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Background@#Elderly patients with hip fractures frequently receive perioperative transfusions, which are associated with increased morbidity and mortality. This study aimed to evaluate the impact of a patient blood management (PBM) program on the appropriateness of red blood cell (RBC) transfusion and clinical outcomes in geriatric patients undergoing hip fracture surgery. @*Methods@#In 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. Elderly patients aged ≥ 65 years who underwent hip fracture surgery from 2017 to 2020 were evaluated. Clinical characteristics and outcomes were analyzed according to the timing of PBM implementation (pre-PBM, early-PBM, and late-PBM). Multiveriate regression analysis was used to evaluate the risk factors of the adverse outcomes, such as in-hospital mortality or 30-day readmission. @*Results@#A total of 884 elderly patients were included in this study. The proportion of patients who received perioperative RBC transfusions decreased significantly (43.5%, 40.1%, and 33.2% for pre-PBM, early-PBM, and late-PBM, respectively; P = 0.013). However, the appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, respectively; P < 0.001). The duration of in-hospital stay and 30-day readmission rates significantly decreased. Multivariable regression analysis revealed that RBC transfusion (odds ratio, 1.815; 95% confidence interval, 1.137–2.899; P = 0.013) was significantly associated with adverse outcomes. @*Conclusion@#Implementing the PBM program increased the appropriateness of RBC transfusion without compromising transfusion quality and clinical outcomes. Therefore, adopting the PBM program may improve the clinical management of elderly patients following hip fracture surgery.
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BACKGOUND: The effect of anesthetic techniques, such as closed circuit anesthesia (CCA) using semiclosed circuit system and semiclosed circuit anesthesia (SCCA), on the work of breathing has not been studied yet in detail. This study was purposed to compare the work of breathing according to anesthetic technique (CCA, SCCA). METHODS: Thirty patients were assigned to receive either SCCA group or CCA group (n = 15). Anesthesia was induced with propofol 2 mg/kg with 2% lidocaine 1 ml. Two percents isoflurane with O2 and N2O 2 L/min were given for 10 min to patients initially to wash in functional residual capacity and the breathing circuits. In SCCA group, anesthesia was maintained with 2% isoflurane in O2 2 L/min and N2O 2 L/min throughout the surgery. In CCA group, O2 was reduced to 200 ml/min and N2O to 100 ml/min with isoflurane vaporizer setting adjusted to 4% for anesthesia maintenance. When the operation was ended, the vaporizer setting of isoflurane deceased to zero and then O2 was increased to 4 L/min for the arousal of the patient. We measured the inspiratory/expiratory concentration of isoflurane, end-tidal CO2, the hemodynamic parameters, the change of airway pressure, the work of breathing, and compliance at anesthetic induction and emergence in both groups. RESULTS: There were no significant differences in the inspiratory/expiratory concentrations of isoflurane, the hemodynamic parameters, end-tidal CO2, airway pressure, the work of breathing and compliance between the groups. CONCLUSIONS: CCA using semiclosed circuit system does not increase the work of breathing compared to SCCA.