Monitorización de la transfusión en la cirugía de cadera a partir de la información del alta del paciente / Surveillance of the blood transfusion in hip surgery using the data from the discharge report of the patients

Objetivo: Analizar el riesgo perioperatorio de ser transfundido en la cirugía de cadera a partir de los datos de los informes de alta. Pacientes y métodos: Se han analizado los informes de alta de 400 pacientes consecutivamente operados de cadera y codi ficados según la Clasifícación Internacional de Enfermedades (CIE-9-MC). Se recogieron la edad, sexo, los códigos de diagnósticos, los códigos de procedimientos incluidas las transfusiones y los códigos de las intervenciones quirúrgicas realizadas. Resultados: 152 pacientes fueron transfundidos (38 por ciento). Mediante análisis univariante, el riesgo transfusional es mayor significativamente en pacientes mayores de 60 años (39,9 por ciento), pacientes intervenidos por complicaciones mecánicas de dis positivos (53,2 por ciento), y en pacientes a los que se realizó revisión de la sustitución de cadera (69 por ciento). Mediante análisis multivariante de regresión logística, la técnica quirúrgica y la edad son factores independientemente asociados con el riesgo de transfusión. Conclusiones: El riesgo de transfusión se asocia con el procedimiento quirúrgico empleado y la edad de¡ paciente. Dada la disponibilidad de los datos de los informes de alta y la fácil explotación de los mismos, sería eficiente usarlos para monitorizar las transfusiones en todas y cada una de las técnicas quirúrgicas, como en el caso aquí descrito de la cirugía de la cadera (AU)

Assessment of perioperative blood transfusion in cardiac surgery using administrative data.

We have analysed the blood transfusion requirements in 288 consecutive adult patients undergoing cardiac surgery using data from the discharge reports, coded in accordance with the international disease classification. 114 patients were transfused (39.6%). The transfusion rate was higher in patients with a principal diagnosis of two valve disorders, acute/subacute ischemic heart disease, congenital anomalies, tumour and injuries. All of these had a transfusion rate greater than 50%. Controlling the confounding effects by multivariate logistic regression analysis, there was an adjusted association of the transfusion rate only with the principal diagnosis and with sex, not with type of admission, preoperative anemia, surgical procedure or age.

Análisis de la transfusión en la cirugía maxilofacial / Analysis of transfusion in maxillofacial surgery

Objetivo: Analizar la transfusión en los pacientes de cirugía maxilofacial a partir de los datos de los informes de alta. Material y método: Se han estudiado los datos de 569 pacientes intervenidos consecutivamente, codificados según la Clasificación Internacional de Enfermedades (CIE-9-MC), evaluando edad, sexo, códigos de diagnósticos, de procedimientos, incluidas las transfusiones, y los códigos de las intervenciones quirúrgicas. Resultados: 32 pacientes fueron transfundidos (5,6 por ciento). La mayor incidencia ocurrió en los pacientes varones, de edad avanzada, con diagnóstico de neoplasias, con la lesión localizada en lengua, resto de la cavidad bucal, mandíbula, encías y maxilares, en las cirugías ablativas de tejidos blandos, ortognáticas y reconstructora de huesos y cuando se realiza más de una técnica quirúrgica durante la intervención. Sin embargo, mediante análisis de regresión logística, los únicos factores de riesgo de transfusión fueron el diagnóstico y la técnica quirúrgica. Conclusiones: El diagnóstico principal y el tipo de cirugía se asocian de modo independiente con el riesgo de transfusión en la cirugía maxilofacia (AU)

Riesgo de transfusión perioperatoria en la cirugía de la mama / Likelihood of perioperative transfusion in breast surgery

Objetivo. Analizar el riesgo perioperatorio de transfusión de los pacientes intervenidos de mama. Pacientes y método. Análisis de los informes de alta de los pacientes operados de mama durante 1996, codificados según la Clasificación Internacional de Enfermedades (CIE-9-MC).Resultados. De 382 pacientes operados, 18 fueron transfundidos (4,7 por ciento). Mediante análisis univariante, el mayor riesgo transfusional se produce en pacientes menores de 40 años (11,4 por ciento), pacientes con hipertrofia mamaria y ginecomastias (38,2 por ciento) y pacientes sujetos a cirugía reductora (40,6 por ciento). Mediante análisis de regresión logística, sólo la técnica quirúrgica es un factor asociado con la transfusión, siendo la probabilidad de transfusión perioperatoria en la cirugía reductora de 9,72 ve ces respecto al resto de técnicas quirúrgicas de la mama. Conclusiones. La técnica quirúrgica es el único factor, de entre los evaluados, con carácter pronóstico del riesgo de transfusión en la cirugía de mama (AU)

[Perioperative blood transfusions in laryngeal surgery]. / Transfusión perioperatoria en la cirugía de laringe.

OBJECTIVE: To analyze perioperative transfusion risk in patients undergoing larynx surgery. PATIENTS AND METHODS: An analysis was made of the records of patients who underwent surgical procedures on the larynx in 1996. RESULTS: Of 174 operated patients, 22 received (12.6%) blood transfusions. The patients most frequently transfused were over 60 years-old (18.2%), had laryngeal cancer (22%), underwent laryngectomy (28.3%), and were submitted to three or more surgical techniques during the intervention (50%). Regression analysis showed that the main surgical procedure and number of surgical techniques performed were factors independently related with the likelihood of requiring a blood transfusion. CONCLUSIONS: Of the variables studied, only the surgical procedure and number of surgical techniques performed were independently related with the likelihood of requiring a blood transfusion.

[An analysis of transfusion in surgery on the bladder]. / Análisis de la transfusión en la cirugía de la vejiga urinaria.

PURPOSE: To analyze the perioperative transfusion incidence in the operated patients of the urinary bladder. METHODOLOGY: We reviewed the records of all patients operated in 1996. The abstracted patient discharge records were codified according to the ICD-9-CM codes. Gender, age, codes of diagnosis, of procedures, among them blood transfusions, and of surgical procedures. RESULTS: There were studied 120 patients of which 12 (10%) were transfused. By univariate analysis, it has been detected an association, significative statistically, of the transfusion with: 1) the principal diagnosis (p: 0.017); where alone the patients with bladder cancer were transfused; 2) diagnosis of perioperative anemia (p: 0.026); 3) the age, with a direct relation among age and transfusion rate (p: 0.001); 4) and with the number of codified diagnoses, indirect indicator of the comorbidity p: 0.003). CONCLUSIONS: In our data, among the variables studies, the transfusion is associated with the principal diagnosis, diagnosis of anemia, number of codified diagnoses and the age.

[Analysis of transfusion in kidney surgery]. / Análisis de la transfusión en la cirugía renal.

OBJECTIVE: To analyze the likelihood of perioperative transfusion in patients undergoing renal surgery. METHODS: The records of all patients who had undergone renal surgery in 1996 were reviewed. The abstracted patient discharge records, encoded according to the ICD-9-CM, were analyzed for gender, age, diagnosis, surgical and non-surgical procedures including transfusions of blood products. RESULTS: 21 (23.3%) of 90 patients who had undergone renal surgery required transfusion. By univariate analysis, the incidence of transfusion was statistically significantly higher in patients with chronic nephropathy, patients undergoing total nephrectomy and renal transplantation, and those having a greater number of ICD-9-CM diagnosis codes (indirect indicator of the clinical severity and comorbidity). By multivariate logistic regression analysis, the surgical procedure was found to be the only predictive factor for blood transfusion (p = 0.013). The main diagnosis, number of diagnosis codes, gender, number of surgical techniques and age were not found to be predictors of transfusion. CONCLUSIONS: Our data show that of the variables analyzed, the surgical procedure is the only predictive factor of the likelihood of requiring blood transfusion.

[Perioperative transfusion in prostatic surgery]. / Transfusión perioperatoria en la cirugía de próstata.

OBJECTIVE: To analyze the likelihood of perioperative transfusion in prostate surgery. METHODS: The records of patients who underwent prostate surgery at the Hospital Central de Asturias en 1996 were reviewed. The abstracted patient discharge records, encoded according to the ICD-9-CM, were analyzed for gender, age, diagnosis, surgical and non-surgical procedures, including transfusions of blood products. RESULTS: 29 (14.2%) of 204 operated patients required transfusion. By univariate analysis, the likelihood of requiring transfusion was significantly higher in patients with cancer (28.8%), patients undergoing radical prostatectomy (40%), and those undergoing more than one surgical procedure (21.2%). By multivariate logistic regression analysis, the surgical procedure, age and simultaneous urinary bladder surgery were related with the likelihood of requiring transfusion. The adjusted odds ratio for perioperative transfusion was 10.14 times in radical prostatectomy than in transurethral prostatectomy, 2.67 times for patients more than 75 years than in those aged less, and 2.85 times in patients undergoing simultaneous urinary bladder surgery than those who do not. CONCLUSIONS: Due to the wide range of variability of the adjusted likelihood for transfusion in prostate surgery (3.5% to 83.4%), estimation of the individual likelihood for transfusion could be useful for planning surgical transfusions, pretransfusion tests and autologous transfusion in these patients.

[Use of elements from the ISO 90000 system in Spanish hemotherapy]. / Uso de los elementos del sistema ISO 9000 en la hemoterapia española.

PURPOSE: To evaluate the prevalence of all twenty elements of ISO 9000 in the practice of the Blood Banks of Spain independently of being certified or not to ISO system. MATERIALS AND METHODS: By a survey sent in november 1996 to the Hospital-Based Blood Bank and Transfusional Services of 225 hospitals with more than 100 beds, and to 25 Community Blood Centers. The survey had 38 questions on the all elements of the ISO system and on other aspects of quality no directly related with it, as to be accredited by transfusional accreditation Committee, to have an hospital transfusion committee, informed consent of the transfusion and guidelines for using hemoderivatives. RESULTS: The survey was answered by 53 (21%) of hospitals and Community Blood Centers. None of the participant were certified to ISO system. The elements more used were the documentation of adverse reactions, procedures manual, validation of blood components, control of nonconforming products, and product identification and traceability, all of them used for more than 80% of participants. On the contrary, the elements less used were to have a quality unit, equipment manual, to validate the computer system, internal quality audits, criteria on purchasing, training and quality manual, all of them used by less than 30% of the participants. CONCLUSIONS: Generally speaking the elements of the ISO system more commonly used are those related to the basic ones of daily work and the least used are those related to the organisation aspects of quality. The Community Blood Centers score higher than hospital blood banks and among these, the best results are in the blood banks of hospitals more than 500 beds and the hospital accredited for teaching.

[Intraoperative transfusion in pediatric surgery]. / Transfusión perioperatoria en la cirugía pediátrica.

PURPOSE: To analyze the likelihood of perioperative transfusion using the data of the abstracted patient discharge records. MATERIAL AND METHODS: It was studied the data of the records of the pediatric patients in whom were done surgical procedures for 1996. The abstracted patient discharge records are codified according the ICD-9-CM codes. RESULTS: 1,166 pediatric patients were operated, of whom were transfused 25 (2.1%). The transfusion rate was higher in patients less than 3 years old, who were operated with three o more surgical procedures simultaneously, who were admitted newly after the admittance here studied, and patients operated of spine, dorsolumbar spine, pharynx, thorax and mediastinum, central nervous system, colon, vessels and hip. CONCLUSIONS: Given the variability of the transfusion rate, to know it will allow a better planning of the surgical transfusions, the policy of the hospital blood bank and to increase the information to patient about the risk of the elective surgery.

[Hemolytic anemia induced by Chelidonium majus. Clinical case]. / Anemia hemolítica inducida por Chelidonium majus. Observación clínica.

A case of haemolytic anaemia secondary to oral ingestion of a Chelidonium majus extract is presented. It coursed with intravascular haemolysis, renal failure, liver cytolysis and thrombocytopenia. The direct Antiglobulin test was positive (4+), IgG+C'. The patient was treated with steroids, red cell and platelet transfusion and also twice with an haemodialytic treatment, with complete resolution of the clinical features about the 12th day. A complete bibliographic revision from 1966-1989 was performed and no cases like this one were found during that period, so this could the first one reported.