Clinical Outcome and Risk Factors of Red Blood Cell Transfusion in Patients Undergoing Elective Primary Meningioma Resection

Neef, Vanessa; König, Sven; Monden, Daniel; Dubinski, Daniel; Benesch, Anika; Raimann, Florian J.; Piekarski, Florian; Ronellenfitsch, Michael; Harter, Patrick N.; Senft, Christian; Meybohm, Patrick; Hattingen, Elke; Zacharowski, Kai; Seifert, Volker; Baumgarten, Peter

doi:10.3390/cancers13143601

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…30 Additionally, previous studies reported that skullbased surgery and meningioma are potential factors linked with blood transfusion. 8,9 These were in concordance with our findings which shows that intraosseous/skull-based tumor and meningioma were associated with both intraoperative transfusion and massive blood loss. Although meningioma is a benign tumor, hypervascularity and numerous feeding vessels are common findings of this tumor.…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of Preoperative Red Cell Preparation and Intraoperative Massive Transfusion in Brain Tumor Operation

Tunthanathip

Saeheng

Oearsakul

et al. 2023

Indian Journal of Neurosurgery

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Background Excessive requests for preoperative packed red cell (PRC) preparation have been noted, resulting in waste of blood products and higher costs in brain tumor surgery. The objectives of the present study were as follows: (1) the primary objective was to assess the effectiveness index of blood preparation and utilization; (2) the secondary objective was to explore factors associated with intraoperative PRC transfusion; and (3) the third objective was to identify the prevalence and analyze risk factors of massive transfusion. Methods A retrospective cohort study was done on patients who had undergone brain tumor operations. The effectiveness indexes of preoperative PRC preparation and intraoperative utilization were calculated as follows: the crossmatch to transfusion (C/T) ratio, transfusion probability (Tp), and transfusion index (Ti). Additionally, factors associated with intraoperative PRC transfusion and massive transfusion were analyzed. Results There were 1,708 brain tumor patients and overall C/T, Tp, and Ti were 3.27, 45.54%, and 1.10, respectively. Prevalence of intraoperative PRC transfusion was 44.8%, and meningioma, intraosseous/skull-based tumor, and tumor size were linked with massive transfusion. Conclusion Unnecessary preoperative blood component preparation for brain tumor surgery was noticed in routine practice. Exploring intraoperative transfusion variables has been challenged in optimizing crossmatch and actual use.

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Section: Discussionsupporting

confidence: 91%

Effectiveness of Preoperative Red Cell Preparation and Intraoperative Massive Transfusion in Brain Tumor Operation

Tunthanathip

Saeheng

Oearsakul

et al. 2023

Indian Journal of Neurosurgery

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“…However, in addition to having a variable cost per unit transfused, blood transfusion has been documented to be linked to a greater risk of developing wound infections, pulmonary embolism, acute lung injury and prolonged hospital length of stay (LOS) [44,45]. Neef et al [46] indicated that transfusion was a risk factor after elective primary meningioma resection, which was consistent with our result. The transfusion rate can be ranged from 20.0 to 35% in previous studies [47][48][49].…”

Section: Discussionsupporting

confidence: 90%

Development and validation of a novel nomogram to predict the risk of the prolonged postoperative length of stay for lumbar spinal stenosis patients

Yasin,

Cai,

Mardan

et al. 2023

BMC Musculoskelet Disord

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Background Lumber spinal stenosis (LSS) is the increasingly reason for spine surgery for elder patients since China is facing the fastest-growing aging population. The aim of this research was to create a model to predict the probabilities of requiring a prolonged postoperative length of stay (PLOS) for lumbar spinal stenosis patients, minimizing the healthcare burden. Methods A total of 540 LSS patients were enrolled in this project. The outcome was a prolonged PLOS after spine surgery, defined as hospitalizations ≥ 75th percentile for PLOS, including the day of discharge. The least absolute shrinkage and selection operator (LASSO) was used to identify independent risk variables related to prolonged PLOS. Multivariable logistic regression analysis was utilized to generate a prediction model utilizing the variables employed in the LASSO approach. The receiver operating characteristic (ROC) curve’s area under the curve (AUC) and the calibration curve’s respective curves were used to further validate the model’s calibration with predictability and discriminative capabilities. By using decision curve analysis, the resulting model’s clinical effectiveness was assessed. Results Among 540 individuals, 344 had PLOS that was within the usual range of P75 (8 days), according to the interquartile range of PLOS, and 196 had PLOS that was above the normal range of P75 (prolonged PLOS). Four variables were incorporated into the predictive model, named: transfusion, operation duration, blood loss and involved spine segments. A great difference in clinical scores can be found between the two groups (P < 0.001). In the development set, the model’s AUC for predicting prolonged PLOS was 0.812 (95% CI: 0.768–0.859), while in the validation set, it was 0.830 (95% CI: 0.753–0.881). The calibration plots for the probability showed coherence between the expected probability and the actual probability both in the development set and validation set respectively. When intervention was chosen at the potential threshold of 2%, analysis of the decision curve revealed that the model was more clinically effective. Conclusions The individualized prediction nomogram incorporating five common clinical features for LSS patients undergoing surgery can be suitably used to smooth early identification and improve screening of patients at higher risk of prolonged PLOS and minimize health care.

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“…Ten studies reported on intracranial tumour surgery 940–949 . A retrospective observational study including 8924 patients reported an RBC transfusion rate of 7% with an increased morbidity and mortality 950 .…”

Section: Discussionmentioning

confidence: 99%

“…Ten studies reported on intracranial tumour surgery. [940][941][942][943][944][945][946][947][948][949] A retrospective observational study including 8924 patients reported an RBC transfusion rate of 7% with an increased morbidity and mortality. 950 Other studies demonstrated an incidence of peri-operative bleeding resulting in RBC transfusion between 2.4 and 7%.…”

Section: Intracranial Surgerymentioning

confidence: 99%

“…This was in contrast to FXIII level, which was not associated with bleeding. 941,951 In a recent article on meningioma resections, Neef et al 946 demonstrated patient's ASA classification, tumour size and surgical time as major risk factors for RBC transfusion. Several studies pointed out that peri-operative management of pre-existing anticoagulant or antiplatelet drug use was not well standardised.…”

Section: Intracranial Surgerymentioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

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147

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Clinical Outcome and Risk Factors of Red Blood Cell Transfusion in Patients Undergoing Elective Primary Meningioma Resection

Cited by 11 publications

References 32 publications

Effectiveness of Preoperative Red Cell Preparation and Intraoperative Massive Transfusion in Brain Tumor Operation

Effectiveness of Preoperative Red Cell Preparation and Intraoperative Massive Transfusion in Brain Tumor Operation

Development and validation of a novel nomogram to predict the risk of the prolonged postoperative length of stay for lumbar spinal stenosis patients

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

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