Objective During primary total knee arthroplasty (TKA), anticoagulant drugs are used for prevention of major venous thrombosis of lower limbs, and this often leads to the increase of perioperative blood loss. To retrospectively analyse the impact of low molecular weight heparin on hidden blood loss and transfusion rate after primary TKA by comparing with the use of aspirin. Methods Between October 2007 and August 2009, the clinical data from 286 patients undergoing primary TKA surgery were retrospectively analyzed. In accordance with different anticoagulation methods, the cases were divided into 2 groups, the trial group (n=166) and the control group (n=120). In the trial group, the patients received low molecular weight heparin (4 000-6 000 U/day) from 8-12 hours after TKA for 14 days; there were 27 males and 139 females with an average age of 66.1 years (range, 22-82 years); the body mass index (BMI) was 26.79 ± 3.87; and the locations were the left knee in 99 cases and the right knee in 67 cases with an average disease duration of 4.1 years (range, 1.8-8.6 years). In the control group, the patients received aspirin (150 mg/day) for 14 days; there were 21 males and 99 females with an average age of 64.9 years (range, 40-84 years); the BMI was 27.87 ± 3.62; and the locations were the left knee in 78 cases and the right knee in 42 cases with an average disease duration of 4.9 years (range, 1.5-8.2 years). There was no significant difference in the general data between 2 groups (P gt; 0.05). Results The incisions healed by first intention in all patients. Postoperative deep venous thrombosis occurred in 37 patients of the trial group and in 28 cases of the control group. All the patients were followed up 12-34 months (mean, 21.6 months). There were significant differences in the United States Hospital for Special Surgery (HSS) score of 2 groups between before surgery and after surgery (P lt; 0.05). The hidden blood loss was (40.55 ± 37.75) g/L in the trial group and (32.52 ± 40.13) g/L in the control group, showing significant difference (t=3.387, P=0.001); the dominant blood loss was (24.08 ± 14.63) g/L and (27.91 ± 18.47) g/L respectively, showing no significant difference (t= —1.899, P=0.059). The blood transfusion rates were 40.4% (67/166) in the trial group and 30.0% (36/120) in the control group, showing no significant difference (χ2=2.771, P=0.081); the transfusion volumes were (1.44 ± 4.03) U and (0.97 ± 3.50) U respectively, showing significant difference (t=2.071, P=0.039). Conclusion The low molecular weight heparin has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
Objective To explore the risk factors and treatment associated with postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 78 patients undergoing pancreatieoduodeneetomy from May 2009 to October 2011 were retrospectively analyzed in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Results The incidence of postoperative hemorrhage was 10.3％ （8/78）. Among these eight patients, intra-abdominal hemorrhage occurred in two cases （one case of early and delayed hemorrhage respectively）, and gastrointestinal hemorrhage occurred in 6 cases （one and five cases of early and delayed hemorrhage respectively）. Univarlate analysis showed that operative blood loss, postoperative celiac infection, pancreatic fistula, and pancreaticogastrostomy were significantly associated with postoperative hemorrhage. Multivariate analysis identified for vailables as independent factors associated with postoperative hemorrhage, namely, pancreaticogastrostomy, postoperative celiac infection, and pancreatic fistula. Conclusions Skillful operation, prevention of pancreatic fistula, and control celiac infection are important for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset, and severity of hemorrhage. To prevent its occurrence is the key of treatment.
ObjectiveTo investigate the hemostasis effect of compression dressing therapy after total hip arthroplasty (THA). MethodThirty-four patients undergoing unilateral THA between December 2014 and March 2015 were randomly divided into observation group (compression dressing group, n=17) and control group (ordinary dressing group, n=17) . There was no significant difference in gender, age, height, weight, lesion hips, pathogeny, disease duration, and preoperative hemoglobin between 2 groups (P>0.05) . The total blood loss theoretical value, the postoperative drainage volume, the visible blood loss, the hidden blood loss, the total blood transfusion volume, the number of patients receiving blood transfusion, and the related complications were compared between 2 groups. ResultsNo significant difference was found in operation time and hospitalization time between 2 groups (t=0.337, P=0.738; t=0.140, P=0.889) . The incisions healed by first intention in all patients. Six cases had incision subcutaneous hematoma in the control group, no incision subcutaneous hematoma occurred in the observation group (χ2=7.286, P=0.018) . No postoperative complications of wound superficial infection and venous thrombosis occurred in 2 groups. After operation, blood transfusion was given in 1 case of observation group and 7 cases of control group, showing significant difference (χ2=5.885, P=0.039) , and the total blood transfusion volume was 600 mL and 3 200 mL, respectively. There was no significant difference in preoperative blood volume and intraoperative blood loss between 2 groups (P>0.05) , but the total blood loss theoretical value, the postoperative drainage volume, the visible blood loss, and the hidden blood loss in observation group were significantly less than those in control group (P<0.05) . ConclusionsThe compression dressing should be performed after THA because it can effectively reduce postoperative blood loss and the incidence of wound hematoma.
Objective To investigate the cause, treatment, and prognosis of the postpancreaticoduodenectomy hemorrhage (PPH) . Method A total of 779 patients who underwent pancreaticoduodenectomy at Fudan University Shanghai Cancer Center between January 2015 and December 2016 were enrolled, and the data of them were retrospectively analyzed. Results Sixteen patients (PPH group) suffered from PPH and 763 patients didn’t suffered from PPH (non-PPH group) of 779 patients. There was no significant difference in the age, gender, type of disease, operative time, blood loss, and ratio of blood transfusion between the 2 groups (P>0.05), but the incidences of pancreatic fistula and delayed gastric emptying, postoperative drainage time, hospital stay, and mortality were all higher or longer in PPH group compared with non-PPH group (P<0.001). Of the 16 PPH patients, early haemorrhage occurred in 3 patients (including 2 patients with gastrointestinal haemorrhage and 1 patient with intra-abdominal haemorrhage) and delayed haemorrhage occurred in 13 patients (including 6 patients with gastrointestinal haemorrhage and 7 patients with intra-abdominal haemorrhage). All the 3 patients with early haemorrhage were cured by surgery. Of the 13 patients with delayed haemorrhage, 5 patients were cured by radiological intervention, 2 patients were cured by endoscopic hemostasis, and 3 patients were cured by conservative treatment, but 3 patients with sentinel bleeding died after interventional embolization+surgery. Conclusions The mortality of PPH is high. Surgery is optimal to early haemorrhage and radiological intervention is optimal to delayed haemorrhage, including embolization or covered stent implantation. The sentinel bleeding should be given great attention.
Postoperative bleeding and coagulation hemothorax is the primary cause for re-operation after general thoracic surgical procedures. We should do a good job in the assessment of preoperative factors to increase the operation control. This article mainly introduces the thoracic surgery bleeding quantitative assessment, bleeding location and cause, hemostasis, transfusion trigger, pleural drainage tube selection, surgical complications, enhanced recovery after surgery and so on.
Objective To compare the efficacy and safety of intra-articular combined with intravenous administration of tranexamic acid (TXA) with different dosage for reducing blood loss in primary total knee arthroplasty (TKA). Methods Between January 2017 and June 2017, 90 patients suffering from unilateral osteoarthritis who underwent primary TKA were randomly scheduled to three interventions, named groups A, B, and C. Single dosage of TXA via intravenous injection (IV) and different dosages of TXA via intra-articular injection (IA) were utilized in three groups, respectively. All patients in three groups received 1 g TXA IV at 10 minutes preoperatively, and received 1, 2, and 3 g TXA IA diluted in 50 mL saline after wound closure in groups A, B and C, respectively. The age, gender, body mass index, affected side of the knee, grade of osteoarthritis, grade of America Society of Anesthesiologist, preoperative hemoglobin (Hb) concentration, platelet count, preoperative prothrombin time, and activated partial thromboplastin time were not significantly different between groups (P>0.05). The postoperative wound blood drainage, Hb concentration at 1, 3, and 7 days after operation, transfusion rate, and thromboembolic complications were observed. All patients were routinely observed for deep vein thrombosis (DVT) by the color Doppler ultrasonography at 1 week, 1 month, and 3 months after operation, and the symptomatic pulmonary embolism (PE) were observed. Results All patients in three groups were followed up 7-12 months (mean, 8.4 months). There was no significant difference in operation time between groups (P>0.05). The postoperative wound blood drainage was significantly less in groups B and C than that in group A (P<0.05), whereas no significant difference was found between group B and group C (P>0.05). Incision skin necrosis occurred in 1 case of group B and fat liquefaction occurred in 1 case of group C. The other incisions of 3 groups healed by first intention. There was no significant difference in incision complication incidence between groups. The Hb concentration was significantly higher in groups B and C than that in group A at 1, 3, and 7 days after operation (P<0.05). While between group B and group C, the significant difference of Hb concentration only existed at 1 day after operation (P<0.05). The number of patients who got blood transfusion was significantly less in group B (4 cases, 13.3%) and group C (5 cases, 16.7%) than that in group A (9 cases, 30%) (P< 0.05), but no significant difference was found between group B and group C (P>0.05). The result of color Doppler ultrasonography showed that 1 case got DVT in the contralateral calf at 3 weeks in group B. And there was no symptomatic PE in 3 groups. Conclusion Combined administration of IV and IA TXA in a clinically relevant reduction in blood loss was effective and safe in primary TKA, and no thromboembolic complication was observed. The combination of 1 g IV with 2 g IA could be the optional choice.
ObjectiveTo explore the risk factors and bleeding points associated with postoperative hemorrhage after thyroidectomy and provide clinical basis for prevention of postoperative bleeding.MethodsThe clinical data of 21 patients with postoperative hemorrhage and 63 patients without postoperative hemorrhage who underwent thyroidectomy from Nov. 2010 to Nov. 2017 in West China Hospital were retrospectively analyzed.ResultsUnivariate analysis showed that hypertension, maximum tumour dimension, lymph node metastasis, recurrent laryngeal nerval infiltration, T stage, N stage, serum triglyceride, and serum high density lipoprotein were significantly associated with postoperative hemorrhage (P<0.05). Multivariate analysis showed that lymph node metastasis (OR=16.219, P=0.002) and low serum high density lipoprotein (OR=0.035, P=0.006) were risk factors for postoperative hemorrhage. Among the patients with postoperative bleeding, the most common five bleeding sites were: ribbon muscle and sternocleidomastoid muscle (both was 19.2%), esophageal tracheal surface blood vessels (11.5%), thyroid bed (7.7%), and larynx recurrent paravascular small vessels (7.7%).ConclusionsLymph node metastasis and serum HDL are independent risk factors of hemorrhage after thyroidectomy. The predilection site for postoperative bleeding is mainly the neck muscle.
ObjectiveTo identify the risk factors of postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot (TOF) and to develop nomogram predicting the risk of postoperative blood loss.MethodsA retrospective case-control study was conducted in pediatric TOF patients who underwent corrective operation in our hospital from November 2018 to June 2019. And the clinical data from each enrolled patient were gathered and analyzed. Clinically significant postoperative blood loss was defined as drainage volume from chest tube ≥16 mL/kg during the first 24 h after surgery, which corresponded to the 75th percentile of the blood loss in our population. The primary outcome was to determine the independent predictors of postoperative blood loss by the least absolute shrinkage and selection operator (LASSO) regression, univariate and multivariate logistic regression analysis. On the basis of the independent predictors of postoperative bleeding, nomogram was developed and its discrimination and calibration were estimated.ResultsA total of 105 children were selected (67 males and 38 females aged 3-72 months). The drainage volume from chest tube in the bleeding group was significantly higher than that in the non-bleeding group during the first 24 h (P<0.0001). Multivariate logistic regression analysis showed that low body weight (OR=0.538, 95%CI 0.369-0.787, P=0.001), high preoperative hemoglobin concentration (OR=1.036, 95%CI 1.008-1.066, P=0.013) and prolonged intraoperative aortic cross clamp time (OR=1.022, 95%CI 1.000-1.044, P=0.048) were independent risk factors for postoperative blood loss. In the internal validation, the model displayed good discrimination with a C-index of 0.835 (95%CI 0.745-0.926) and high quality of calibration plots in nomogram models was noticed.ConclusionThe nomogram demonstrated good discrimination and calibration in estimating the risk of postoperative blood loss among pediatric patients following corrective operation of TOF.