for Cybersecurity, University of South Florida, Tampa, FL, United States of America
| | - Vic Velanovich
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
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Kibler M, Marchandot B, Messas N, Labreuche J, Vincent F, Grunebaum L, Hoang VA, Reydel A, Crimizade U, Kindo M, Hoang MT, Zeyons F, Trinh A, Petit-Eisenmann H, De Poli F, Leddet P, Duhamel A, Jesel L, Ohana M, Susen S, Ohlmann P, Van Belle E, Morel O. Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 72:2139-2148. [PMID: 30360823 DOI: 10.1016/j.jacc.2018.08.2143] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/13/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.
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Affiliation(s)
- Marion Kibler
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Nathan Messas
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire, Lille, France
| | - Flavien Vincent
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Lelia Grunebaum
- Department of Haemostasis, Centre Hospitalier Universitaire, Strasbourg, France
| | - Viet Anh Hoang
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Antje Reydel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Ulun Crimizade
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Michel Kindo
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Minh Tam Hoang
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Floriane Zeyons
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Annie Trinh
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Hélène Petit-Eisenmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Fabien De Poli
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Pierre Leddet
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Alain Duhamel
- Department of Biostatistics, Centre Hospitalier Universitaire, Lille, France
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Sophie Susen
- University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Eric Van Belle
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France. https://twitter.com/Eric_Van_Belle
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France.
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Mortazavi BJ, Bucholz EM, Desai NR, Huang C, Curtis JP, Masoudi FA, Shaw RE, Negahban SN, Krumholz HM. Comparison of Machine Learning Methods With National Cardiovascular Data Registry Models for Prediction of Risk of Bleeding After Percutaneous Coronary Intervention. JAMA Netw Open 2019; 2:e196835. [PMID: 31290991 PMCID: PMC6624806 DOI: 10.1001/jamanetworkopen.2019.6835] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Better prediction of major bleeding after percutaneous coronary intervention (PCI) may improve clinical decisions aimed to reduce bleeding risk. Machine learning techniques, bolstered by better selection of variables, hold promise for enhancing prediction. OBJECTIVE To determine whether machine learning techniques better predict post-PCI major bleeding compared with the existing National Cardiovascular Data Registry (NCDR) models. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used the NCDR CathPCI Registry data version 4.4 (July 1, 2009, to April 1, 2015), machine learning techniques were used (logistic regression with lasso regularization and gradient descent boosting [XGBoost, version 0.71.2]), and output was then compared with the existing simplified risk score and full NCDR models. The existing models were recreated, and then performance was evaluated through additional techniques and variables in a 5-fold cross-validation in analysis conducted from October 1, 2015, to October 27, 2017. The setting was retrospective modeling of a nationwide clinical registry of PCI. Participants were all patients undergoing PCI. Percutaneous coronary intervention procedures were excluded if they were not the index PCI of admission, if the hospital site had missing outcomes measures, or if the patient underwent subsequent coronary artery bypass grafting. EXPOSURES Clinical variables available at admission and diagnostic coronary angiography data were used to determine the severity and complexity of presentation. MAIN OUTCOMES AND MEASURES The main outcome was in-hospital major bleeding within 72 hours after PCI. Results were evaluated by comparing C statistics, calibration, and decision threshold-based metrics, including the F score (harmonic mean of positive predictive value and sensitivity) and the false discovery rate. RESULTS The post-PCI major bleeding rate among 3 316 465 procedures (patients' median age, 65 years; interquartile range, 56-73 years; 68.1% male) was 4.5%. The existing full model achieved a mean C statistic of 0.78 (95% CI, 0.78-0.78). The use of XGBoost and full range of selected variables achieved a C statistic of 0.82 (95% CI, 0.82-0.82), with an F score of 0.31 (95% CI, 0.30-0.31). XGBoost correctly identified an additional 3.7% of cases identified as high risk who experienced a bleeding event and an overall improvement of 1.0% of cases identified as low risk who did not experience a bleeding event. The data-driven decision threshold helped improve the false discovery rate of the existing techniques. The existing simplified risk score model improved the false discovery rate from more than 90% to 78.7%. Modifying the model and the data decision threshold improved this rate from 78.7% to 73.4%. CONCLUSIONS AND RELEVANCE Machine learning techniques improved the prediction of major bleeding after PCI. These techniques may help to better identify patients who would benefit most from strategies to reduce bleeding risk.
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Affiliation(s)
- Bobak J. Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Emily M. Bucholz
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Now with the Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Chenxi Huang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Richard E. Shaw
- Division of Cardiology, Department of Medicine, California Pacific Medical Center, Sutter Health, San Francisco
| | | | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Anker AM, Miranda BH, Prantl L, Kehrer A, Strauss C, Brébant V, Klein SM. 50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery. Aesthetic Plast Surg 2019; 43:608-615. [PMID: 30903252 DOI: 10.1007/s00266-019-01345-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding. METHODS A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003-2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs. RESULTS Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons. CONCLUSIONS This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding. LEVEL OF EVIDENCE IV 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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Affiliation(s)
- A M Anker
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - B H Miranda
- Plastic and Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, NW3 2QG, UK
| | - L Prantl
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Kehrer
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C Strauss
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - V Brébant
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Klein
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Iyengar A, Sanaiha Y, Aguayo E, Seo YJ, Dobaria V, Toppen W, Shemin RJ, Benharash P. Comparison of Frequency of Late Gastrointestinal Bleeding With Transcatheter Versus Surgical Aortic Valve Replacement. Am J Cardiol 2018; 122:1727-1731. [PMID: 30316451 DOI: 10.1016/j.amjcard.2018.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022]
Abstract
Improvements in technology and operator experience have led to exponential growth of transcatheter aortic valve implantation (TAVI) programs. Late bleeding complications were recently highlighted after TAVI with a high impact on morbidity. The purpose of the present study was to assess the incidence and financial impact of late Gastrointestinal (GI) bleeding after TAVI, and compare with the surgical cohort. Retrospective analysis of the National Readmissions Database was performed from January 2011 to December 2014, and patients who underwent TAVI or surgical aortic valve replacement (SAVR) were identified. Incidence of readmission with a diagnosis of GI bleeding was utilized as the primary end point. Overall, 43,357 patients were identified who underwent TAVI, whereas 310,013 patients underwent SAVR. Compared with SAVR, TAVI patients were older (81 vs 68y, p < 0.001), more women (48% vs 36%, p < 0.001), and had higher Elixhauser Comorbidity Index (6 vs 5, p < 0.001). Hospital stay was shorter with TAVI (5 vs 8 days, p < 0.001), but raw in-hospital mortality rates were similar (4.2% vs 3.8%, p = 0.022). In the TAVI cohort, 3.3% of patients were rehospitalized for GI bleeding compared with 1.5% of the SAVR cohort (p < 0.001). Average time to bleeding readmission was similar between cohorts (92 vs 84 days, p = 0.049). After multivariable adjustment, TAVI remained significantly associated with readmissions for GI bleeding compared with SAVR Adjusted Odds Ratio (AOR 1.54 [1.38 to 1.71], p < 0.001). In this national cohort study, TAVI was associated with more frequent readmissions for late GI bleeding compared with SAVR. In conclusion, strategies to reduce late GI bleeding may serve as important targets for improvement in overall quality of care.
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Affiliation(s)
- Amit Iyengar
- David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Yas Sanaiha
- Division of Cardiac Surgery, David Geffen School ofMedicine, University of California, Los Angeles, CA
| | - Esteban Aguayo
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Young-Ji Seo
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vishal Dobaria
- Division of Cardiac Surgery, David Geffen School ofMedicine, University of California, Los Angeles, CA
| | - William Toppen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Richard J Shemin
- Division of Cardiac Surgery, David Geffen School ofMedicine, University of California, Los Angeles, CA
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School ofMedicine, University of California, Los Angeles, CA
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Peterson JA, Maroney SA, Zwifelhofer W, Wood JP, Yan K, Bercovitz RS, Woods RK, Mast AE. Heparin-protamine balance after neonatal cardiopulmonary bypass surgery. J Thromb Haemost 2018; 16:1973-1983. [PMID: 30016577 PMCID: PMC6173634 DOI: 10.1111/jth.14245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 12/18/2022]
Abstract
Essentials Heparin-protamine balance (HPB) modulates bleeding after neonatal cardiopulmonary bypass (CPB). HPB was examined in 44 neonates undergoing CPB. Post-operative bleeding occurred in 36% and heparin rebound in 73%. Thrombin-initiated fibrin clot kinetic assay and partial thromboplastin time best assessed HPB. SUMMARY Background Neonates undergoing cardiopulmonary bypass (CPB) are at risk of excessive bleeding. Blood is anticoagulated with heparin during CPB. Heparin activity is reversed with protamine at the end of CPB. Paradoxically, protamine also inhibits blood coagulation when it is dosed in excess of heparin. Objectives To evaluate heparin-protamine balance in neonates undergoing CPB by using research and clinical assays, and to determine its association with postoperative bleeding. Patients/Methods Neonates undergoing CPB in the first 30 days of life were studied. Blood samples were obtained during and after surgery. Heparin-protamine balance was assessed with calibrated automated thrombography, thrombin-initiated fibrin clot kinetic assay (TFCK), activated partial thromboplastin time (APTT), anti-FXa activity, and thromboelastometry. Excessive postoperative bleeding was determined by measurement of chest tube output or the development of cardiac tamponade. Results and Conclusions Of 44 neonates enrolled, 16 (36%) had excessive postoperative bleeding. The TFCK value was increased. By heparin in neonatal blood samples, but was only minimally altered by excess protamine. Therefore, it reliably measured heparin in samples containing a wide range of heparin and protamine concentrations. The APTT most closely correlated with TFCK results, whereas anti-FXa and thromboelastometry assays were less correlative. The TFCK and APTT assay also consistently detected postoperative heparin rebound, providing an important continued role for these long-established coagulation tests in the management of postoperative bleeding in neonates requiring cardiac surgical repair. None of the coagulation tests predicted the neonates who experienced postoperative bleeding, reflecting the multifactorial causes of bleeding in this population.
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Affiliation(s)
- J A Peterson
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - S A Maroney
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - W Zwifelhofer
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - J P Wood
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - K Yan
- Departments of Pathology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R S Bercovitz
- Departments of Pathology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R K Woods
- HermaHeart Center, Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
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Meyer A, Zverinski D, Pfahringer B, Kempfert J, Kuehne T, Sündermann SH, Stamm C, Hofmann T, Falk V, Eickhoff C. Machine learning for real-time prediction of complications in critical care: a retrospective study. Lancet Respir Med 2018; 6:905-914. [PMID: 30274956 DOI: 10.1016/s2213-2600(18)30300-x] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/29/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The large amount of clinical signals in intensive care units can easily overwhelm health-care personnel and can lead to treatment delays, suboptimal care, or clinical errors. The aim of this study was to apply deep machine learning methods to predict severe complications during critical care in real time after cardiothoracic surgery. METHODS We used deep learning methods (recurrent neural networks) to predict several severe complications (mortality, renal failure with a need for renal replacement therapy, and postoperative bleeding leading to operative revision) in post cardiosurgical care in real time. Adult patients who underwent major open heart surgery from Jan 1, 2000, to Dec 31, 2016, in a German tertiary care centre for cardiovascular diseases formed the main derivation dataset. We measured the accuracy and timeliness of the deep learning model's forecasts and compared predictive quality to that of established standard-of-care clinical reference tools (clinical rule for postoperative bleeding, Simplified Acute Physiology Score II for mortality, and the Kidney Disease: Improving Global Outcomes staging criteria for acute renal failure) using positive predictive value (PPV), negative predictive value, sensitivity, specificity, area under the curve (AUC), and the F1 measure (which computes a harmonic mean of sensitivity and PPV). Results were externally retrospectively validated with 5898 cases from the published MIMIC-III dataset. FINDINGS Of 47 559 intensive care admissions (corresponding to 42 007 patients), we included 11 492 (corresponding to 9269 patients). The deep learning models yielded accurate predictions with the following PPV and sensitivity scores: PPV 0·90 and sensitivity 0·85 for mortality, 0·87 and 0·94 for renal failure, and 0·84 and 0·74 for bleeding. The predictions significantly outperformed the standard clinical reference tools, improving the absolute complication prediction AUC by 0·29 (95% CI 0·23-0·35) for bleeding, by 0·24 (0·19-0·29) for mortality, and by 0·24 (0·13-0·35) for renal failure (p<0·0001 for all three analyses). The deep learning methods showed accurate predictions immediately after patient admission to the intensive care unit. We also observed an increase in performance in our validation cohort when the machine learning approach was tested against clinical reference tools, with absolute improvements in AUC of 0·09 (95% CI 0·03-0·15; p=0·0026) for bleeding, of 0·18 (0·07-0·29; p=0·0013) for mortality, and of 0·25 (0·18-0·32; p<0·0001) for renal failure. INTERPRETATION The observed improvements in prediction for all three investigated clinical outcomes have the potential to improve critical care. These findings are noteworthy in that they use routinely collected clinical data exclusively, without the need for any manual processing. The deep machine learning method showed AUC scores that significantly surpass those of clinical reference tools, especially soon after admission. Taken together, these properties are encouraging for prospective deployment in critical care settings to direct the staff's attention towards patients who are most at risk. FUNDING No specific funding.
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Affiliation(s)
- Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
| | - Dina Zverinski
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Boris Pfahringer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute of Imaging Science and Computational Modelling, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; Berlin Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Hofmann
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Carsten Eickhoff
- Department of Computer Science, ETH Zurich, Zurich, Switzerland; Center for Biomedical Informatics, Brown University, Providence, RI, USA
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Lim JJ, Takano A, Anantham D. Diagnosis of Diffuse Parenchymal Lung Disease Using Transbronchial Cryobiopsy in an Ambulatory Setting. Ann Acad Med Singap 2018; 47:394-398. [PMID: 30324969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jane Jx Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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O'Connell Ferster AP, Schaefer E, Schubart JR, Carr MM. Ancillary medications and outcomes in post-tonsillectomy patients. Ear Nose Throat J 2018; 97:E19-E24. [PMID: 30138521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
To investigate the impact of medications on outcomes after tonsillectomy, a retrospective review using the MarketScan database was performed. A total of 306,536 privately insured children and adolescents (1 to 17 years old) who underwent tonsillectomy/adenoidectomy were identified from 2008 to 2012. Pharmaceutical claims identified patients who received outpatient prescriptions for ibuprofen, steroids, or topical anesthetics until discharge and for medications for the treatment of attention deficit hyperactivity disorder (ADHD) or montelukast up to 14 days postoperatively. Logistic regression compared prescription claims to outcomes, including postoperative bleeding, dehydration, emergency department visits, and readmissions. Ibuprofen was the only medication associated with increased odds of postoperative bleeding (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.07 to 1.95). Patients receiving steroids had lower odds of dehydration (OR: 0.74, 95% CI: 0.65 to 0.84) and emergency department visits (OR: 0.82, 95% CI: 0.76 to 0.88). Odds of dehydration were highest in patients taking ADHD medications (OR: 1.38, 95% CI: 1.15 to 1.66) and topical anesthetics (OR: 1.32, 95% CI: 1.10 to 1.59). Although causality cannot be assumed in observational studies, steroids and ibuprofen should be used judiciously.
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Affiliation(s)
- Ashley P O'Connell Ferster
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., PO Box 850, Hershey, PA 17033-0850, USA.
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Motoda S, Shiraki N, Ishihara T, Sakaguchi H, Kabata D, Takahara M, Kimura T, Kozawa J, Imagawa A, Nishida K, Shintani A, Iwahashi H, Shimomura I. Predictors of postoperative bleeding after vitrectomy for vitreous hemorrhage in patients with diabetic retinopathy. J Diabetes Investig 2018; 9:940-945. [PMID: 29265703 PMCID: PMC6031499 DOI: 10.1111/jdi.12791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/25/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION To clarify the association between perioperative variables and postoperative bleeding in pars plana vitrectomy for vitreous hemorrhage in diabetic retinopathy. MATERIALS AND METHODS The present retrospective study enrolled 72 eyes of 64 patients who were admitted to Osaka University Hospital between April 2010 and March 2014, and underwent vitrectomy for vitreous hemorrhage as a result of diabetic retinopathy. RESULTS Postoperative bleeding developed in 12 eyes. Using binomial logistic regression analysis, we found that the duration of operation was the only significant variable associated with postoperative bleeding within 12 weeks after vitrectomy. Furthermore, Poisson regression analysis identified fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs, as well as duration of operation, to be significantly associated with the frequency of bleeding within 52 weeks after vitrectomy. CONCLUSIONS Long duration of operation can be used to predict bleeding within both 12 and 52 weeks after vitrectomy. In addition, fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs might be risk factors for postoperative bleeding up to 1 year after vitrectomy.
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Affiliation(s)
- Saori Motoda
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Nobuhiko Shiraki
- Department of OphthalmologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Takuma Ishihara
- Department of Clinical Epidemiology and BiostatisticsGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Hirokazu Sakaguchi
- Department of OphthalmologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Daijiro Kabata
- Department of Clinical Epidemiology and BiostatisticsGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Mitsuyoshi Takahara
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
- Department of Diabetes Care MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Takekazu Kimura
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
- Department of Diabetes Care MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Junji Kozawa
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Akihisa Imagawa
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Kohji Nishida
- Department of OphthalmologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Ayumi Shintani
- Department of Clinical Epidemiology and BiostatisticsGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Hiromi Iwahashi
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
- Department of Diabetes Care MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Iichiro Shimomura
- Department of Metabolic MedicineGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
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Campelo-Parada F, Carrié D, Bartorelli AL, Namiki A, Hovasse T, Kimura T, Serra-Peñaranda A, Varenne O, Lalmand J, Kadota K, Ikari Y, Tobaru T, Fujii K, Nakamura S, Saito S, Wijns W. Radial Versus Femoral Approach for Percutaneous Coronary Intervention: MACE Outcomes at Long-Term Follow-up. J Invasive Cardiol 2018; 30:262-268. [PMID: 29958176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the main outcomes of radial versus femoral access at long-term follow-up. BACKGROUND Little is known about the long-term major cardiovascular events and bleeding complications of patients undergoing percutaneous coronary intervention (PCI) with radial vs femoral approach. METHODS A total of 1107 patients from the CENTURY II trial were included. To minimize baseline differences between radial and femoral groups, we applied propensity-score matching for this comparison. RESULTS In this multicenter study, the radial approach was used in 73.4% of patients. After propensity-score matching, baseline and procedural characteristics were comparable between both groups. Procedural success was high and similar in radial and femoral approaches (98.2% vs 97.5%; P=.47) while radial access was associated with a shorter hospital stay (1.69 ± 1.92 days vs 2.08 ± 1.98 days; P<.01). The short-term bleeding and vascular complication rates were significantly lower in the radial group (1.7% vs 6.2% [P<.001 in-hospital] and 2.7% vs 9.6% [P<.001 at 1-month follow-up]). At 3-year follow-up, radial access was associated with lower rates of all-cause mortality (3.9 vs 6.9%; P=.04) and cardiovascular death (2.1 vs 4.9%; P=.02). The composite of all-cause mortality, myocardial infarction, and revascularization showed no differences between groups (18.2 vs 21.1%; P=.29). CONCLUSIONS Compared to the femoral approach, the radial approach is associated with significantly lower long-term all-cause mortality rate as well as lower in-hospital and short-term bleeding rates. These results suggest additional long-term benefits of radial access for PCI, but should be interpreted within the context of the current study and further verified in future studies.
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Ren H, Yin L, Ma L, Wei M, Ma X. Emergency bedside evacuation of a subset of large postoperative epidural hematomas after neurosurgical procedures. Medicine (Baltimore) 2018; 97:e11475. [PMID: 30045271 PMCID: PMC6078748 DOI: 10.1097/md.0000000000011475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/16/2018] [Indexed: 11/25/2022] Open
Abstract
Postoperative epidural hematoma (POEDH) is a known complication after neurosurgical procedures. Large POEDHs are life-threatening and require emergency evacuation, and open surgery is the mainstay of treatment. Most of POEDHs are hyperdense on computed tomography (CT). We herein report a subset of POEDHs requiring evacuation, which presented with isodense features on CT. The presenting symptoms of patients were severe headache accompanied by nausea and vomiting as well as unilateral limb weakness (n = 1) and consciousness disorder (n = 4). The Glasgow coma score of the patients was 8.4 ± 3.5. All patients underwent emergency bedside burr hole evacuation through a tube, rather than open surgery. The meantime for the bedside procedures is 6.0 ± 1.5 minutes. All 5 POEDHs were proven liquid and evacuated successfully. All patients recovered quickly with good outcomes. We concluded that the isodensity of the POEDHs on CT represent their liquid nature. Bedside burr hole evacuation through a tube may be a recommendable method for this subset of POEDHs requiring evacuation. Thus, an open surgery and general anesthesia may be avoided.
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MESH Headings
- Adult
- Emergency Medical Services/methods
- Female
- Hematoma, Epidural, Cranial/diagnosis
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/physiopathology
- Hematoma, Epidural, Cranial/surgery
- Hemostasis, Surgical/methods
- Humans
- Male
- Middle Aged
- Neurologic Examination/methods
- Neurosurgical Procedures/adverse effects
- Neurosurgical Procedures/methods
- Point-of-Care Testing
- Postoperative Hemorrhage/diagnosis
- Postoperative Hemorrhage/physiopathology
- Postoperative Hemorrhage/surgery
- Reoperation/methods
- Suction/methods
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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Affiliation(s)
- Hecheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin
| | - Long Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin
| | - Lin Ma
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin
| | - Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin
| | - Xiaodong Ma
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Zhao XY, Li JX, Tang XF, Xian Y, Xu JJ, Song Y, Jiang L, Xu LJ, Chen J, Zhang Y, Song L, Gao LJ, Gao Z, Zhang J, Wu Y, Qiao SB, Yang YJ, Gao RL, Xu B, Yuan JQ. Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions. Chin Med J (Engl) 2018; 131:262-267. [PMID: 29363639 PMCID: PMC5798045 DOI: 10.4103/0366-6999.223858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy. We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients. METHODS We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital, China. All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center. Major bleeding was defined as Types 2, 3, and 5 according to Bleeding Academic Research Consortium Definition criteria. RESULTS During a 2-year follow-up, 245 of 9782 patients (2.5%) had major bleeding (MB). CRUSADE (21.00 [12.00, 29.75] vs. 18.00 [11.00, 26.00], P < 0.001) and ACUITY-HORIZONS (9.00 [3.00, 14.00] vs. 6.00 [3.00, 12.00], P < 0.001) risk scores were both significantly higher in the MB than non-MB groups. Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC], 0.565; 95% confidence interval [CI], 0.529-0.601, P = 0.001; AUROC, 0.566; 95% CI, 0.529-0.603, P < 0.001, respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC: 0.579, 95% CI: 0.531-0.627, P = 0.001; AUROC, 0.591; 95% CI, 0.544-0.638, P < 0.001, respectively). However, neither score was a significant predictor in the non-ACS subgroup (P > 0.05). The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup. CONCLUSIONS CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients. The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup.
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Affiliation(s)
- Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Xian
- Department of Neurology, Duke Clinical Research Institute, Durham, NC 27705, USA
| | - Jing-Jing Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Jiang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lian-Jun Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jue Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yin Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Li-Jian Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuan Wu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu-Bin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Godier A, Greinacher A, Faraoni D, Levy JH, Samama CM. Use of factor concentrates for the management of perioperative bleeding: guidance from the SSC of the ISTH. J Thromb Haemost 2018; 16:170-174. [PMID: 29168325 DOI: 10.1111/jth.13893] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A Godier
- Department of Anesthesiology and Intensive Care Medicine, Fondation Adolphe de Rothschild and INSERM UMRS-1140 Faculté de Pharmacie, Descartes University, Paris, France
| | - A Greinacher
- Department of Immunology and Transfusion Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - D Faraoni
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J H Levy
- Departments of Anesthesiology, Surgery, and Critical Care, Duke University School of Medicine, Durham, NC, USA
| | - C M Samama
- Department of Anesthesiology and Intensive Care Medicine, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, Paris Descartes University, Paris, France
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Cucchini U, Muraru D, Badano LP. Cardioembolic Stroke in Patient With Transcatheter Occluded Left Atrial Appendage. J Invasive Cardiol 2018; 30:E7-E8. [PMID: 29289951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A cerebral ischemic event in a patient managed with left atrial appendage (LAA) transcatheter obliteration is illustrated. Transesophageal echocardiography allowed identification and accurate definition of the LAA device leakage.
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Affiliation(s)
- Umberto Cucchini
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Via Giustiniani, 2, 35128 Padova, Italy.
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Becerra AF, Cornavaca MT, Revigliono JI, Contreras A, Albertini R, Tabares AH. Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience. Med Clin (Barc) 2017; 149:281-286. [PMID: 28283268 DOI: 10.1016/j.medcli.2017.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. MATERIAL AND METHODS A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it. RESULTS A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal). CONCLUSIONS Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events.
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Affiliation(s)
- Ana Florencia Becerra
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | | | | | - Alejandro Contreras
- Servicio de Cardiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Ricardo Albertini
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Aldo Hugo Tabares
- Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina; Servicio de Medicina Vascular y Trombosis, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Gajo E, Iftikhar O, Pearson PJ, Feldman T, Guerrero M, Levisay J, Salinger MH. Arterial Cutaneous Femoral Fistulous Tract Closure Using Surgiflo Hemostatic Matrix: A Novel Adjunct for Post-TAVR Access-Site Management. J Invasive Cardiol 2017; 29:277-279. [PMID: 28756421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Several options are available to address hemostasis at the end of a cardiac catheterization or percutaneous transfemoral transcatheter aortic valve replacement (TAVR) when conventional options are ineffective. To date, there have been few studies exploring the use of a topical thrombin preparation, as one of its main contraindications is that it cannot be used intravascularly due to risk of embolization. The following case shows safe utilization of Surgiflo hemostatic gel matrix under fluoroscopic guidance against an inflated balloon in order to achieve closure of a fistulous tract from a femoral artery access site during percutaneous TAVR.
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Affiliation(s)
| | | | | | | | | | | | - Michael H Salinger
- Department of Cardiology, NorthShore University HealthSystem, Evanston, IL 60201 USA.
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Gozdzik W, Adamik B, Wysoczanski G, Gozdzik A, Rachwalik M, Skalec T, Kübler A. Preoperative thromboelastometry for the prediction of increased chest tube output in cardiac surgery: A retrospective study. Medicine (Baltimore) 2017; 96:e7669. [PMID: 28746233 PMCID: PMC5627859 DOI: 10.1097/md.0000000000007669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Bleeding following cardiac surgery is a serious event with potentially life-threatening consequences. Preoperative recognition of coagulation abnormalities and detection of cardiopulmonary bypass (CPB) related coagulopathy could aid in the start of preventive treatment strategies that minimize perioperative blood loss. Most algorithms that analyze thromboelastometry coagulation tests in elective cardiac surgery do not include test results performed before surgery. We evaluated preoperative rotational thromboelastometry test results for their ability to predict blood loss during and after cardiac surgery.A total of 114 adult patients undergoing cardiac surgery with CPB were included in this retrospective analysis. Each patient had thromboelastometry tests done twice: preoperatively, before the induction of anesthesia and postoperatively, 10 minutes after heparin reversal with protamine after decannulation.Patients were placed into 1 of 2 groups depending on whether preoperative thromboelastometry parameters deviated from reference ranges: Group 1 [N = 29; extrinsically activated test (EXTEM) or INTEM results out of normal range] or Group 2 (N = 85; EXTEM and INTEM results within the normal range). We observed that the total amount of chest tube output was significantly greater in Group 1 than in Group 2 (700 mL vs 570 mL, P = .03). At the same time, the preoperative values of standard coagulation tests such as platelet count, aPTT, and INR did not indicate any abnormalities of coagulation.Preoperative coagulation abnormalities diagnosed with thromboelastometry can predict increased chest tube output in the early postoperative period in elective adult cardiac surgery. Monitoring of the coagulation system with thromboelastometry allows rapid diagnosis of coagulation abnormalities even before the start of the surgery. These abnormalities could not always be detected with routine coagulation tests.
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Affiliation(s)
| | | | | | - Anna Gozdzik
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University
| | - Maciej Rachwalik
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University
| | | | - Andrzej Kübler
- Centre of Pain Therapy and Palliative Care, University Hospital, Wroclaw, Poland
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Begtrup KM, Krag AE, Hvas AM. No impact of fish oil supplements on bleeding risk: a systematic review. Dan Med J 2017; 64:A5366. [PMID: 28552094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether it is necessary to discontinue fish oil supplementation prior to surgery. METHODS Studies were identified through PubMed and Embase searches and by reviewing the reference lists of the included papers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Included in the review were publications including a minimum of 20 healthy subjects and studies on patients who were undergoing surgery and who had fish oil exposure. RESULTS In total, 52 publications were included; 32 publications on healthy subjects and 20 publications on patients undergoing surgery. The majority of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. CONCLUSION Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.
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Behera UC, Panda L, Gupta S, Modi RR. Subconjunctival hemorrhage and vision loss after regional ocular anesthesia. Int Ophthalmol 2017; 38:1309-1312. [PMID: 28434070 DOI: 10.1007/s10792-017-0539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of retinal vascular occlusion and associated subconjunctival hemorrhage in needle optic nerve injury during local bulbar anesthesia. METHODS Surgical records of these two subjects who presented with acute vision loss after cataract extraction were studied, and systemic workup and ocular imaging were carried out to establish the cause. RESULTS Computerized tomography showed evidence of optic nerve injury. CONCLUSION Subconjunctival hemorrhage could be an associated clinical finding in hypodermic needle injury-related retinal vascular occlusion during ocular anesthesia.
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Affiliation(s)
| | - Lapam Panda
- L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, 751024, India
| | - Sumi Gupta
- Srikrishna Eye Institute, N-71 Shivalik Nagar, Haridwar, Uttarakhand, 249403, India
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Ansari D, Tingstedt B, Lindell G, Keussen I, Ansari D, Andersson R. Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome. Scand J Surg 2017; 106:47-53. [PMID: 26929287 DOI: 10.1177/1457496916631854] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. MATERIALS AND METHODS A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria. RESULTS A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy. CONCLUSION Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.
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Affiliation(s)
- D Ansari
- 1 Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - B Tingstedt
- 1 Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - G Lindell
- 1 Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - I Keussen
- 2 Department of Radiology, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - D Ansari
- 3 Department of Cardiothoracic Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - R Andersson
- 1 Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
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Fatic N, Kuzmanovic I, Markovic D, Davidovic L, Vukovic M, Kostić D. Kidney injury secondary to endovascular treatment of renal artery stenosis. Angiol Sosud Khir 2017; 23:159-163. [PMID: 28594810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.
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Affiliation(s)
- N Fatic
- Department of vascular surgery, Clinic Center of Montenegro
| | - I Kuzmanovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - D Markovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - L Davidovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - M Vukovic
- Department of vascular surgery, Clinic Center of Montenegro
| | - D Kostić
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
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45
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Khattar NK, Parry PV, Agarwal N, George HK, Kretz ES, Larkin TM, Gruen GS, Abla AA. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop. Orthopedics 2016; 39:e374-6. [PMID: 26966944 DOI: 10.3928/01477447-20160307-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023]
Abstract
Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.
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46
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Tarabrin OA, Tyutrin II, Gavrichenkov DG, Shcherbakov SS, Mazurenko AI, Turenko AV. DIAGNOSTICS AND CORRECTION OF THROMBOHEMORRHAGIC DISORDERS IN PATIENTS WITH GIANT UTERINE MYOMA AT THE PERIOPERATIVE STAGE OF TREATMENT. Anesteziol Reanimatol 2016; 61:450-453. [PMID: 29894615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study was to reduce perioperative blood loss in patients with giant uterine myoma. As a result of studies have provided evidence that the use of anti fibrinolytic therapy as intravenous infusion of tranexamic acid for 30 minutes before the surgery in a dose of 20 mg/kg followed by infusion of 5 mg/kg per hour for the first postoperative day, helped to reduce perioperative blood loss by 29%. Hemoglobin level was higher by 10% (p < 0,05), blood loss was lower by 29% (p < 0,05), the length of stay in hospital was reduced by 24% (p < 0,05) in patients of the second group on the second postoperative day.
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47
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Rababa'h AM, Altarabsheh SE, Haddad O, Deo SV, Obeidat Y, Al-Azzam S. Hawthorn Herb Increases the Risk of Bleeding after Cardiac Surgery: An Evidence-Based Approach. Heart Surg Forum 2016; 19:E175-9. [PMID: 27585196 DOI: 10.1532/hsf.1570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/15/2016] [Indexed: 11/20/2022]
Abstract
<strong>Objectives:</strong> Hawthorn extract consumption is becoming more widespread among the Jordanian population with cardiovascular disorders. We conducted this prospective observational longitudinal study to determine the impact of hawthorn extract on bleeding risk in patients who undergo cardiac surgery. <br /><strong>Methods:</strong> A prospective observational study was performed on 116 patients who underwent cardiac surgery in the period between June 2014 and May 2015. Patients were divided into two groups: Group I (patients recently consumed hawthorn extract) and Group II (patients never consumed hawthorn extract). Endpoint measures included the rates of reopening to control bleeding, early mortality, duration of intensive care unit stay, total in-hospital stay period, and duration and amount of chest tube drainage. <br /><strong>Results:</strong> Hawthorn patients had a significantly higher rate of postoperative bleeding necessitating take back to the operating room compared to the control group (10% versus 1%; <br />P = .03) respectively. The overall mortality rate for group I and II was 4% and 0% respectively; P = .17. Chest tubes were kept in for longer times in group I compared to group II <br />(54 ± 14.6 versus 49 ± 14.7 hours respectively; P = .01). Group I stayed longer in the intensive care unit compared to group II (24 versus 22 hours respectively; P = .01). The total in-hospital stay period was comparable between the two groups. <br /><strong>Conclusion:</strong> Hawthorn extract consumption does increase the potential for bleeding and the amount of chest tube output after cardiac surgery.
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Affiliation(s)
- Abeer M Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Osama Haddad
- Department of Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Department of Cardiovascular Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yagthan Obeidat
- Department of Cardiac Surgery, Al-Mouwasat Hospital, Dammam, Saudi Arabia
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Paiva MM, da Silva RD, Jaworski P, Kim FJ, Molina WR. Subcapsular hematoma after ureteroscopy and laser lithotripsy. Can J Urol 2016; 23:8385-8387. [PMID: 27544565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Subcapsular hematoma is an uncommon complication after ureteroscopy and laser lithotripsy. We report on a 38-year-old male with an 8 mm lower pole stone who underwent a left ureteroscopy and laser lithotripsy. The stone was successfully fragmented. Several hours after being discharged home, the patient returned complaining of back pain and hematuria. He was hemodynamically stable. Laboratory exams were normal. A CT study showed a crescent renal subcapsular hematoma surrounding the left kidney. The patient was admitted to the ward for conservative treatment. No additional intervention was necessary. Most subcapsular hematomas tend to resolve spontaneously.
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Affiliation(s)
- Matheus Miranda Paiva
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado, USA
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Takai K, Komori T, Shin M, Niimura M, Taniguchi M. Superficial siderosis complicated by hydrocephalus: bleeding from the dura mater in the cerebrospinal fluid cavity after brain tumor surgery. Acta Neurochir (Wien) 2016; 158:1299-302. [PMID: 27117905 DOI: 10.1007/s00701-016-2817-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND In most patients with superficial siderosis of the central nervous system, the exact source of bleeding remains unknown and a treatment has not yet been established. METHODS We herein presented a case of superficial siderosis complicated by hydrocephalus 19 years after supratentorial brain tumor resection. RESULTS The bleeding source was identified as the dura mater in the intracranial cerebrospinal fluid cavity, and not a recurrent tumor. CONCLUSION Chronic intracranial bleeding from the dura mater was successfully arrested by replacement of the dura mater with the autologous fascia of the thigh, and hydrocephalus was treated with endoscopic surgery.
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Affiliation(s)
- Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Manabu Niimura
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan
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Abstract
The cone and plate(let) analyzer is an established method for assessing platelet function. It evaluates adherence of platelets on an extracellular matrix, expressed as a percentage of surface coverage and the average size of the aggregates. The purpose of this study was to determine the applicability of the cone and plate(let) analyzer in monitoring platelet function and predicting postoperative bleeding. The relationship between postoperative bleeding, perioperative platelet function, and other parameters was studied. A significant decrease in surface coverage was detected upon establishment of cardiopulmonary bypass (from 6.9% ± 3.9% to 4.7% ± 1.7%) with a return to preoperative values at the end of surgery. Preoperative average size and surface coverage were the only parameters that significantly and linearly correlated with postoperative bleeding. Patients with an aggregate average size < 20 μm2 had a significantly higher incidence of severe bleeding (> 965 mL) than those with a size > 20 μm2 (44% vs. 0%), and a higher mean blood loss (908 ± 322 mL vs. 337 ± 78 mL). Similar results were obtained for surface coverage < 5%, indicating the predictive value of these parameters. Preoperative platelet function as evaluated by the cone and plate(let) analyzer is an independent risk factor determining postoperative bleeding.
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Affiliation(s)
- Rabin Gerrah
- Department of Cardiothoracic Surgery, Assuta Medical Center, 62 Jabotinsky Street, Tel Aviv 62748, Israel.
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