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Background A previous study on postoperative acute anaemia in orthopaedic surgery was conducted in 2011 (S1), showing that anaemia is recurrent and not always treated. We have recommended prescribing oral iron in the month preceding surgery. A pre-dispensed oral iron prescription has been set up for use during preoperative anaesthesia consultations. We decided to evaluate the impact of this recommendation by a second study in 2012 (S2). Purpose To assess the impact of preoperative oral iron prescription on the prevalence and treatment of postoperative acute anaemia in orthopaedic surgery. Materials and Methods Both studies included patients who underwent total hip or knee arthroplasty (THA/TKA). S1 was conducted retrospectively on all patients operated on in 2011. S2 was conducted prospectively on patients who had been prescribed preoperative iron in September/October 2012. We collected data about operations, iron prescriptions, haemoglobin levels, transfusions and lengths of stay. Results Operations: 327 (S1): 205THA/122TKA vs. 30 (S2): 13THA/17TKA. Postoperative iron prescription: 69% of patients (S1): oral iron 32%, intravenous iron 20%, both oral and intravenous iron 17% vs. 43% of patients (S2): oral iron 23%, intravenous iron 13%, both oral and intravenous iron 7%. Haemoglobin levels: between preoperative and immediate postoperative periods, mean decrease was from 12.9 ± 0.2 g/dl to 11.1 ± 0.1 g/dl (S1) vs. 13.3 ± 0.2 g/dl to 11.7 ± 0.2 g/dl (S2), between preoperative period and hospital discharge, mean loss was 2.2 ± 0.2 g/dl (S1) vs. 1.9 ± 0.17 g/dl (S2) (p Conclusions The prospective study showed that oral iron preventive treatment significantly decreases haemoglobin level fall, transfusion rate and length of stay. Therefore it is necessary to sensitise prescribers concerning preventive iron coverage. A further study is needed to evaluate the impact of a longer iron preventive treatment on a larger number of patients. No conflict of interest.

Purpose: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. Materials and Methods: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. Results: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. Conclusion: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.

PRA levels from 58 Caucasian and 70 African American ESRD patients were compared against a panel of cryopreserved lymphocytes from 60 donors (40 Caucasian, 15 African American, 5 others) to determine whether there was significant racial influence on PRA outcome. African Americans were found to have significantly higher mean PRA levels than Caucasians (27% vs. 18%, P = 0.02). Restricting this analysis to only 1 degree transplant candidates showed predictably lower mean PRAs: 6% in Caucasians and 15% in African Americans, but the difference between the two groups remained significant (P = 0.015). The percentage of patients with PRA > or = 10% was also greater among African Americans than Caucasians (43% vs. 24%, P = 0.026). For patients not previously transplanted, the difference between these frequencies remained significant: 11% in Caucasians, 30% in African Americans (P = 0.025). Untransplanted African American patients with positive PRAs (> or = 10%) had significantly higher PRA against African American cell donors (mean = 55%) than against Caucasian cell donors (mean = 44%) (mean difference = 10.6%, P = 0.0056). African Americans were more frequently transfused than Caucasians. The percentage of patients not previously transplanted receiving 0, 1-5, and > 5 transfusions were 69%, 22%, and 9% for Caucasians and 43%, 44%, and 13% for African Americans (P = 0.03). This higher transfusion rate is the most likely contributor to the elevated PRA levels observed in African Americans.

In a prospective study 116 patients underwent liver resection. Three different resection techniques, blunt dissection (n = 61), ultrasonic aspirator (CUSA) (n = 27) and jet-cutter (n = 28) were compared. Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of area of transected liver surface. Liver resection with the jet-cutter was significantly faster with a resection time of 0.33 min/cm2 in comparison to blunt dissection (0.57 min/cm2) and CUSA (0.50 min/cm2) (P < 0.01) and associated with lower blood loss of 17.7 ml/cm2 (P < 0.01) than the other techniques (blunt dissection 32.5 ml/cm2, CUSA 24.3 ml/cm2). Tissue damage with respect to transaminases SGOT and SGPT was comparable to the other techniques. The jet-cutter is a promising new instrument in liver surgery.

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

Introduction The laparoscopic approach to distal pancreatectomy for benign and malignant diseases appears to offer advantages and is replacing open surgery in some centres. However, well-designed studies comparing laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP) are limited. We present a single-institution study comparing the outcomes of LDP to ODP. Methods The demographic details, clinical characteristics and outcomes of patients who underwent laparoscopic distal pancreatectomy were compared to those who had the surgery performed by open technique. The two approaches were compared on an intention-to-treat basis. Data shown represent medians. Results Between 2002 and 2009, 32 patients (20 female) underwent 16 LDP and 16 ODP respectively. The laparoscopic and open groups were comparable for age (57 vs 63 years, p = 0.584), sex distribution and tumour size (3.9 vs 4 cm, p=0.939). Both groups had a comparable number of malignant cases (56% vs 50%, p=1.0). Although LDP took longer to complete (287.5 vs 240 min, p=0.061), it was associated with significantly lower blood loss (300 vs 500 ml, p=0.031) but comparable perioperative transfusion rate (p=0.471). The laparoscopic approach was associated with a significantly higher spleen-preservation rate (overall: 50% vs 12.5%, p=0.05; benign pathology: 85.7% vs 25%, p=1.0). LDP patients had a significantly lower HDU stay (1 vs 4.5 days, p Conclusion The laparoscopic approach to distal pancreatectomy results in significantly lower blood loss, and shorter HDU and hospital stay compared with open surgery. The postoperative morbidity and R0 resection margin rates were comparably similar. Competing interests None declared.

Systemic anticoagulation (AC) can increase the bleeding risk in CRRT. However, regional citrate anticoagulation (RCA) is a valid alternative to heparin (Hep) in patients at high risk of bleeding. The aim was to evaluate efficacy and safety of RCA-CVVH using a low-concentration citrate (Citr) solution.

Background: Allogenic blood transfusion is associated with several potential complications, especially in patients with cancer. The objective of this prospective single-centre study was to identify the rates of perioperative blood transfusion and overtransfusion in a tertiary-level cancer hospital. Methods: Between March and May 2008, we studied all adult patients undergoing elective major cancer surgery under anaesthesia and recorded intra- and immediate post-operative (within 24 h) blood transfusions and post-operative investigations. Overtransfusion was defined as post-transfusion haemoglobin (Hb) exceeding 10 g/dL. Results: One hundred and eighty-six of 1175 (16%) patients received perioperative blood transfusion. The main trigger for intraoperative transfusion was blood loss exceeding the patient's maximum allowable blood loss (92, 49%). Ninety-five (51%) transfused patients had post-transfusion Hb more than 10 g/dL. The rate of overtransfusion was not higher in patients who received single-unit transfusions. Conclusion: The perioperative transfusion rate in patients undergoing cancer surgery was 16%. More than half of these patients were overtransfused. Following this audit, point-of-care facilities for intraoperative haemoglobin measurement have been introduced.

RESULTS: Mean BMI among the 819 patients was 30kg/m2 (1852kg/m) with 421 of BMI 30kg/m, 358 obese, and 40 morbidly bese and no difference among groups in proportion of high-risk atients. Mean total operative time was 148min, 157min, and 78min for normal, obese, and morbidly obese patients, respectively p 0.05). Estimated blood loss was 109mL, 128mL and 156mL p 0.05) with transfusion rate of only 0.4% and none in the moridly obese group. Mean hospitalization was 1.0d in all three groups. ean nodal yields were 9.6, 9.9, and 10.6 nodes for normal, obese nd morbidly obese patients (p NS). Extended PLND was perormed in 18%, 19%, and 15% with mean yields of 16.7, 15.3, and 16.5 odes, respectively (p NS). Node positivity was identified in 5.2%, .7%, and 12.5% (p NS). Complications of PLND occurred in 2%, %, and 5%, which were mostly symptomatic lymphoceles.

Objective: To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit.Materials and Methods: Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods.Results: A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight < 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion.Conclusion: The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate.

Patients who have undergone thrombolytic therapy are at increased risk for reinfarction. The question arose, however, as to whether angioplasty should be done immediately after thrombolysis, or whether it was better to delay the procedure for a period of hours or days. Three recent trials showed that immediate angioplasty is associated with a higher mortality, higher transfusion rate, and more frequent requirement of emergency bypass surgery than delayed angioplasty. As a result, angioplasty immediately after thrombolytic therapy is generally now reversed for special situations, such as increasing or recurrent ischemia despite administration of a thrombolytic agent

INTRAVENOUS OXYTOCIN FOR THE PREVENTION OF POSTPARTUM HEMORRHAGE AFTER CESAREAN SECTION SOON CHEOL HONG, JI WON KIM, HYUN TAE PARK, HYUN-JOO SEOL, HAI JOONG KIM, SUN HAENG KIM, KYU WAN LEE, Korea University Medical Center, Seoul, South Korea, Korea University Medical Center, , Sudan, Korea University Medical Center, Department of Obstetrics and Gynecology, Seoul, South Korea, Korea University Medical Center, Obstetrics and Gynecology, Seoul, South Korea, Korea University Medical Center, Obstetrics and Gynecolgy, Seoul, South Korea OBJECTIVE: To evaluate the value of additional rectal misoprostol in preventing the risk of postpartum hemorrhage after cesarean delivery STUDY DESIGN: Subjects were randomized to receive two, 200microgram misoprostol tablets rectally (study medication) plus 20 units oxytocin in Ringer fs lactate intravenously or two lactose talets rectally plus 20 units oxytocin in Ringer fs lactate intravenously (control medication). Our outcome measures were change in hemoglobin and hematocrit value from baseline to postpartum day 1, additional uterotonin, transfusion rate and side effects. RESULTS: There were no significant differences between two groups with regard to a drop in hemoglobin and hematocrit. The primary outcome measures were similar in the two groups CONCLUSION: Additional rectal misoprostol to intravenous oxytocin is not more effective than intravenous oxytocin for the prevention of postpartum hemorrhage after cesarean section

Purpose: Our intension was to identify the influence of obesity on the operative results of laparoscopic renal surgery. Our study was performed on the basis of the body mass index (BMI). Materials and Methods: Between March 2003 and December 2006, patients with localized renal cell cancer, who underwent a laparoscopic radical nephrectomy, were included in the study. The patients were divided into 3 groups according to their BMI: group I (BMI 25). Patients with abdominal operation or radiation exposure histories were excluded from the study. The study started at the time of operator's overcoming of the learning curve for a laparoscopic radical nephrectomy. The operative data were retrospectively reviewed. Results: Forty-one patients were included in the study. The mean ages of the three groups were 61.2±6.7, 58.2±6.1 and 59.2±5.7 years, respectively. The mean BMI were 20.3±2.6, 24.1±0.8 and 27.9±2.2 in groups I, II and III (n=15, 12 and 14), respectively. According to the degree of obesity, the operation time was meaningfully increased in group III (group I: 162.1± 39.4, group II: 147.5±17.5, group III: 199.4±2.2 minutes). The complications of a laparoscopic radical nephrectomy, including transfusion rate, had no relation with the degree of obesity. Conclusions: For a laparoscopic radical nephrectomy, obesity could influence the operative time, but not the complications. (Korean J Urol 2007; 48:771-774) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

This study compares our first and second years' experience in performing laparoscopically assisted vaginal hysterectomy (LAVH). During our second year, 42 LAVH's were performed by 20 different surgeons compared with 49 LAVH's performed by 25 different surgeons during the first year. Ten new surgeons attempted the procedure in the second year, three of whom had assisted in the previous year. The remainder were assisted by experienced surgeons from the first year's group. Of the 17 assistant surgeons, 12 had been surgeons or assistants the previous year. The patient cohorts did not differ statistically in age, gravity, parity, or indications for surgery. Although the overall rate of complications was not statistically different, two patients in the second year group required subsequent laparotomy, one to repair a bladder laceration and one for intraabdominal bleeding from an incompletely ligated uterine artery. Both surgeons were among the five most experienced in the total group. There were no statistical differences in hematocrit drop, transfusion rate, febrile morbidity, uterine weights or length of hospital stay. The operative times were 161±92 minutes in the first year and 154±88 minutes in the second year. We conclude that LAVH may continue to be safely introduced into a community hospital setting but that more complications may be expected as surgeons gain experience and attempt more difficult cases.

The purpose of this study was to analyze blood utilization by 92,815 transfused patients treated in 300 United States hospitals during 1974. In order to achieve this end, transfused patients were first divided into 349 diagnosis groups. Blood transfusion data for the highest ranking 50 groups in terms of total units administered to patients in the group are presented and discussed, as well as the blood needs of patients in 19 major disease categories such as malignant neoplasm. Blood transfusion is then correlated with the month of the year by presenting the mean number and the total number of units transfused per month for the country as a whole and for each of four geographic regions. Individual diagnosis groups with significant variation in the mean number of units transfused among the months are also listed and discussed. To aid in the interpretation of mean monthly transfusion rates for the various diagnosis groups, a list of operative procedures with significant variation in the quarterly frequency is offered. Diagnosis groups with significant variation in the mean transfusion rate among the four geographic regions are presented with interpretation of the data.

Vaginal hysterectomy as the procedure of choice following previous abdominal pelvic operation has been evaluated. The source material comprised the case histories of 1,563 patients having vaginal hysterectomy between January, 1961, and January, 1971. Of these, in 942 no previous pelvic procedures had been done, and in 621 there was a history of one or more previous pelvic operations, including 48 abdominal suspensions and 56 cesarean sections. The indications for vaginal hysterectomy and the type of procedures performed were similar in both groups. These two groups were compared in terms of morbidity, major and minor complications, duration of hospitalization, frequency of morcellation, transfusion rate, and the postoperative decrease in hemoglobin. Analysis of these results provides the basis for our conclusion that vaginal hysterectomy is not contraindicated per se after previous abdominal pelvic operations.

Blood-volume was determined in three hundred and one healthy full-term infants after their cords were clamped at different time-intervals after birth. The infants were divided into two groups, depending on whether the mothers received intravenous methylergometrine during the early third stage of labour or not. The results demonstrated that postnatal transfer of the placental blood to the baby took place at a rapid rate and in a stepwise manner, amounting to about 55% of the baby's blood-volume at birth. This stepwise and rapid rate of placental transfusion correlated with the time of uterine contraction during the third stage of labour. In relation to the uterine contraction at birth, about 23-30% of the blood was transferred during the first 10 to 15 seconds. The remaining 70-77% of blood transfer in the non-methylergometrine group was effected partly at 1 minute and completely at 3 minutes after a uterine contraction, whereas in the methylergometrine group, placental transfusion was accelerated, and the remaining 70-77% of blood was almost completely transferred at 1 minute owing to an earlier and enhanced uterine contraction which, it is suggested, plays a key part. No direct significant influence of respiration on placental transfusion was demonstrated.

Background Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA. Questions/purposes The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused? Methods A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon. Results In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients. Conclusion Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA. Electronic supplementary material The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users.

After total knee replacement, overall blood loss is often underestimated, although it exceeds the visible blood loss caused by bleeding into the tissues or into the joint. The use of fibrin sealants during surgery has been suggested to reduce perioperative blood loss and transfusion rates and may be beneficial for patient recovery and the postoperative function of the joint. This will be a single-centre, single-blinded, randomised controlled trial with a parallel design, for which 68 patients undergoing total knee replacement will be recruited and followed up at 3, 6 and 12 months; 34 will be control patients who will receive the standard orthopaedic surgery treatment (electrocoagulation), and the other 34 will receive the same treatment plus 5 ml EVICEL™ applied during surgery and used according to the manufacturer’s instructions. The primary objective is to test the null hypothesis that the effect of EVICEL™ for controlling haemostasis and reducing postoperative blood loss in patients undergoing total knee replacement is not superior to the use of electrocoagulation alone. The secondary objective is to show that EVICEL™ reduces the need for transfusion, increases range of motion, improves clinical outcome and wound healing, and reduces the need for analgesics. The tertiary objective is to show that EVICEL™ reduces the costs of total knee replacement treatment. So far, studies on the effect of fibrin sealants in total knee replacement have delivered inconsistent and ambivalent results, indicating that there is still a need for high-evidence studies as proposed in the presented study protocol. German registration number DRKS00007564 ; date of registration: 26 November 2014.