Is Menstruation a Valid Reason to Postpone Cardiac Surgery?

Background:Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective,matched case?control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who weremenstruating (group?M;n = 25) and their matched controls, i.e., women who were not menstruating (group?NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup?P) and perioperative period (subgroup?PO) was compared to determine the effect of OHS onmenstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr?M = 245.6 ± 120.1 ml vs gr?NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr?P = 36.8 ± 4.8 ml vs gr?PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr?P = 4.2 ± 0.6 days vs gr?PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Blood level changes in total knee arthroplasty with and without a tourniquet / Variação sanguínea nas artroplastias de joelho com e sem o uso de garrote

ABSTRACT OBJECTIVE: To evaluate the difference between the total blood loss in patients undergoing primary total knee arthroplasty with and without the use of tourniquet. METHODS: A retrospective cohort study, with analysis of medical records of patients undergoing primary total knee arthroplasty in 2015, with and without the use of a tourniquet. Comparison was performed of hemoglobin (HB) and hematocrit (HT) variation in the complete blood count (CBC) during the pre- and post-operative period between the two groups. RESULTS: There were 117 patients undergoing primary total knee arthroplasty included, minimum age of 33 and maximum of 86 years, with a mean of 67 years. 64.1% of the surgeries used a tourniquet and 35.9% did not. The mean preoperative HB in Group 1 was 13.08 and 12.97 in Group 2 (p = 0.435). The mean postoperative HB in Group 1 was 11.64 and 10.93 in Group 2 (p = 0.016). The variation of HB in Group 1 was 1.44 and 2.04 in Group 2 (p = 0.025). The mean preoperative HT in Group 1 was 38.96 and 39.01 in Group 2 (p = 0.898). The mean postoperative HT in Group 1 was 34.47 and 32.19 in Group 2 (p = 0.005). The variation of HT in Group 1 was 4.49 and 6.82 in Group 2 (p = 0.001). A total of 21 patients received transfusions RCC (red cell concentrates), as a result of HB below 8 g/dL or clinical symptoms, respectively, representing seven of Group 1 (9.3% of total intra-group) and 14 of Group 2 (33.3% of total intra-group), with p = 0.001. CONCLUSION: In patients undergoing primary total knee arthroplasty using a tourniquet, a lower variance in the hematimetric indices was observed and fewer blood transfusions were necessary.

RESUMO OBJETIVO: Avaliar a diferença entre a perda sanguínea total em pacientes submetidos à artroplastia total do joelho com e sem o uso de garrote. MÉTODOS: Estudo de coorte retrospectivo, com análise dos prontuários de pacientes submetidos a artroplastia primária total de joelho em 2015, com e sem o uso de garrote. Comparou-se a variação de hemoglobina (HB) e hematócrito (HT) no pré- e pós-operatório entre os dois grupos. RESULTADOS: Foram incluídos 117 pacientes submetidos a artroplastia total de joelho primária, idade mínima de 33 e máxima de 86 anos, com média de 67; em 64,1% das cirurgias, foi usado garrote e em 35,9%, não. No pré-operatório, a média da HB no Grupo 1 foi de 13,08; no Grupo 2, 12,97 (p = 0,435). No pós-operatório, a média da HB no Grupo 1 foi de 11,64; no Grupo 2, 10,93 (p = 0,016). A variação da HB no Grupo 1 foi de 1,44; no Grupo 2, de 2,04 (p = 0,025). No pré-operatório, a média do HT no Grupo 1 foi de 38,96; no Grupo 2, de 39,01 (p = 0898). No pós-operatório, a média do HT no Grupo 1 foi de 34,47; no Grupo 2, de 32,19 (p = 0,005). A variação do HT no Grupo 1 foi de 4,49; no Grupo 2, de 6,82 (p = 0,001). Dos pacientes, 21 receberam transfusão de CH (concentração de hemácias), por HB abaixo de 8 ou sintomas clínicos, sete do Grupo 1 (9,3% do total intragrupo) e 14 do Grupo 2 (33,3% do total intragrupo) com p = 0,001. CONCLUSÃO: Nos pacientes submetidos a artroplastia total de joelho primária com o uso de garrote, ocorreu uma menor variância dos índices hematimétricos e um menor número de transfusões sanguíneas foi necessário.

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

OBJECTIVE: Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. METHODS: A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions. RESULTS: The number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups. CONCLUSION: TXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.

The Impact of Engorged Vein within Traumatic Posterior Neck Muscle Identified in Preoperative Computed Tomography Angiography to Estimated Blood Loss during Posterior Upper Cervical Spine Surgery / 대한신경손상학회지

OBJECTIVE: Injuries of upper cervical spine are potentially fatal. Thus, appropriate diagnosis and treatment is essential. In our institute, preoperative computed tomography angiography (CTA) has been performed for evaluation of injuries of bony and vascular structure. The authors confirmed the engorged venous plexus within injured posterior neck muscle. We have this research to clarify the relationship between the engorged venous plexus and engorged vein. METHODS: A retrospective review identified 23 adult patients who underwent 23 posterior cervical spine surgeries for treatment of upper cervical injury between 2013 and 2015. Preoperative CTA was used to identify of venous engorgement within posterior neck muscle. The male to female ratio was 18:5 and the mean age was 53.5 years (range, 25-78 years). Presence of venous engorgement and estimated blood loss (EBL) were analyzed retrospectively. RESULTS: The EBL of group with venous engorgement was 454.55 mL. The EBL of group without venous engorgement was 291.67 mL. The EBL of group with venous engorgement was larger than control group in significant. CONCLUSION: The presence of engorged venous plexus is important factor of intraoperative bleeding. Preoperative CTA for identifying of presence of engorged venous plexus and fine operative techniques is important to decrease of blood loss during posterior cervical spine surgery.

Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980+/-683 mL) was lower than the non-embolised control group (1,629+/-946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors

PURPOSE: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. RESULTS: Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.

Total knee arthroplasty: indication of blood transfusion according to hematimetric variation and clinical symptoms of hypoperfusion

Objective: To analyze the relationship between hematimetric variation and the presence of clinical symptoms of hypoperfusion for indicating blood transfusion in patients undergoing total knee arthroplasty. Methods: A retrospective analysis was conducted on data gathered from the medical files of 55 patients with a diagnosis of gonarthrosis, who underwent total knee arthroplasty at a hospital orthopedics and traumatology service between February 2011 and December 2012. The patients studied presented unilateral joint degeneration and fitted into the indications for surgical treatment. All the patients underwent a preoperative cardiological evaluation, presenting a pattern of ASA I–III and absence of blood dyscrasia, and preoperative hemoglobin measurements were made. However, no minimum hematimetric value was established for the surgical treatment; there were only clinical criteria for blood perfusion. Results: Among the 55 patients, 35 were female and 20 were male, and the mean age was 68 years. Six patients underwent homologous blood transfusion, because of their clinical condition of tissue hypoperfusion, persistent hypotension, loss of consciousness, sweating and coercible vomiting. They presented postoperative hemoglobin of 7.5–8.8 g/dL. Conclusion: For patients with falls in hemoglobin counts greater than 20% and values lower than 9 g/dL after the surgery, there is a possible need for blood transfusion, which should only be indicated when accompanied by major symptoms of tissue hypoperfusion...

Objetivo: Analisar a relação entre a variação hematimétrica e a presença de sintomas clínicos de hipoperfusão para a indicação de transfusão sanguínea em pacientes submetidos a artroplastia total do joelho. Métodos: Fez-se uma análise retrospectiva dos dados coletados nos prontuários de 55 pacientes com diagnóstico de gonartrose submetidos a artroplastia unilateral total do joelho feita pelo serviço de ortopedia e traumatologia de um hospital de fevereiro de 2011 a dezembro de 2012. Os pacientes estudados apresentaram degeneração articular unilateral e se enquadraram na indicação para o tratamento cirúrgico. Todos foram submetidos a avaliação pré-operatória cardiológica e manteve-se um padrão correspondente a ASA-I até III, ausência de discrasia sanguínea e mensuração de hemoglobina pré-operatória. Porém, não foi estabelecido valor hematimétrico mínimo para o tratamento cirúrgico, apenas critérios clínicos de perfusão sanguínea. Resultados: Dos 55 pacientes, 35 do sexo feminino e 20 do masculino, com média de 68 anos, apenas seis foram submetidos a transfusão sanguínea homóloga, decorrente do quadro clínico de hipoperfusão tecidual, hipotensão persistente, perda da consciência, sudorese e vômitos coercíveis e apresentaram hemoglobina pós-operatória entre 7,5 e 8,8 g/dL. Conclusão: Pacientes com queda acima de 20% na contagem de hemoglobina e valores abaixo de 9 g/dL após a cirurgia sugerem uma possível necessidade de transfusão sanguínea, que só deve ser indicada quando acompanhada de sintomas maiores de hipoperfusão tecidual...

The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

PURPOSE: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes. RESULTS: Of the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m2. Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of 4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3.9.7; p=0.016). A distance between the tumor and the collecting system of < or =4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI, 1.3.6.3; p=0.012). CONCLUSIONS: Tumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.

Effect of intraoperative HES 6% 130/0.4 on the need for blood transfusion after major oncologic surgery: a propensity-matched analysis

OBJECTIVES: To evaluate the effect of the intraoperative use of hydroxyethyl starch on the need for blood products in the perioperative period of oncologic surgery. The secondary end-points included the need for other blood products, the clotting profile, the intensive care unit mortality and length of stay. METHODS: Retrospective observational analysis in a tertiary oncologic ICU in Brazil including 894 patients submitted to oncologic surgery for a two-year period from September 2007. Patients were grouped according to whether hydroxyethyl starch was used during surgery (hydroxyethyl starch and No-hydroxyethyl starch groups) and compared using a propensity score analysis. A total of 385 propensity-matched patients remained in the analysis (97 in the No-hydroxyethyl starch group and 288 in the hydroxyethyl starch group). RESULTS: A higher percentage of patients in the hydroxyethyl starch group required red blood cell transfusion during surgery (26% vs. 14%; p = 0.016) and in the first 24 hours after surgery (5% vs. 0%; p = 0.015) but not in the 24- to 48-hour period after the procedure. There was no difference regarding the transfusion of other blood products, intensive care unit mortality or length of stay. CONCLUSION: Hydroxyethyl starch use in the intraoperative period of major oncologic surgery is associated with an increase in red blood cell transfusions. There are no differences in the need for other blood products, intensive care unit length of stay or mortality. .

Risk Factors Associated with Blood Loss During a Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to find if any clinical or laboratory factors have significant correlations with blood loss caused by a transurethral resection of the prostate (TURP). MATERIALS AND METHODS: The medical records of 218 patients who had undergone a TURP were retrospectively reviewed. For each patient, the preoperative factors evaluated included age, type of presentation (patients who had been treated due to acute urinary retention; retention group, patients who had been treated due to lower urinary tract symptoms; symptomatic group), blood pressure, complete blood count, coagulation screening, prostate size on transrectal ultrasonography (TRUS), urine analysis, urine culture, ECG and drugs. Intraoperative and postoperative factors were also evaluated, including type of anesthesia, operator, operating time, weight of resected prostate tissue, blood transfusion and prostate histology. These factors were analyzed with respect to blood loss during the TURP using student's t, ANOVA and chi-square tests. RESULTS: The mean intraoperative blood loss and resected prostate weight were 415 ml and 15g, respectively. The factors which were found to significantly correlate with blood loss during a TURP were: resected prostate weight (r=0.44, p=0.0001), prostate size on TRUS (r=0.32, p=0.001), operating time (r=0.31, p=0.001), preoperative urine culture (p= 0.020), preoperative antimicrobials taken (p=0.020), and prostate histology (p=0.048). CONCLUSIONS: Of the factors found to correlate with blood loss during the TURP, the only reversible factor was a preoperative urinary tract infection. So, we expect that the prevention of preoperative urinary tract infection and its effective treatment in patients might be helpful in decreasing blood loss during a TURP.