ABSTRACT
Although many published studies have investigated the benefits of tranexamic acid (TXA) in reducing perioperative bleeding, no large meta-analysis has been conducted to demonstrate its overall benefit. Methods: A systematic review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Cochrane, Ovid, Embase, Web of Science, ClinicalTraisl.Gov, and Scopus databases were searched for articles reporting the benefit of TXA in reducing perioperative bleeding in craniosynostosis surgery from establishment through October 2022. The results of our meta-analysis were pooled across the studies using a random-effects model, and presented as a weighted mean difference with 95% confidence interval (95% CI). Results: The database search yielded 3207 articles, of which 27 studies with a corresponding number of 9696 operations were eligible. The meta-analysis included only 18 studies, accounting for 1564 operations. Of those operations, 882 patients received systemic TXA, whereas 682 patients received placebo (normal saline), no intervention, low dose TXA, or other control substances. This meta-analysis demonstrated a significant beneficial effect of TXA in reducing perioperative bleeding, particularly when compared with other controlled substances, with a weighted mean difference of -3.97 (95% CI = -5.29 to -2.28). Conclusions: To our knowledge, this is the largest meta-analysis in the literature investigating the benefit of TXA in reducing perioperative blood loss in craniosynostosis surgery. We encourage implementing TXA-protocol systems in hospitals after the appraisal of the data presented in this study.
ABSTRACT
BACKGROUND: Sickle cell disease (SCD) is a significant health burden in Saudi Arabia that leads to chronic hemolysis with subsequent formation of cholelithiasis. The prevalence of cholelithiasis in the Middle East varies in patients with SCD. The aim of our study was to determine the prevalence of cholelithiasis among SCD patients at a large tertiary care center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia, where more than 300 patients with hemoglobinopathies were followed up. METHODS: In this cross-sectional retrospective study conducted from May 2006 to May 2022, we reviewed 414 patients with SCD who were divided into two groups according to the presence or absence of cholelithiasis. Demographic data, SCD phenotype, splenectomy, cholecystectomy, and hydroxyurea were reviewed from the patient's medical records. They were analyzed to suggest a correlation between the incidence of cholelithiasis and the chances of cholecystectomy. RESULTS: A total of 414 patients with SCD were reviewed. The mean age of participants was 31 years (10-82), with 52% male. Patients with homozygous sickle hemoglobin (HbSS) constituted 73% of the cohort. The rest (26%) had HbS/ß-thalassemia. Thirty-three patients (8%) had splenectomy done. Compliance with hydroxyurea was observed in 174 patients (42%). A total of 64.7% of patients had cholelithiasis (n=269), out of which 159 patients (59.1%) had cholecystectomy done. Surprisingly, a significant association was found between cholecystectomy and the use of hydroxyurea (p=0.003). Additionally, there was a significant association found between the development of cholelithiasis and increasing age (p=0.037). CONCLUSION: There was a high prevalence of cholelithiasis found in patients with SCD. It correlated significantly with high-age groups. Further research is warranted to confirm the relationship between hydroxyurea and cholelithiasis.
ABSTRACT
BACKGROUND: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned readmission rate, determinants, and most common events within 30 days post-cardiac surgery. Recommendations to prevent or minimize these complications are included. METHODS: Setting and design - a retrospective record review was conducted among all adult patients, who underwent open heart surgery between 2010 and 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Using Google Forms, we manually collected data from hospital records. STATISTICAL ANALYSIS USED: binomial logistic regression model (using the backward stepwise method). Regression outcomes were expressed as odds ratios (ORs) and 95% CIs. A P-value of < 0.05 indicated statistical significance. RESULTS: Among 400 patients who underwent cardiac surgery, 343 patients were included in the study, including 53 unplanned readmissions, which was a rate of 16.3% (95% CI, 12.8 to 20.6%). The most frequently reported reasons for readmission were sternal wound infections (7.3%), pleural effusion (2.0%), and heart failure (1.7%). Female gender, high postoperative LDH and urea were the most important risk factors. CONCLUSION: Discharge planning, patient education, and cardiac surgery nurse home visit constitute the most important factors to minimize 30 days of unplanned readmission.
