Predictors of Blood Loss and Haematocrit after Periacetabular Osteotomy

Lee, Cara Beth; Kalish, Leslie A.; Millis, Michael B.; Kim, Young-Jo

doi:10.5301/hipint.5000062

Cited by 14 publications

(21 citation statements)

References 23 publications

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“…We observed no difference in the blood loss and operative time between the rectus-preserving group and the classic approach group. Longer surgical time has been shown to correlate with blood loss during PAO [9].Operative time and blood loss were significantly lower when a minimally invasive transartorial approach was used compared with the extensive ilioinguinal approach [23]. Previous studies estimated intraoperative PAO blood loss from 300 mL to 4500 mL [2,6,16].…”

Section: Discussionmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. Questions/purposes The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. Methods A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Results Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p \ 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p \ 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, À1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach. Conclusions The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

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Section: Discussionmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Although different blood-conserving strategies, including the use of predonated autologous blood, cell saver autotransfusion, and tranexamic acid, have been described to avoid allogeneic transfusion, there is no universally accepted protocol to manage blood loss associated with periacetabular osteotomy. 5,9,14,15 Periacetabular osteotomy increasingly has been performed with arthrotomy 11,13 or in combination with hip arthroscopy 12,21,22 because of evidence that femoroacetabular impingement adversely affects the outcome of periacetabular osteotomy [23][24][25] and because of the high prevalence of intra-articular pathology. 10,11 Findings on predictive factors associated with blood loss during periacetabular osteotomy are limited and conflicting, and this study was conducted to determine patient and procedure risk factors related to blood loss in a cohort of 41 young patients undergoing periacetabular osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…9 This is of great importance because now periacetabular osteotomy is more commonly performed with concomitant procedures to correct associated intra-articular pathology. [10][11][12][13] Several strategies, including autologous preoperative blood donation 5 and intraoperative use of cell saver systems, 9,14 have been reported for the management of blood loss associated with periacetabular osteotomy. Independent of the method used, the vast majority of patients require red blood cell transfusion.…”

Section: Factors That Predict Blood Loss After Bernese Periacetabularmentioning

confidence: 99%

“…Independent of the method used, the vast majority of patients require red blood cell transfusion. 5,9,14,15 Although allogeneic blood transfusion is currently accepted as a safe procedure, with minimal risk of transfusion-transmitted infection, transfusion-associated morbidity remains a concern. 16 Few studies have described blood conservation methods used during periacetabular osteotomy.…”

Section: Factors That Predict Blood Loss After Bernese Periacetabularmentioning

confidence: 99%

“…15 Further, previous studies showed conflicting results on potential risk factors for increased blood loss. 9,14 Identification of patients who are at increased risk for blood loss during periacetabular osteotomy potentially could allow more specific strategies to conserve blood and avoid allogeneic transfusion.…”

Section: Factors That Predict Blood Loss After Bernese Periacetabularmentioning

confidence: 99%

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Factors That Predict Blood Loss After Bernese Periacetabular Osteotomy

Novais¹,

Carry²,

Kestel³

et al. 2016

Orthopedics

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Although strategies to reduce bleeding and avoid allogeneic transfusion have been described, there is controversy about the factors associated with blood loss after Bernese periacetabular osteotomy. This study was conducted to determine risk factors for postoperative blood loss. After institutional review board approval was obtained, a retrospective review was conducted of 41 young patients who underwent periacetabular osteotomy for symptomatic acetabular dysplasia over a 3-year period. Of these patients, two-thirds donated blood before surgery. A Cell Saver Elite autotransfusion system (Haemonetics, Braintree, Massachusetts) was used intraoperatively in all cases. Hemoglobin and hematocrit were obtained before surgery and during the hospital stay. The primary outcome variable was the percentage of total blood volume lost during surgery. Univariate analysis was performed to test the association between potential predictors of blood volume loss. Candidate variables that were significant at alpha=0.15 were tested with multivariate analysis. The average percentage of blood volume lost during surgery was 30.3% (95% confidence interval, 25.1%-35.5%). Univariate analysis showed that operative time, arthrotomy, femoral head-neck osteochondroplasty, labral procedure, male sex, and age were prognostic factors associated with increased blood volume loss. However, operative time (average, 294.6 minutes; range, 204-444 minutes) was the only independent predictor of increased blood loss in the final model. Additional procedures, such as femoral head-neck osteochondroplasty and labral repair or debridement performed through an anterior hip arthrotomy at the time of periacetabular osteotomy, were associated with increased operative time. The findings suggest that all patients undergoing periacetabular osteotomy, including those having concomitant procedures, may benefit from pre- and intraoperative strategies to conserve blood and avoid allogeneic transfusion. [Orthopedics. 2016; 39(6):e1147-e1153.].

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