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Mansour A, Massart N, Gouin-Thibault I, Seite T, Cognasse F, Anselmi A, Parasido A, Piau C, Flécher E, Verhoye JP, Nesseler N. Impact of Intraoperative Allogeneic Platelet Transfusion on Healthcare-Associated Infections in Cardiac Surgery: Insights From a Large Single-Center Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:1650-1658. [PMID: 38604882 DOI: 10.1053/j.jvca.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Despite significant improvement in patient blood management, cardiac surgery remains a high hemorrhagic risk procedure. Platelet transfusion is used commonly to treat thrombocytopenia-associated perioperative bleeding. Allogeneic platelet transfusion may induce transfusion-related immunomodulation. However, its association with postoperative healthcare-associated infections is still a matter of debate. The objective was to evaluate the impact of allogeneic platelet transfusion during cardiac surgery on postoperative healthcare-associated infection incidence. DESIGN Retrospective cohort study. SETTING Tertiary referral academic center. PARTICIPANTS Patients undergoing cardiac surgery from 2012 to 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Intraoperative platelet transfusion was defined as exposure in a causal model. The primary outcome was the incidence of healthcare-associated infections comprised of bloodstream infection, hospital-acquired pneumonia, and surgical-site infection. Among 7,662 included patients, 528 patients (6.8%) were exposed to intraoperative platelet transfusion, and 329 patients (4.3%) developed 454 postoperative infections. Bloodstream infection affected 106 patients (1.4%), hospital-acquired pneumonia affected 174 patients (2.3%), and surgical-site infection affected 148 patients (1.9%). Intraoperative platelet transfusion was associated with an increased risk of bloodstream infection after adjustment by multivariable logistic regression (odds ratio [OR] 2.85; 95% CI 1.40-5.8; p = 0.004; n = 7,662), propensity score matching (OR 3.95; 95% CI 1.57-12.0), p = 0.007; n = 766), and propensity score overlap weighting (OR 3.04; 95% CI 1.51-6.1, p = 0.002; n = 7,762). Surgical-site infection and hospital-acquired pneumonia were not significantly associated with platelet transfusion. CONCLUSIONS These results suggested that intraoperative allogeneic platelet transfusion is a risk factor for bloodstream infection after cardiac surgery. These results supported the development of patient blood management strategies aimed at minimizing perioperative platelet transfusion in cardiac surgery.
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Affiliation(s)
- Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, INSERM, CIC 1414, IRSET, UMR_S1085, FHU SUPORT, Univ Rennes, Rennes, France; Department of Hematology, Pontchaillou, University Hospital of Rennes, INSERM, IRSET, UMR_S1085, Univ Rennes, Rennes, France
| | - Nicolas Massart
- Intensive Care Unit, Saint Brieuc General Hospital, Saint Brieuc, France
| | - Isabelle Gouin-Thibault
- Department of Hematology, Pontchaillou, University Hospital of Rennes, France, Rennes, France
| | - Thibault Seite
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France, Rennes, France
| | - Fabrice Cognasse
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France; University Jean Monnet, Saint-Etienne, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Alessandro Parasido
- Department of Cardiothoracic Surgery, Pontchaillou, University Hospital of Rennes, France, Rennes, France
| | - Caroline Piau
- Department of Microbiology, Pontchaillou, University Hospital of Rennes, France, Rennes, France
| | - Erwan Flécher
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, CHU Rennes, INSERM, CIC 1414 , NuMeCan UMR_S124, FHU SUPORT, Univ Rennes, Rennes, France.
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Xu X, Zhang Y, Gan J, Ye X, Yu X, Huang Y. Association Between Storage Time of Transfused Red Blood Cells and Infection After Clean-contaminated Surgery: A Retrospective Cohort Study. Ann Surg 2024; 280:253-260. [PMID: 37982526 DOI: 10.1097/sla.0000000000006155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To investigate the association between the storage time of transfused red blood cells (RBCs) and risks of infections after clean-contaminated surgery. BACKGROUND Storage lesions of RBCs can aggravate transfusion-related immunomodulation. Very few randomized controlled trials have investigated the impacts of storage time on postoperative outcomes in noncardiac patients. METHODS We included adult patients who had undergone clean-contaminated surgery from 2014 to 2018 and received allogeneic RBC transfusion. In transfusion episode-level analysis, the exposure was the storage time of each transfusion episode. In patient-level analysis, the exposures were the mean, weighted mean, maximum storage time, and Scalar Age of Blood Index of RBCs transfused into each patient. The primary outcome was infections that developed after transfusions within postoperative day 30. RESULTS The 4046 patients were included who received 11604 transfusion episodes. Of these, 1025 (25.3%) patients developed postoperative infections. An increased storage time of transfused RBCs was not associated with increased odds of postoperative infections in either transfusion episode-level analysis [odds ratio (OR), 1.03 per 5 days, 95% CI, 0.95-1.11] or patient-level analysis (mean: OR, 1.02, 95% CI, 0.95-1.10; weighted mean: OR, 1.02, 95% CI, 0.95-1.10; maximum: OR, 1.06, 95% CI, 0.98-1.14; Scalar Age of Blood Index: OR, 0.99, 95% CI, 0.96-1.03), after adjusting 17 confounders. CONCLUSIONS Prolonged storage time of transfused RBCs was not associated with increased risks of infections after clean-contaminated surgery.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, China
| | - Jia Gan
- Department of Blood Transfusion, Peking Union Medical College Hospital, Beijing, China
| | - Xiangyang Ye
- Department of Information Management, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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Hu Z, Tian Z, Wei X, Chen Y. Letter to the editor: Dynamic insights into infection risk over time in two-stage implant-based breast reconstruction: a retrospective cohort study. Int J Surg 2024; 110:4520-4521. [PMID: 38767582 PMCID: PMC11254195 DOI: 10.1097/js9.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Zhe Hu
- Jining Medical University
| | | | - Xi Wei
- Jining Medical University
| | - Yueqin Chen
- Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
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Li X, Yu L, Fu M, Yang J, Tan H. Perioperative Risk Factors for Postoperative Pulmonary Complications After Minimally Invasive Esophagectomy. Int J Gen Med 2024; 17:567-577. [PMID: 38374814 PMCID: PMC10876009 DOI: 10.2147/ijgm.s449530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Postoperative pulmonary complications (PPCs) are the most prevalent complication after esophagectomy and are associated with a worse prognosis. This study aimed to investigate the perioperative risk factors for PPCs after minimally invasive esophagectomy (MIE). Methods Seven hundred and sixty-seven consecutive patients who underwent McKeown MIE via thoracoscopy and laparoscopy were retrospectively studied. Patient characteristics, perioperative data, and postoperative complications were analyzed. Results The incidence of PPCs after MIE was 25.2% (193/767). Univariate analysis identified age (odds ratio [OR] 1.022, P = 0.044), male sex (OR 2.955, P < 0.001), pulmonary comorbidities (OR 1.746, P = 0.032), chronic obstructive pulmonary disease (COPD) (OR 2.821, P = 0.003), former smoking status (OR 1.880, P = 0.001), postoperative albumin concentration (OR 0.941, P = 0.007), postoperative creatinine concentration (OR 1.011, P = 0.019), and perioperative transfusion (OR 2.250, P = 0.001) as risk factors for PPCs. In multivariate analysis, the independent risk factors for PPCs were male sex (OR 3.135, P < 0.001), body mass index (BMI) (OR 1.088, P = 0.002), COPD (OR 2.480, P = 0.012), neoadjuvant chemoradiotherapy (OR 2.057, P = 0.035), postoperative albumin concentration (OR 0.929, P = 0.002), and perioperative transfusion (OR 1.939, P = 0.013). The area under the receiver operating characteristic curve for the predictive model generated by multivariate logistic regression analysis was 0.671 (95% confidence interval 0.628-0.713). Conclusions Male sex, BMI, COPD, neoadjuvant chemoradiotherapy, postoperative albumin concentration, and perioperative transfusion were independent predictors of PPCs after MIE.
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Affiliation(s)
- Xiaoxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miao Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiaonan Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
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Niu M, Zhou Z, Wang L, Yang J, Sun M, Lv X, Zhang F. Association of triglyceride-glucose index with myocardial injury post-stroke in older patients with first-ever ischemic stroke. BMC Geriatr 2023; 23:357. [PMID: 37291516 PMCID: PMC10249284 DOI: 10.1186/s12877-023-04041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Myocardial injury post-stroke is a common sequela of acute stroke. Triglyceride-glucose index (TyG index), a valuable surrogate indicator of insulin resistance, has been suggested to be closely related to cardiovascular outcomes. However, it is unknown whether the TyG index is independently associated with a higher risk of myocardial injury post-stroke. We therefore investigated the longitudinal association between TyG index and risk of myocardial injury post-stroke in older patients with first-ever ischemic stroke and no prior cardiovascular comorbidities. METHODS We included older patients with first-ever ischemic stroke and no prior cardiovascular comorbidities between January 2021 to December 2021. The individuals were stratified into low and high TyG index groups according to the optimal cutoff value with TyG index. We performed logistic regression analysis, propensity score matching (PSM) analysis, restricted cubic spline analysis, and subgroup analyses to explore the longitudinal association between TyG index and risk of myocardial injury post-stroke. RESULTS We included 386 individuals with a median age of 69.8 years (interquartile range: 66.6, 75.3). The optimal TyG index cut-off for predicting myocardial injury post-stroke was 8.9 (sensitivity 67.8%; specificity 75.5%; area under curve 0.701). Multivariate logistic regression analysis revealed that the risk of genesis of myocardial injury post-stroke increased with elevated TyG index (odds ratio [OR], 2.333; 95% confidence interval [CI], 1.201-4.585; P = 0.013). Furthermore, all covariates were well balanced between the two groups. The longitudinal association between TyG index and myocardial injury post-stroke remained significantly robust (OR: 2.196; 95% CI: 1.416-3.478; P < 0.001) after PSM adjustment. CONCLUSION Individuals with an elevated TyG index were more susceptible to having an increased risk of myocardial injury post-stroke. TyG index thus might be served as a complementary approach for optimized-for-risk stratification in older patients with first-ever ischemic stroke and no prior cardiovascular comorbidities.
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Affiliation(s)
- Mu Niu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Zhikang Zhou
- Department of Anesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Long Wang
- Department of Pain Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jian Yang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Miao Sun
- Department of Anesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Faqiang Zhang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
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Raeven P, Hagn G, Niederstaetter L, Brugger J, Bayer-Blauensteiner S, Domenig C, Hoetzenecker K, Posch M, Leitner G, Gerner C, Baron DM. Red blood cell transfusion-related eicosanoid profiles in intensive care patients—A prospective, observational feasibility study. Front Physiol 2023; 14:1164926. [PMID: 37008004 PMCID: PMC10060532 DOI: 10.3389/fphys.2023.1164926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Eicosanoids are bioactive lipids present in packed red blood cells (PRBCs), and might play a role in transfusion-related immunomodulation (TRIM). We tested the feasibility of analyzing eicosanoid profiles in PRBC supernatant and in plasma samples of postoperative intensive care unit (ICU) patients transfused with one unit of PRBCs.Methods: We conducted a prospective, observational feasibility study enrolling postoperative ICU patients: 1) patients treated with acetylsalicylic acid following abdominal aortic surgery (Aorta); 2) patients on immunosuppressants after bilateral lung transplantation (LuTx); and 3) patients undergoing other types of major surgery (Comparison). Abundances of arachidonic acid (AA) and seven pre-defined eicosanoids were assessed by liquid chromatography and tandem mass spectrometry. PRBC supernatant was sampled directly from the unit immediately prior to transfusion. Spearman’s correlations between eicosanoid abundance in PRBCs and storage duration were assessed. Patient plasma was collected at 30-min intervals: Three times each before and after transfusion. To investigate temporal changes in eicosanoid abundances, we fitted linear mixed models.Results: Of 128 patients screened, 21 were included in the final analysis (Aorta n = 4, LuTx n = 8, Comparison n = 9). In total, 21 PRBC and 125 plasma samples were analyzed. Except for 20-hydroxyeicosatetraenoic acid (HETE), all analyzed eicosanoids were detectable in PRBCs, and their abundance positively correlated with storage duration of PRBCs. While 5-HETE, 12-HETE/8-HETE, 15-HETE, 20-HETE, and AA were detectable in virtually all plasma samples, 9-HETE and 11-HETE were detectable in only 57% and 23% of plasma samples, respectively.Conclusions: Recruitment of ICU patients into this transfusion study was challenging but feasible. Eicosanoid abundances increased in PRBC supernatants during storage. In plasma of ICU patients, eicosanoid abundances were ubiquitously detectable and showed limited fluctuations over time prior to transfusion. Taken together, larger clinical studies seem warranted and feasible to further investigate the role of PRBC-derived eicosanoids in TRIM.
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Affiliation(s)
- Pierre Raeven
- Division of General Anesthesia and Intensive Care, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hagn
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Laura Niederstaetter
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Sophia Bayer-Blauensteiner
- Division of General Anesthesia and Intensive Care, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Christoph Domenig
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Gerda Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - David M. Baron
- Division of General Anesthesia and Intensive Care, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
- *Correspondence: David M. Baron,
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Niu T, Bao X, Wei J, Shi Y, Ma W, Wang R. Impact of Penicillin Allergy-Based Alternative Antibiotics on the Risk of Postoperative Central Nervous System Infection: A Retrospective Cohort Study. World Neurosurg 2023; 171:e745-e751. [PMID: 36584894 DOI: 10.1016/j.wneu.2022.12.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Central nervous system (CNS) infection is one of the most serious complications after neurosurgery. This study aimed to analyze the effect of penicillin allergy (PA) and alternative prophylactic antibiotics on risk of postoperative CNS infection in patients undergoing neurosurgery. METHODS Data of patients who underwent neurosurgical procedures from January 2015 to December 2021 were analyzed retrospectively. Patients with PA were compared with patients without PA in a 1:1 ratio. A multivariate logistic regression model was used to examine whether PA was a risk factor for postoperative CNS infection. RESULTS Overall, 15,049 eligible neurosurgical records were reviewed, from which 578 surgical records of 556 patients with PA were matched to 578 records of 570 patients without PA. Patients with PA showed significantly lower probability to receive prophylactic cephalosporins (55.9% vs. 98.8%, P < 0.01), but significantly higher probability to receive clindamycin (41.86% vs. 1.03%, P < 0.01), than patients without PA. Multivariate analysis revealed that patients with PA were more likely to experience postoperative CNS infection than patients without PA (odds ratio = 2.03; 95% confidence interval, 1.15-3.56; P = 0.014). The incidence of postoperative CNS infection returned to a level comparable to that in general population when patients with suspected PA received prophylactic cephalosporins. CONCLUSIONS PA is associated with higher risk of postoperative CNS infection in patients undergoing neurosurgery. This may be attributed to the use of alternative prophylactic antibiotics other than cephalosporins, especially clindamycin.
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Affiliation(s)
- Tong Niu
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yili Shi
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Li J, Xia Y, Jin S, Dong H, Zhao P, Jiang H, Hu R. Effects of acute normovolemic hemodilution on allogeneic blood transfusion & coagulation in orthognathic surgery: A randomized study. Transfusion 2023; 63:125-133. [PMID: 36342237 DOI: 10.1111/trf.17178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute normovolemic hemodilution (ANH) is one of the important techniques predominantly used in cardiac, hepatic, and vascular surgery for decreasing allogeneic blood transfusion. However, the effect of ANH in orthognathic surgery has been rarely studied. Therefore, this study aims to assess the ANH-mediated reduction in the allogeneic red blood cell transfusion for orthognathic surgery patients. STUDY DESIGN AND METHODS In this single-center study, 18-80 years old patients were recruited. Patients with hemoglobin ≥11 g/dL and normal coagulation function were randomly divided into ANH or standard treatment group. RESULTS Ninety six patients underwent ANH, and 101 patients received standard treatment. No differences in demographic or major pre-operative characteristics were observed between the two groups. One patient in the ANH and three patients in the standard treatment group received allogeneic blood [3(2.97%) vs. 1(1.16%), control vs. ANH, p = .395]. Multivariate logistic regression analysis revealed that ANH treatment was not associated with transfusion of allogeneic blood (p = .763). After retransfusing autologous blood, PT and APTT in the ANH group significantly increased compared to standard treatment group (PT: -1.73 ± 1.09 vs. -2.15 ± 1.06, p = .035; APTT: -6.39 ± 5.76 vs. -8.16 ± 5.70, p = .031; control vs. ANH). No significant differences between the two groups were observed for changes in coagulation parameters at first postoperative day. However, platelet counts in the ANH group decreased compared to the standard group. No significant difference in major adverse outcomes was observed between the two groups. CONCLUSION ANH did not reduce the incidence of allogeneic transfusion in patients undergoing orthognathic surgery.
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Affiliation(s)
- Jiayun Li
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Yangyang Xia
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Shanliang Jin
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Hui Dong
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - PengCheng Zhao
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Hong Jiang
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Rong Hu
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
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Kim S, Choi K, Keum MA, Kim MS, Yoon SG, Kyoung KH. Evaluation of red blood cell transfusion threshold in the management of brain-dead organ donors. Medicine (Baltimore) 2022; 101:e32353. [PMID: 36550826 PMCID: PMC9771295 DOI: 10.1097/md.0000000000032353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The disparity between the demand and supply of organs has necessitated an expansion of the criteria for organ donation. Consequently, numerous guidelines have been proposed for managing brain-dead organ donors (BDODs) to improve their organ function and the organ procurement rate. Therefore, we aimed to evaluate the previously recommended threshold for red blood cell transfusion in BDODs. Medical records of BDODs were retrospectively reviewed from January 2012 to December 2021. We enrolled BDODs who stayed for more than 24 hours at an hospital organ procurement organization. We analyzed their organ function and the rate of organ procurement according to the hemoglobin concentration. A total of 111 BDODs were enrolled and divided into the following 2 groups: hemoglobin (Hb) ≥ 10 g/dL (45.0 %) and Hb < 10 g/dL (55.0 %). There were no significant differences between the groups in the total bilirubin, creatinine, arterial blood lactate, and the rate of organ procurement. A correlation analysis did not reveal any association between the hemoglobin concentration and organ function of the BDODs. Hemoglobin concentration of 10 g/dL cannot be considered a threshold for red blood cell transfusion. Furthermore, organ function is not correlated with a hemoglobin concentration > 7 g/dL. Restrictive transfusion strategy is appropriate for BDOD management.
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Affiliation(s)
- Sungjeep Kim
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyunghak Choi
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Ae Keum
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Soo Kim
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sun Geon Yoon
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyu-Hyouck Kyoung
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Eisler L, Hassan F, Lenke LG, Chihuri S, Hod EA, Li G. Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis. JB JS Open Access 2022; 7:JBJSOA-D-22-00038. [PMID: 36285249 PMCID: PMC9586922 DOI: 10.2106/jbjs.oa.22.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results.
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Affiliation(s)
- Lisa Eisler
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY,Email for corresponding author:
| | - Fthimnir Hassan
- Department of Orthopedic Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Lawrence G. Lenke
- Department of Orthopedic Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Guohua Li
- Departments of Anesthesiology and Epidemiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY
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Zhang J, Jiang L, Zhu X. A Machine Learning-Modified Novel Nomogram to Predict Perioperative Blood Transfusion of Total Gastrectomy for Gastric Cancer. Front Oncol 2022; 12:826760. [PMID: 35480095 PMCID: PMC9035891 DOI: 10.3389/fonc.2022.826760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Perioperative blood transfusion reserves are limited, and the outcome of blood transfusion remains unclear. Therefore, it is important to prepare plans for perioperative blood transfusions. This study aimed to establish a risk assessment model to guide clinical patient management. Methods This retrospective comparative study involving 513 patients who had total gastrectomy (TG) between January 2018 and January 2021 was conducted using propensity score matching (PSM). The influencing factors were explored by logistic regression, correlation analysis, and machine learning; then, a nomogram was established. Results After assessment of the importance of factors through machine learning, blood loss, preoperative controlling nutritional status (CONUT), hemoglobin (Hb), and the triglyceride–glucose (TyG) index were considered as the modified transfusion-related factors. The modified model was not considered to be different from the original model in terms of performance, but is simpler. A nomogram was created, with a C-index of 0.834, and the decision curve analysis (DCA) demonstrated good clinical benefit. Conclusions A nomogram was established and modified with machine learning, which suggests the importance of the patient’s integral condition. This emphasizes that caution should be exercised regarding transfusions, and, if necessary, preoperative nutritional interventions or delayed surgery should be implemented for safety.
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