The impact of mild peri-operative hypothermia on the effectiveness of tranexamic acid in total hip arthroplasty

Reina, Nicolas; Fennema, Peter; Hourlier, Hervé

doi:10.1007/s00264-016-3170-y

Cited by 18 publications

(8 citation statements)

References 27 publications

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“…Numerous studies have supported the use of TXA in orthopedic surgery. [ 10 , 12 – 14 , 23 , 24 ] Although it has been evaluated in many studies, the safety and efficacy of TXA for blood loss reduction in spinal surgery has not been clearly demonstrated, especially for CLF. [ 25 , 26 ]…”

Section: Discussionmentioning

confidence: 99%

“…In addition, TXA has been reported to reduce blood loss and transfusion requirements during orthopedic surgery, most commonly in knee and hip joint replacement. [ 10 , 12 – 14 ] Although the benefits of TXA in spinal surgery have been reported, its use in cervical spinal surgery is somewhat limited. Indeed, there are no studies of TXA in cervical laminectomy with lateral mass screw fixation and bone grafting (CLF) so far.…”

Section: Introductionmentioning

confidence: 99%

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Can tranexamic acid reduce blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting

Gao

Yang

et al. 2017

Medicine

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To assess the safety and efficacy of tranexamic acid (TXA) for decreasing perioperative blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting (CLF), in which all surgical procedures are identical.From November 2014 to April 2016, we performed a retrospective comparative analysis of 119 patients with multilevel cervical spondylotic myelopathy who had undergone a CLF from C3 to C6 in our center. All surgeries were performed on the patients using a consistent, standard procedure. Patients were divided into control (46) and TXA (73) groups according to whether or not they had received TXA treatment before and during surgery. Demographic profiles of patients such as gender, age, body weight, height, and body mass index were collated and differences between the 2 groups compared. Preoperative and postoperative hematological data in addition to intraoperative and postoperative blood loss were compared between the 2 groups. Additionally, any complications of TXA were also evaluated to assess safety.There was no statistically significant difference in demographic traits between the 2 groups. Intraoperative blood loss in the TXA group (179.66 ± 81.45 mL) was significantly lower than that of the control group (269.13 ± 94.68 mL, P < 0.001), as was postoperative blood loss (108.08 ± 44.31 and 132.83 ± 49.39 mL, respectively; P = 0.005). Total blood loss in the TXA group (287.74 ± 115.40 mL) was also significantly lower than that of the control group (401.96 ± 127.88, P < 0.01). No major intraoperative complications occurred in any of the cases.TXA significantly reduced perioperative blood loss in CLF with no major side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can tranexamic acid reduce blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting

Gao

Yang

et al. 2017

Medicine

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“…Blood-saving protocols can help to reduce the cost of allogeneic transfusion efforts to maintain preoperative Hb levels at 13 g/dL or greater is recommended for reducing postoperative transfusion (26). Pre-operative autologous blood donation, acute normovolemic haemodilution, hypotensive anesthesia, tranexamic acid administration, epsilon-aminocaproic acid administration, subcutaneous placement of a vacuum drain, strict application of postoperative hemorrhagic management, and the administration of parenteral iron and erythropoietin (27,28,29). Inclusion of a fibrin sealant may significantly reduce post-operative blood transfusions and induce a faster recovery for patients undergoing complete RHA, allowing early discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

To Revi̇se or Not to Revi̇se! That İs the Questi̇On

Dırvar¹,

Dirvar²,

Cengîz

et al. 2021

Kocatepe Tıp Dergisi

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Bir kamu hastanesinin ortopedi ve travmatoloji kliniğinde kalça revizyon artroplasti ameliyatı yapılan hastaların yatarak tedavi gördüğü süreçte, kurumca katlanılan maliyetlerinin araştırılması ve fatura edilen miktar ile karşılaştırılması amaçlanmıştır.GEREÇ VE YÖNTEM: 01.01.2016 ile 30.09.2017 tarihleri arasında bir kamu hastanesinde total kalça revizyon artroplastisi ameliyatı yapılan 60 hastanın demografik bilgileri ve revizyon nedenleri tespit edilmiştir. Hastalar septik ve aseptik olarak iki gruba ayrılmıştır. Hastaların, yatarak tedavi gördüğü sürece katlanılan tıbbi sarf, ilaç/serum, tedavi, ameliyat, anestezi, görüntüleme, laboratuvar, kan ve kan ürünleri, yemek, refakatçı maliyetleri, cihaz amortisman giderleri, konsültasyon, kontrol muayenesi, ameliyat öncesi hasta hazırlık aşaması, vizit ve diğer maliyetleri her bir hasta için ayrı ayrı hesaplanmıştır. BULGULAR:Bir hastanın toplam maliyeti ortalama 21.956,00 ₺ iken fatura tutarı ortalama 17.220,00 ₺ tespit edilmiş olup arada 4.736,00 ₺ fark bulunmaktadır. Bu fark septik gruptaki hastalarda 9.876,00 ₺, aseptik gruptaki hastalarda 2.534,00 ₺ olarak tespit edilmiştir. SGK'nın kuruma yaptığı fatura ödemesi, revizyon kalça artroplastisi maliyetinin% 78,4'ünü kapsıyor. Septik grupta yatış süresi, tıbbi sarf, ilaç, tedavi, ameliyat, anestezi, laboratuvar, görüntüleme, kan merkezi, konsültasyon, vizit, yemek maliyeti, toplam maliyet ve fatura tutarı aseptik gruptan anlamlı (p< 0.05) olarak daha yüksek bulunmuştur. SONUÇ: Kamu hastanesinin mali sürdürebilirliğinin sağlanması için SGK tarafından düzenlemelerin yapılmasına ihtiyaç bulunmaktadır. Ayrıca, revizyon cerrahisinde medikal ve teknik protokolleri takip edilmesi maliyetin azalmasına yardımcı olabilir.

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“…Because Hb levels are usually the main criteria for pharmacological optimization and for transfusion in THA, the Hb concentrations were controlled at pre-defined time points. As the formula currently used to calculate blood loss does not ensure that the values obtained are sufficiently accurate for absolute measurement [29], we use an index we developed ten years ago, which takes into account the impact of transfusion in the decline of Hb for the peri-operative period of 7 days [19,22]. This interval allows us to eliminate the biases due to the decrease of Hb following THA surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Primary endpoint was the bleeding index (BI). For each patient, BI was calculated by subtracting the Hb level at POD-1 from the Hb level at POD7, and then adding the number of units of packed red blood cells (PRBCs) transfused within that timeframe, under the assumption that the transfusion of one PBRC raises Hb by 1 g/dl [21,22]. Total blood loss was estimated using a standardized method [23].…”

Section: Methodsmentioning

confidence: 99%

Surgical prescription of epoetin alfa in contemporary total hip arthroplasty: a prospective comparative study

Hourlier¹,

Fennema²

2019

International Orthopaedics (SICOT)

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Purpose Pre-operative anaemia treatment has been associated with reduced morbidity in joint arthroplasty. This study examined the impact of a surgical prescription of epoetin (EPO) in contemporary total hip arthroplasty (THA). Methods We conducted a comparative study in a series of 1402 primary THAs performed in patients all having a pre-operative haemoglobin (Hb) level documented four to eight weeks before THA surgery. In group A (647 hips), one subcutaneous injection of 40,000 IU EPO once a week for four weeks was prescribed at the discretion of anaesthetist during the pre-operative visit in patients with pre-operative Hb between 10 and 13 g/dl. In group S comprising the remaining 755 hips, an amended EPO therapy including two injections of 20,000 to 40,000 IU was prescribed by the surgeon in patients with Hb less than 12 g/dl deemed at high risks to be transfused following THA. Primary study endpoint was the bleeding index (BI). Results EPO therapy was delivered in 43 patients (6.7%) in group A and in 26 patients (3.4%) in group S (p = 0.006). The mean total dose of EPO administrated was 115,349 IU in group A versus 75,200 IU in group S (p < 0.001). The mean BI were 2.7 ± 1.0 in group A and 2.8 ± 1.0 g/dl in group S (p = 0.375). No patient was blood-transfused up to post-operative day seven in group S versus five patients in group A (p = 0.021). Conclusions The amended protocol does not lead to increased peri-operative bleeding. Advances in intra-operative methods to reduce the bleeding allow changing indications of EPO in patients undergoing THA with a low level of Hb.

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The impact of mild peri-operative hypothermia on the effectiveness of tranexamic acid in total hip arthroplasty

Abstract: The incidence of hypothermia in our THA population was high, despite peri-operative air warming. However, mild hypothermia was not significantly associated with increased blood loss and did not reduce the effectiveness of TXA.

Cited by 18 publications

References 27 publications

Can tranexamic acid reduce blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting

Can tranexamic acid reduce blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting

To Revi̇se or Not to Revi̇se! That İs the Questi̇On

Surgical prescription of epoetin alfa in contemporary total hip arthroplasty: a prospective comparative study

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