Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in s...Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.展开更多
Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patie...Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From展开更多
Background Total knee arthroplasty （TKA） is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin （HB） counts postoperatively...Background Total knee arthroplasty （TKA） is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin （HB） counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.展开更多
Background： Total knee arthroplasty （TKA） is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexam...Background： Total knee arthroplasty （TKA） is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid （TXA） is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss （TBL） came from hidden blood loss （HBL） on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous （IV） TXA in further redticing HBL after primary TKA. Methods： A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10-15 rain before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group （n = 21） was given additional 1 g of TXA intravenously twice a day, whereas the control group （n = 22） received an equal volume of saline. Drain output, hemoglobin （Hb）, and hematocrit （HCT） were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis （DVT）. The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant ifP 〈 0.05. Results： The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1-5 compared to the control; however, the difference was not significant （F = 2.732, P = 0.106）. The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 （F= 5.254, P = 0.027）. No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group （supplemental 133.1 [71.8,287.3] ml and control 296.0 [ 185.3, 421.4] ml, Z = 2.478, P = 0.013. median [interquartile range]）. There was one DVT in the control group and none in the supplemental group. All patients were tbllowed at 1 year after surgery, and no further complications were reported. Conclusion： Based on the current study, additional doses of IV TXA could potentially further reduce HBL alter primary TKA without increasing the risk of venous thromboembolism.展开更多
Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who...Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.展开更多
文摘Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.
文摘Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From
文摘Background Total knee arthroplasty （TKA） is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin （HB） counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.
文摘Background： Total knee arthroplasty （TKA） is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid （TXA） is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss （TBL） came from hidden blood loss （HBL） on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous （IV） TXA in further redticing HBL after primary TKA. Methods： A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10-15 rain before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group （n = 21） was given additional 1 g of TXA intravenously twice a day, whereas the control group （n = 22） received an equal volume of saline. Drain output, hemoglobin （Hb）, and hematocrit （HCT） were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis （DVT）. The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant ifP 〈 0.05. Results： The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1-5 compared to the control; however, the difference was not significant （F = 2.732, P = 0.106）. The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 （F= 5.254, P = 0.027）. No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group （supplemental 133.1 [71.8,287.3] ml and control 296.0 [ 185.3, 421.4] ml, Z = 2.478, P = 0.013. median [interquartile range]）. There was one DVT in the control group and none in the supplemental group. All patients were tbllowed at 1 year after surgery, and no further complications were reported. Conclusion： Based on the current study, additional doses of IV TXA could potentially further reduce HBL alter primary TKA without increasing the risk of venous thromboembolism.
基金This project was partially supported by a grant from the National Natural Science Foundation of China （No.81273972）.
文摘Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.
