RESUMEN
Objective To determine the incidence of acute kidney injury in patients undergoing primary total knee arthroplasty with ASA physical status Ⅰ or Ⅱ.Methods A total of 2 623 patients from January 2014 to December 2019,513 males and 2 110 females,aged ≥ 18 years,ASA physical status Ⅰor Ⅱ,who underwent primary total knee arthroplasty were included.Demographic characteristics and perio-perative data were collected.AKI was diagnosed according to the criteria from Kidney Disease Improving Global Outcomes(KDIGO)and the patients were divided into two groups:AKI group and non-AKI group.Independent risk factors of acute kidney injury were evaluated by binary logistic regression.Results Forty-one patients(1.9％)developed acute kidney injury postoperatively.Binary logistic regression showed perio-perative transfusion(OR=3.979,95％CI 2.243-7.056,P＜0.001),the duration of operation(OR=1.007,95％CI 1.001-1.013,P=0.031)and perioperative combined use of antibiotics(vancomycin+cefuroxime/clindamycin)(OR=4.053,95％CI 1.350-12.165,P=0.013)were independent predic-tive factors of acute kidney injury.Conclusion Perioperative transfusion,longer duration of operation,and combined use of antibiotics(vancomycin+cefuroxime/clindamycin)were risk factors for postoperative AKI in patients with ASA physical status Ⅰ or Ⅱ.
RESUMEN
【Objective】 To evaluate the safety and effectiveness of Perioperative Transfusion Trigger Score (POTTS) in guiding surgical patients blood transfusion intraoperatively and postoperatively. 【Methods】 A total of 900 patients(perioperative Hb 60~100 g/L) from December 2017 to March 2021 were collected, including 251 males and 649 females, with ASA grading Ⅰ~Ⅳ, and randomly divided into experimental group and controls. In the experimental group, the allogeneic RBC transfusion trigger(Hb threshold) and transfusion units in anemia patients was determined by POTTS. While those in the controls were decided by physicians according to current guidelines concerning transfusion. The proportion and units of allogeneic RBC transfusion, the incidence of postoperative complications, the mortality of hospitalization and discharge for 4 weeks, Hb value, healing of surgical incision, ICU admission rate and ICU length of stay, length of hospitalization, etc were recorded. 【Results】 The proportion of allogeneic RBC transfusion in the experimental group(35.3%)were less than the controls(42.2%)(P<0.05). The units of allogeneic RBC transfused, incidence of postoperative complications and mortality in hospital and 4 weeks after surgery, healing of surgical incision (grade A/ grade B/ grade C), the Hb level 24 h after surgery and at discharge, the ICU admission rate and ICU length of stay, length of hospitalization were not significantly different between the groups. 【Conclusion】 The peri-operative allogeneic red blood cells transfusion guided by POTTS can reduce the proportion of allogeneic RBC transfusion, and is safe and effective.
RESUMEN
【Objective】 To evaluate the effect of multi-disciplinary patient blood management(PBM) on perioperative blood transfusion in patients with cardiothoracic surgery of gradeⅢ~Ⅳ. 【Methods】 The blood transfusion data and relevant clinical information of adult patients underwent grade Ⅲ~Ⅳ cardiothoracic surgeries before and after PBM (from January 2016 to December 2018)in our hospital were collected using Hospital Information System and Management System of Blood Transfusion Department. Patients were grouped according to three separate12-month periods: 933 cases subjected to conventional blood transfusion practice from Jan. to Dec.2016 as the control group, 1 139 cases experienced initial implement PBM(started on Jan.1, 2017)from Jan. to Dec.2017 as the early PBM group, and 1 411 cases received improved PBM from Jan. to Dec.2018 as the improved PBM group. The perioperative autotransfusion rate, allogeneic transfusion rate, length of hospital stay and hospitalization expenses of the three groups were compared by χ2 test and variance analysis. 【Results】 The comparison results among control group, early PBM group and improved PBM group were as following: 1) The proportion of patients using iron and EPO to treat preoperative anemia were 15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01) and 10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05), respectively. 2) The incidence of autotransfusion were 57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01). The allogeneic transfusion volume per capita(U) were 351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05). The incidence of allogeneic blood transfusion were 18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01). The allogeneic blood transfusion volume per capita (U) were 6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01). 3) The per capita hospital stay (d) and ICU stay (d) were19.54±16.56 vs 16.46±12.06 vs 15.11±10.18 and 4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05), respectively. The per capita hospitalization expenses (ten thousand yuan/person) were 10.76±8.39 vs 9.58±7.58 vs 9.13±5.9(P<0.05). 【Conclusion】 The application of PBM in perioperative blood transfusionfor adult cardiothoracic surgery Ⅲ ~ Ⅳcan significantly decrease the incidence of autologous and allogeneic blood transfusion, the length of hospitalstay and hospitalization expenses.
RESUMEN
BACKGROUND: The amount of blood components "on hold" preoperatively is usually determined by the surgeon's experiences or habits, and is often an amount in excess of the amount actually transfused. This method could diminish the effective use of blood components and result in an excessive workload for the blood bank, a shortage of blood products, and an increase in the quantity of discarded blood products. We quantified the amount of RBC components transfused during surgeries to establish the maximal surgical blood order schedule (MSBOS). METHODS: We analyzed the number of RBC component units transfused to patients >17 years of age who underwent elective surgeries performed at a university hospital between November 2005 and February 2007. RESULTS: There were 48,007 elective surgeries performed during the investigated period. The Departments of Surgery, Ophthalmology, Otolaryngology, and Urology carried out 8,317, 7,407, 5,928, and 5,268 surgical cases, respectively. The MSBOS values for 60 types of surgeries categorized into 7 surgical fields are listed. CONCLUSION: In the current study, we analyzed a greater number of surgical cases than previous studies in an effort to generate accurate and practical data. The mean amount of transfused RBC units was less in most types of surgeries compared to previous studies; this finding is presumed to be the result of improvements in surgical techniques and advances in medical science. A regular and comprehensive revision of the MSBOS is required to correspond to the changes in the medical environment and the shifting characteristics of patients, and to maximize the utility of blood products. A committee to supervise transfusion practices is also essential to coordinate different policies of the laboratory, surgical,and anesthesiology departments.