Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Jawed, Abdulla; Ahmed, Awais; Williams, Mark R.

doi:10.1007/s00264-018-4104-7

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…In this study, we found that CCI and ISS scores are independently associated with intraoperative transfusion, which can be attributed to greater co-morbidity burden and increased injury severity. Indeed, a previous retrospective study found that patients with ISS above 20 were more likely to receive blood transfusion postoperatively [27]. Although ISS did not predict postoperative transfusion in our cohort, these findings indicate that ISS is a physiological surrogate for greater blood product requirements during major surgery.…”

Section: Discussioncontrasting

confidence: 58%

“…Additionally, while previous studies have found that anterior surgical approaches are associated with increased blood loss [29], this is the first study to demonstrate that anterior approaches are also associated with increased odds of postoperative transfusion. Although a previous investigation of 119 pelvic and acetabular fractures found no difference in postoperative transfusion between anterior and posterior surgical approaches, it also included combined anterior-posterior approaches in its analysis [27]. Furthermore, we demonstrated that the iliofemoral and isolated lateral window approaches decreased odds of intraoperative transfusion by 4.3 fold relative to the AIP approach.…”

Section: Discussionmentioning

confidence: 52%

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Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Wadhwa

Tigchelaar

Chen

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Tranexamic acid (TXA) reduces need for transfusion in total joint arthroplasty, though findings in acetabular surgery are conflicting. We compared outcomes after acetabular fracture surgery with or without perioperative intravenous (IV) TXA administration. Methods We performed a retrospective review of 305 patients with acetabular fractures that underwent open reduction and internal fixation (ORIF). Eighty-nine patients received TXA, and 216 did not. The primary outcome was rates of intraoperative and postoperative allogeneic blood transfusion. Results Baseline demographics and characteristics were similar. Time from injury to surgery and estimated blood loss were comparable. Operative time (p < 0.01) and intraoperative IV fluids (p < 0.01) were greater in the non-TXA group. The proportion of patients who received blood transfusion and mean units transfused intraoperatively and postoperatively did not differ. Mean differences in preoperative and postoperative hemoglobin and hematocrit, hospital length of stay, and perioperative complications also did not differ. In a multivariable regression model, age 60-70 years, Charlson Comorbidity Index, Injury Severity Score, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approaches and intraoperative transfusion requirement were independently associated with postoperative transfusion. Conclusion In this study, perioperative IV TXA did not decrease blood loss, need for transfusion, or improve in-hospital outcomes of acetabular fracture surgery. Age 60-70, CCI, ISS, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approach and need for intraoperative transfusion were independently associated with postoperative transfusion. Further prospective trials are warranted to confirm these findings

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 52%

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Wadhwa

Tigchelaar

Chen

et al. 2021

Eur J Orthop Surg Traumatol

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“…Ten articles were reviewed pertaining to cell salvage as an intraoperative management modality. Intraoperative cell salvage devices have increasingly been adopted in the setting of major orthopedic trauma [73][74][75]. These devices salvage red blood cells from the operative field, extensively wash them of contaminants, resuspend them in a saline solution and then transfuse them into the patient [75,76].…”

Section: Cell Salvagementioning

confidence: 99%

“…However, in the setting of PAF, recent literature demonstrates conflicting reports to its efficacy. Three recent retrospective studies found no reduction in allogeneic blood transfusions [73,75,82]. In fact, Scannell et al found that blood-related expenses significantly increased with the use of cell salvage [75].…”

Section: Cell Salvagementioning

confidence: 99%

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

Yakkanti

Mohile

Cohen-Levy

et al. 2021

Arch Orthop Trauma Surg

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Purpose The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. Methods A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre-and postoperative venous thromboembolism (VTE) prophylaxis. Results A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. ConclusionThe literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.

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“…Studies on the intraoperative transfusion strategies during orthopaedic xation surgeries were mostly about autologous blood transfusion and its outcome [7,8], the impact of the intraoperative allogeneic blood transfusion on de nitive stabilization surgeries of pelvic fracture patients has not been discussed and still remains unclear. Multiple factors can affect the intraoperative blood transfusion, such as the coagulation function, the estimated blood loss, the type of surgery, and the traumatic condition.…”

Section: Introductionmentioning

confidence: 99%

Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes

Xie

Wang

Huang

et al. 2021

Preprint

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Background: Orthopaedic definitive stabilization surgeries are conducted when pelvic fracture patients are stabilized and blood transfusion is usually inevitable for patients undergo major surgeries and few studies provide insight into the influence of the intraoperative transfusion of packed red blood cells (PRBCs) on the outcomes of pelvic patients . As it presents a risk to the recipient by inducing uncertain morbidity and mortality, this study was aiming at the influence of PRBCs during such surgeries on clinical outcomes of pelvic fracture patients.Methods: 300 patients were collected and 103 patients were analyzed after exclusion. According to the units of intraoperative transfused PRBCs, 52 patients were in the <3U PRBCs group, 39 patients were in the 3-6U group and 12 patients were in the >6U group. Their characteristics, blood tests, details during surgeries, and outcomes were evaluated.Results: Patients in the>6U PRBCs group were more likely admitted with hemorrhagic shock, lower blood platelet count (BPC) and higher Abbreviated Injury Scale (AIS) (all p<0.05). Blood tests of them at admission revealed higher levels of serum creatinine (Scr), prothrombin time (PT) and thromboplastin time (APTT), lower level of total serum protein (TSP), serum albumin (SA), and serum globulin (SG) (all p<0.05). They underwent more subsequent surgeries and intensive care unit (ICU) stays (all p<0.001). No significant differences between complications and clinical outcomes were observed among three groups. Increased intraoperative transfusion of PRBCs was an independent factor for increased numbers of subsequent surgeries after orthopaedic surgeries, and prolonged ICU days.Conclusions: More intraoperative transfusion during orthopedic fixation surgeries indicated patients with more possibilities of hemorrhagic shock, severe pelvic injury, renal injury, and coagulopathy at admission. Increased intraoperative blood transfusion was associated with more ICU days and increased re-operations, whereas it wouldn’t increase the risk of more complications or worsen clinical outcomes.

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Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Cited by 9 publications

References 21 publications

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes

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