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Medicine Nov 2018Postoperative hemorrhage following total-knee arthroplasty (TKA) remains an important topic. The objective of the meta-analysis is to assess the effectiveness of oral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative hemorrhage following total-knee arthroplasty (TKA) remains an important topic. The objective of the meta-analysis is to assess the effectiveness of oral antifibrinolytics for blood management in patients undergoing TKA.
METHODS
We searched Medline (1966 to August 2018), PubMed (1966 to August 2018), Embase (1980 to August 2018), ScienceDirect (1985 to August 2018), and the Web of Science (1995 to August 2018) for randomized control trials (RCTs). To assess the heterogeneity of study trial and determine the model for analysis (random-effect model or fixed-effect model), I tests and Chi-squared were conducted. We utilized the STATA 12.0 (StataCorp, College Station, TX) to perform all statistical analyses.
RESULTS
A total of 5 RCTs met our inclusion criteria. This meta-analysis shows that there are significant differences between the 2 groups regarding total blood loss, hemoglobin reduction, and transfusion rates. In addition, no adverse effects were identified in treatment groups.
CONCLUSION
The oral form of antifibrinolytics in TKA is able to significantly decrease blood loss, postoperative hemoglobin reduction, as well as transfusion requirements. No increased risk of postoperative complications was observed. Higher quality RCTs is necessary to confirm our finding.
Topics: Administration, Oral; Aged; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Female; Humans; Male; Middle Aged; Postoperative Hemorrhage; Tranexamic Acid; Treatment Outcome
PubMed: 30407285
DOI: 10.1097/MD.0000000000012924 -
Artificial Organs Dec 2020Nonsurgical bleeding is the most frequent complication of left ventricular assist device (LVAD) support. Supraphysiologic shear rates generated in LVAD causes impaired...
Nonsurgical bleeding is the most frequent complication of left ventricular assist device (LVAD) support. Supraphysiologic shear rates generated in LVAD causes impaired platelet aggregation, which increases the risk of bleeding. The effect of shear rate on the formation size of platelet aggregates has never been reported experimentally, although platelet aggregation size can be considered to be directly relevant to bleeding complications. Therefore, this study investigated the impact of shear rate and exposure time on the formation size of platelet aggregates, which is vital in predicting bleeding in patients with an LVAD. Human platelet-poor plasma (containing von Willebrand factor, vWF) and fluorochrome-labeled platelets were subjected to a range of shear rates (0-10 000 s ) for 0, 5, 10, and 15 minutes using a custom-built blood-shearing device. Formed sizes of platelet aggregates under a range of shear-controlled environment were visualized and measured using microscopy. The loss of high molecular weight (HMW) vWF multimers was quantified using gel electrophoresis and immunoblotting. An inhibition study was also performed to investigate the reduction in platelet aggregation size and HMW vWF multimers caused by either mechanical shear or enzymatic (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13-ADAMTS13, the von Willebrand factor protease) mechanism under low and high shear conditions (360 and 10 000 s ). We found that the average size of platelet aggregates formed under physiological shear rates of 360-3000 s (200-300 μm ) was significantly larger compared to those sheared at >6000 s (50-100 μm ). Furthermore, HMW vWF multimers were reduced with increased shear rates. The inhibition study revealed that the reduction in platelet aggregation size and HWM vWF multimers were mainly associated with ADAMTS13. In conclusion, the threshold of shear rate must not exceed >6000 s in order to maintain the optimal size of platelet aggregates to "plug off" the injury site and stop bleeding.
Topics: ADAMTS13 Protein; Blood Platelets; Healthy Volunteers; Heart-Assist Devices; Humans; Molecular Weight; Platelet Aggregation; Postoperative Hemorrhage; Prosthesis Implantation; Protein Multimerization; Risk Assessment; Stress, Mechanical; von Willebrand Factor
PubMed: 32735693
DOI: 10.1111/aor.13783 -
Transplant International : Official... May 2017Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney...
Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical-site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24-hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical-site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical-site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.
Topics: Adult; Case-Control Studies; Female; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Ontario; Postoperative Hemorrhage; Risk Factors
PubMed: 28120465
DOI: 10.1111/tri.12926 -
International Journal of Pediatric... Dec 2022To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
OBJECTIVES
To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
METHODS
This was a retrospective national population-based cohort study of data from the Swedish National Patient Register (NPR) and The Swedish Cause of Death Register (CDR). All patients aged 0-18 years who underwent adenoidectomy from 2007 to 2017 (without concomitant tonsil surgery) were included in this study. To evaluate postoperative morbidity and mortality, all diagnostic and surgical codes registered in the NPR for health care contacts within 30 days of surgery were analysed. The patients retrieved from the NPR were matched with the CDR to identify any deaths occurring within 30 days of the surgery.
RESULTS
A total of 51 746 adenoidectomies were included in this study. No deaths related to adenoidectomy were identified. All types of haemorrhagic complications were rare. Only 0.1% of the surgeries resulted in an outpatient contact due to postoperative haemorrhage and only 0.1% of the adenoidectomies resulted in a readmission due to haemorrhage. The rarest haemorrhagic complication was RTT (return to theatre), with only 4 events (0.01%). Postoperative haemorrhage was most frequent on the first day after surgery. Other complications were rare as well, requiring a total of 922 (2.6%) outpatient visits and 75 (0.2%) readmissions in the adenoidectomy group, with postoperative infection being the most commonly reported.
CONCLUSIONS
Overall, adenoidectomy should be considered a safe surgical procedure associated with few postoperative complications. No deaths related to adenoidectomy were found. Severe complications, such as late postoperative haemorrhage after adenoidectomy, were rare, and haemorrhage resulting in RTT was even rarer. The highest rate of postoperative haemorrhage was observed the first day after surgery, and most haemorrhagic complications occurred within a week. Comparisons with studies on tonsil surgery show that adenoidectomy is associated with substantially lower postoperative morbidity.
Topics: Child; Humans; Adenoidectomy; Tonsillectomy; Retrospective Studies; Cohort Studies; Postoperative Hemorrhage; Postoperative Complications; Morbidity
PubMed: 36265351
DOI: 10.1016/j.ijporl.2022.111335 -
Australian Family Physician May 2013There is accumulating evidence of a strong association between blood transfusion and adverse patient outcomes. Patient blood management aims to achieve improved patient... (Review)
Review
BACKGROUND
There is accumulating evidence of a strong association between blood transfusion and adverse patient outcomes. Patient blood management aims to achieve improved patient outcomes by avoiding unnecessary exposure to blood products through effective conservation and management of a patient's own blood.
OBJECTIVE
To introduce the general practitioner's role in patient blood management.
DISCUSSION
There are a number of ways in which GPs can contribute to patient blood management, particularly in the care of patients scheduled for elective surgery. These include awareness, identification, investigation and management of patients with or at risk of anaemia; assessment of the adequacy of iron stores in patients undergoing planned procedures in which substantial blood loss is anticipated; awareness and assessment of medications and complementary medicines that might increase bleeding risk; and awareness of and ability to discuss with patients, the possible risks associated with blood transfusion and alternatives that may be available.
Topics: Anemia; Disease Management; General Practice; Hemoglobins; Humans; Postoperative Hemorrhage; Practice Guidelines as Topic
PubMed: 23781528
DOI: No ID Found -
International Journal of Surgery... 2014The aim of the present study was to critically review the incidence of venous thromboembolism and postoperative hemorrhage in patients undergoing total thyroidectomy...
INTRODUCTION
The aim of the present study was to critically review the incidence of venous thromboembolism and postoperative hemorrhage in patients undergoing total thyroidectomy without preoperative prophylaxis.
METHODS
A prospective electronic database of all patients undergoing total thyroidectomy over a six-year period within August 2013 in our medical unit was analyzed. The incidence of postoperative bleeding and Venous thromboembolism (VTE) was reviewed by subgrouping all patients according to a risk factor score (RFS) for VTE as outlined in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Best Practice Guidelines.
RESULTS
An overall 1018 consecutive patients [244 men (24%, mean age 46 ± 13 years), 778 women (76%, mean age 44 ± 17 years)] underwent total thyroidectomy. Postoperative bleeding occurred in 8/1018 patients (0.8%). One out of 1018 (0.1%) patients also subcategorized according to the RFS had VTE. The incidence of VTE complication in the entire population was lower than the risk of postoperative bleeding (P < .0001).
CONCLUSION
The risk of developing VTE in patients who undergo total thyroidectomy for benign and malignant diseases without preoperative prophylaxis is roughly 8-fold less than developing a potentially life threatening complication as postoperative bleeding. Until large well conducted prospective studies on the impact of preoperative prophylaxis on postoperative VTE and bleeding will clarify the issue, it is conceivable to propose the use of stockings and/or anticoagulants according to the individual patient risk factors.
Topics: Adult; Female; Follow-Up Studies; Humans; Incidence; Italy; Male; Middle Aged; Postoperative Hemorrhage; Preoperative Care; Prospective Studies; Risk Factors; Thyroid Diseases; Thyroidectomy; Venous Thromboembolism
PubMed: 24859402
DOI: 10.1016/j.ijsu.2014.05.009 -
Interactive Cardiovascular and Thoracic... Mar 2014Fibrinogen concentrate is increasingly used in cardiac surgery when bleeding is anticipated or ongoing. Since randomized clinical studies to support this are lacking, it... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Fibrinogen concentrate is increasingly used in cardiac surgery when bleeding is anticipated or ongoing. Since randomized clinical studies to support this are lacking, it is relevant to know whether lower fibrinogen levels are associated with excessive bleeding. We performed a systematic review and meta-analysis to define the association between fibrinogen levels and blood loss after cardiac surgery.
METHODS
A database search (January 2013) was performed on publications assessing the association between pre- and postoperative fibrinogen levels and postoperative blood loss in adult patients undergoing cardiac surgery. Cohort studies and case-control studies were eligible for inclusion. The main outcome was the pooled correlation coefficient, calculated via Fisher's Z transformation scale, in a random-effects meta-analysis model stratified for the time point at which fibrinogen was measured.
RESULTS
A total of 20 studies were included. The pooled correlation coefficient of studies (n = 9) concerning preoperative fibrinogen levels and postoperative blood loss was -0.40 (95% confidence interval: -0.58, -0.18), pointing towards more blood loss in patients with lower preoperative fibrinogen levels. Among papers (n = 16) reporting on postoperative fibrinogen levels and postoperative blood loss, the pooled correlation coefficient was -0.23 (95% confidence interval: -0.29, -0.16).
CONCLUSIONS
Our meta-analysis indicated a significant but weak-to-moderate correlation between pre- and postoperative fibrinogen levels and postoperative blood loss in cardiac surgery. This moderate association calls for appropriate clinical studies on whether fibrinogen supplementation will decrease postoperative blood loss.
Topics: Biomarkers; Cardiac Surgical Procedures; Chi-Square Distribution; Coagulants; Fibrinogen; Humans; Postoperative Hemorrhage; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24316606
DOI: 10.1093/icvts/ivt506 -
European Archives of... Apr 2022Tonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Tonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid tonsillectomies and might reduce postoperative pain, but comparative studies to assess performance are warranted.
METHODS
This randomized self-controlled clinical trial was conducted from October 2019 to October 2020 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Vienna. Forty-eight patients underwent a tonsillectomy with the device on one side and using cold-steel with localized bipolar cauterization on the other side (control). Main outcomes were the time for tonsil removal (per side) and the time to stop bleeding (per side). Secondary measurements were postoperative pain, assessed once on day 0 and five times on days 1, 3, 5, 7, and 10. Postoperative bleeding episodes and consequences were recorded.
RESULTS
Device tonsillectomies were performed significantly faster than controls; the mean surgical time difference was 209 s (p < 0.001, 95% CI 129; 288). Intraoperative blood loss was significantly lower on the device side (all p < 0.05). Postoperative measurements of pain and bleeding were similar for both sides. Two return-to-theatre secondary bleeding events were recorded for the control side.
CONCLUSION
The novel electrosurgical temperature-controlled divider reduced the tonsillectomy surgical time and intraoperative blood loss, with no apparent negative effects on postoperative pain or bleeding, compared to a cold-steel tonsillectomy with localized bipolar cauterization. In time-restricted settings, the device could be beneficial, particularly after familiarization with device handling.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03793816.
Topics: Blood Loss, Surgical; Electrosurgery; Humans; Pain, Postoperative; Palatine Tonsil; Postoperative Hemorrhage; Tonsillectomy; Tonsillitis
PubMed: 34338876
DOI: 10.1007/s00405-021-07008-9 -
Journal of Otolaryngology - Head & Neck... Dec 2023To describe the incidence of respiratory complications, postoperative hemorrhage, length of stay, and cost of care in children with mucopolysaccharidosis (MPS)...
OBJECTIVE
To describe the incidence of respiratory complications, postoperative hemorrhage, length of stay, and cost of care in children with mucopolysaccharidosis (MPS) undergoing adenotonsillectomy (AT).
METHODS
Analysis of the 2009, 2012, and 2016 editions of the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) identified 24,700 children who underwent AT (40 children with MPS). Demographics, respiratory complications, postoperative hemorrhage, length of stay, and total cost were compared across children with and without MPS.
RESULTS
Children with MPS had a higher likelihood of being male (P < 0.017). There was a higher rate of respiratory complications in children with MPS compared with children without MPS [6/40 (15%) vs. 586/24,660 (2.4%), P < 0.001], which remained significant after adjusting for sex [adjusted odds ratio 6.88 (95% CI 2.87-16.46)]. There was also a higher risk of postoperative hemorrhage [4/40 (10%) vs. 444/24,660 (1.8%), P < 0.001), with sex-adjusted odds ratio of 5.97 (95% CI 2.12-16.86). Median (IQR) length of stay was increased in children with MPS (3 days, 1-4) compared with children without MPS (1 day, 1-2, P < 0.001). There was an increase in median (IQR) charges for hospital stay in children with MPS compared with their peers [$33,016 ($23,208.50-$72,280.50 vs. $15,383 ($9937-$24,462), P < 0.001].
CONCLUSIONS
Children with MPS undergoing AT had an increased risk of respiratory complications, postoperative hemorrhage, longer length of stay, and a higher cost of treatment when compared with children without MPS. This information may help inform interventional, perioperative, and postoperative decision making.
Topics: Child; Humans; Male; Female; Tonsillectomy; Sleep Apnea, Obstructive; Adenoidectomy; Postoperative Hemorrhage; Mucopolysaccharidoses; Postoperative Complications; Retrospective Studies
PubMed: 38142272
DOI: 10.1186/s40463-023-00685-y -
Brazilian Journal of Otorhinolaryngology 2021Several surgical techniques have been used during tonsillectomy to reduce complications. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Several surgical techniques have been used during tonsillectomy to reduce complications.
OBJECTIVES
To assess the effects of pillar suture in conjunction with tonsillectomy as compared to tonsillectomy without suture in children.
METHODS
Two authors independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2018. Of the included studies, we compared tonsillectomy and pillar suture in combination (suture groups) with tonsillectomy alone,without suture, (control group). Postoperative pain intensity and other morbidities (e.g., postoperative bleeding, palatal hematoma, discomfort, and pillar edema) were measured during the postoperative period.
RESULTS
Postoperative bleeding [primary (OR = 0.47 [0.27; 0.81]) and secondary (OR = 0.14 [0.02; 0.78]) were significantly decreased in the pillar suture group compared to the control group. There were no significant differences between the two groups in postoperative pain at day 7 (SMD = -0.39 [-0.79; 0.00]), palatal hematoma (OR = 5.00 [0.22; 112.88]), palatal discomfort sensation (OR = 2.62 [0.60; 11.46]), site infection (OR = 5.27 [0.24; 113.35]), and velopharyngeal insufficiency (OR = 2.82 [0.11; 74.51]). By contrast, pillar edema (OR = 9.55 [4.29; 21.29]) was significantly increased in the pillar suture group compared to the control group.
CONCLUSIONS
Pillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.
Topics: Child; Humans; Morbidity; Pain, Postoperative; Postoperative Hemorrhage; Sutures; Tonsillectomy
PubMed: 32057680
DOI: 10.1016/j.bjorl.2019.12.007