Search Results (10)

Background/Objectives: Biportal endoscopic spine surgery (BESS) is one of the minimally invasive spine surgery techniques. BESS has several advantages, such as better visualization, less muscle injury, early rehabilitation, etc. Due to its clear visualization, delicate intraoperative hemostasis of the bleeding foci, including cancellous bone and small epidural vessels, can be achieved. Therefore, some authors have reported that BESS resulted in less intraoperative visible blood loss (VBL) compared to conventional open surgery. However, it is difficult to analyze the exact amount of intraoperative blood loss because of the continuous normal saline irrigation. In addition, hidden blood loss (HBL) tends to be overlooked, and the amount of HBL might be larger than expected. We aim to calculate the amount of HBL during BESS and to compare our findings with convention open surgery. Methods: We retrospectively obtained the clinical data of patients that underwent lumbar central decompression from July 2021 to June 2024. Patients were divided into two groups: the BESS group that underwent biportal endoscopic lumbar decompression, and the open surgery group that underwent open decompression. Both groups used unilateral laminotomy and bilateral decompression techniques. Total blood loss (TBL) using preoperative and postoperative change in hematocrit (Hct) was measured using Gross’s formula and the Nadler equation. Since TBL consists of VBL and HBL, HBL was calculated by subtracting the VBL measured intraoperatively from TBL. Results: A total of sixty-six patients in the BESS group and seventeen patients in the open surgery group were included in the study. The TBL was 247.16 ± 346.88 mL in the BESS group and 298.71 ± 256.65 mL in the open surgery group, without significant difference (p = 0.569). The calculated HBL values were 149.44 ± 344.08 mL in the BESS group and 171.42 ± 243.93 mL in the open surgery group. The HBL in the BESS group was lower than the HBL in the open surgery group, without significant difference (p = 0.764). Conclusions: The TBL and HBL during lumbar central decompression were smaller in patients who underwent BESS compared to those who underwent open surgery. While TBL was significantly lower in BESS, HBL did not show statistical significance between the two groups. HBL during BESS should not be neglected, and related hemodynamics should be considered postoperatively. Full article

Background: Shoulder arthroscopy is a common, minimally invasive surgery, but the resulting postoperative blood loss remains poorly understood. In this study, we quantified the intraoperative and postoperative blood loss, the hemoglobin (Hb) drop, and the effects of irrigation fluid retention, as well as the influence of solutions administered through infusions. Methods: A prospective observational study of 49 patients undergoing arthroscopic rotator cuff tear (RCT) repair was conducted. Their preoperative and postoperative Hb levels were measured, along with the intraoperative and postoperative blood loss. Irrigation fluid retention was analyzed, and multiple regression was used to assess the factors contributing to Hb drops. Results: The intraoperative blood loss amounted to 36.46 ± 20.34 mL, while the total blood loss reached 791.17 ± 280.96 mL, with 94.64% occurring postoperatively. The postoperative Hb drop (2.06 ± 0.74 g/dL) was significantly greater than the intraoperative Hb drop (0.11 ± 0.06 g/dL) (p < 0.001). An older age (p = 0.02) and male sex (p = 0.025) significantly predicted the postoperative Hb drop, while irrigation fluid retention and administration of crystalloids and colloids had no notable effects. Capsulotomy was associated with a small but significant increase in intraoperative blood loss (p < 0.01). Increased intraoperative blood loss correlated with greater irrigation fluid retention (r = 0.41, adjusted R2 = 0.152, p < 0.001). Conclusions: In shoulder arthroscopy, the postoperative blood loss and Hb drop are significantly greater than the intraoperative blood loss and Hb drop, as well as the fluid gain, emphasizing the need for careful monitoring, especially in high-risk patients. Future studies should investigate the potential impacts of low-molecular-weight heparin on postoperative bleeding after shoulder arthroscopy. Full article

Background: Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing bleeding across various surgical procedures. However, its role in bariatric surgery remains underexplored. This study aimed to evaluate the effectiveness of TXA in mitigating hidden blood loss following laparoscopic sleeve gastrectomy (SG). Methods: A single-center, single-blind, randomized, controlled trial was conducted at the University Clinical Center, Medical University of Gdańsk, Poland, between July 2022 and June 2023. A total of 238 patients undergoing SG were randomized to receive either TXA or no pharmacological intervention. The primary outcome was hemoglobin concentration in abdominal drainage post-surgery. Secondary outcomes included total blood loss, drainage volume, the need for blood transfusion, and postoperative complications. Statistical analyses were conducted using intention-to-treat and per-protocol strategies. Results: A statistically significant reduction in hemoglobin concentration in abdominal drainage samples was observed in the TXA group (p = 0.011). No significant differences were found in total blood loss, drainage volume, necessity for blood transfusions, or extended hospital stay between groups. Conclusions: While TXA administration may reduce the hidden blood loss effect, its general clinical significance appears questionable. Nonetheless, intraoperative TXA may be beneficial for a selected patient group with multiple preoperative disorders and risk factors. Further research is necessary to comprehensively assess the risks and benefits of TXA administration in bariatric surgery. Full article

(1) Background: The amount of blood loss during oblique lumber interbody fusion (OLIF) surgery is often underestimated and may contribute to adverse postoperative outcomes. This study aims to evaluate hidden blood loss (HBL) in patients who underwent OLIF for degenerative lumbar spine disease and to analyze its risk factors. (2) Methods: The medical records of 179 patients who underwent OLIF surgery from 2015 to 2022 were reviewed. The HBL and total blood loss (TBL) were estimated using the Gross formula. Pearson correlation, Spearman correlation, and multivariate linear regression analyses were used to investigate risk factors for HBL. (3) Results: The mean HBL was 675.2 mL, and the mean hemoglobin loss was 1.7 g/dL during OLIF surgery. In the multivariate linear regression analysis, TBL (p < 0.001), estimated blood loss (p < 0.001), and pedicle screw fixation type (p = 0.039) were identified as independent risk factors of HBL. (4) Conclusions: The OLIF is associated with substantial perioperative HBL, for which we identified risk factors of TBL, EBL, and pedicle screw fixation type. Notably, OLIF with percutaneous pedicle screw fixation resulted in greater HBL than stand-alone OLIF or OLIF with open pedicle screw fixation. Full article

Background: This study aimed to determine the efficacy and safety of posttraumatic antifibrinolysis with multidose tranexamic acid (TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric fracture patients. Method: Ninety-six elderly intertrochanteric fracture patients admitted to our department from June 2021 to September 2022 were randomized into two groups. The control group (Group A) received 100 mL of normal saline, while the experimental group (Group B) received 1.5 g of TXA intravenously q12 h from postadmission Day 1 (PAD1) to the day before surgery, and both groups received 1.5 g of TXA q12 h from postoperative Day 1 (POD1) to POD3. Haemoglobin (Hb), haematocrit (Hct), coagulation parameters, fibrinogen degradation product (FDP), and D-dimer (D-D) were recorded from PAD1 to POD3. HBL was calculated using the gross formula and recorded as the primary outcome. Result: In all-over analyses, the patients in Group B had lower perioperative HBL (on PAD3, POD1, and POD3), preoperative HBL (HBLpre), decline of haemoglobin (ΔHb-on PAD3), allogeneic blood transfusion (ABT) rate, FDP (on PAD3), and D-D (on PAD3) compared with Group A. No significant differences were exhibited in postoperative HBL (HBLpost) between the 2 groups. In subgroup analyses, for patients who received intervention within 24 h, the result is consistent with the whole. For patients who received intervention over 72 h of injury, there were no significant differences in perioperative HBL, ΔHb, ABT rate, FDP, and D-D between the 2 groups. There were no significant differences in APTT, PT, the rate of venous thromboembolism, wound complications, or 90-day mortality between the 2 groups. Conclusion: For elderly intertrochanteric fracture patients, early posttraumatic antifibrinolysis with multidose TXA is effective in reducing perioperative HBL, which mainly manifests as the reduction of preoperative HBL, especially for patients injured within 24 h. Application of TXA beyond 72 h of injury was ineffective. Full article

Background: Full endoscopic lumbar interbody fusion (Endo-LIF) is a representative recent emerging minimally invasive operation. The hidden blood loss (HBL) in an Endo-LIF procedure and its possible risk factors are still unclear. Methods: The blood loss (TBL) was calculated by Gross formula. Sex, age, BMI, hypertension, diabetes, ASA classification, fusion levels, surgical approach type, surgery time, preoperative RBC, HGB, Hct, PT, INR, APTT, Fg, postoperative mean arterial pressure, postoperative heart rate, Intraoperative blood loss (IBL), patient blood volume were included to investigate the possible risk factors by correlation analysis and multiple linear regression between variables and HBL. Results:Ninety-six patients (23 males, 73 females) who underwent Endo-LIF were retrospective analyzed in this study. The HBL was 240.11 (65.51, 460.31) mL (median [interquartile range]). Fusion levels (p = 0.002), age (p = 0.003), hypertension (p = 0.000), IBL (p = 0.012), PT (p = 0.016), preoperative HBG (p = 0.037) were the possible risk factors. Conclusion: Fusion levels, younger age, hypertension, prolonged PT, preoperative HBG are possible risk factors of HBL in an Endo-LIF procedure. More attention should be paid especially in multi-level minimally invasive surgery. The increase of fusion levels will lead to a considerable HBL. Full article

Progressive scoliosis eventually leads to extensive spinal fusion surgery, which carries a risk for significant bleeding. Neuromuscular scoliosis (NMS) patients have an additional inherent risk of major perioperative bleeding. The purpose of our research was to investigate the risk factors for measured (intraoperative, drain output) and hidden blood loss related to pedicle screw instrumentation in adolescents, divided into adolescent idiopathic scoliosis (AIS) and NMS patient groups. A retrospective cohort study with prospectively collected data of consecutive AIS and NMS patients undergoing segmental pedicle screw instrumentation at a tertiary level hospital between 2009 and 2021 was conducted. In total, 199 AIS (mean age 15.8 years, 143 females) and 81 NMS patients (mean age 15.2 years, 37 females) were included in the analysis. In both groups, levels fused, increased operative time, and smaller or larger size of erythrocytes were associated with perioperative blood loss (p < 0.05 for all correlations). In AIS, male sex (p < 0.001) and the number of osteotomies correlated with more drain output. In NMS, levels fused correlated with drain output, p = 0.00180. In AIS, patients’ lower preoperative MCV levels (p = 0.0391) and longer operation times, p = 0.0038, resulted into more hidden blood loss, but we did not find any significant risk factors for hidden blood loss in NMS patients. Full article

Introduction: Different robotic systems have been used widely in human surgery since 2000, but pediatric patients require some features that are lacking in the most frequently used robotic systems. Hypothesis: The Senhance^® robotic system is a safe and an effective device for use in infants and children that has some advantages over other robotic systems. Methods: All patients between 0 and 18 years of age whose surgery was amenable to laparoscopy were offered enrollment in this IRB-approved study. We assessed the feasibility, ease and safety of using this robotic platform in pediatric patients including: set-up time, operative time, conversions, complications and outcomes. Results: Eight patients, ranging from 4 months to 17 years of age and weighing between 8 and 130 kg underwent a variety of procedures including: cholecystectomy (3), inguinal herniorrhaphy (3), orchidopexy for undescended testes (1) and exploration for a suspected enteric duplication cyst (1). All robotic procedures were successfully performed. The 4-month-old (mo), 8 kg patient underwent an uneventful robotic exploration in an attempt to locate a cyst that was hidden in the mesentery at the junction of the terminal ileum and cecum, but ultimately the patient required an anticipated laparotomy to palpate the cyst definitively and to excise it completely. There was no blood loss and no complications. Robotic manipulation with the reusable 3 mm instruments proved successful in all cases. Conclusions: Our initial experience with the Senhance^® robotic platform suggests that this is a safe and effective device for pediatric surgery that is easy to use, and which warrants continued evaluation. Most importantly, there appears to be no lower age or weight restrictions to its use. Full article

Bleeding patients exhibit different fibrinolytic phenotypes after injury, and the universal use of tranexamic acid (TXA) is doubted. We aimed to evaluate the efficacy of postoperative antifibrinolytic treatment in total hip arthroplasty (THA) patients with different fibrinolytic phenotypes. A retrospective analysis was conducted in 238 patients who underwent THA. Patients were divided into two groups by different fibrinolytic phenotypes (non-fibrinolytic shutdown and fibrinolytic shutdown), determined by the LY30 level on postoperative day 1 (POD1). The two groups were further stratified into four sub-groups based on different postoperative TXA regimens (Group A received no TXA postoperatively, while Group B did). Hidden blood loss (HBL), decline of hemoglobin (ΔHb), D-dimer (D-D), fibrinogen/fibrin degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), and demographics were collected and compared. The clinical baseline data were comparable between the studied groups. In patients who presented non-fibrinolytic shutdown postoperatively, Group B suffered significantly lower HBL and ΔHb than Group A on POD3 and POD5. In patients who presented postoperative fibrinolytic shutdown, Group B failed to benefit from the postoperative administration of TXA when compared to Group A. No difference was found in postoperative levels of D-D, FDP, PT, and APTT. Postoperative antifibrinolytic therapy is beneficial for THA patients who presented non-fibrinolytic shutdown postoperatively, while the efficacy and necessity should be considered with caution in those with fibrinolytic shutdown. LY30 is a promising parameter to distinguish different fibrinolytic phenotypes and guide TXA administration. However, further prospective studies are needed to confirm these findings. Full article

Background and Objectives: Measured blood loss frequently underestimates true blood loss; this discrepancy is called hidden blood loss (HBL). The purpose of the present study was to measure HBL in oblique lateral interbody fusion (OLIF). Materials and Methods: Patients who underwent two-stage OLIF at our institute from September 2017 to September 2021 were retrospectively reviewed. Total blood loss (TBL) and HBL were calculated using the gross formula. The age, sex, body mass index (BMI), operation time, measured blood loss, the number of fused segments, hematocrit (HCT), anticoagulant or platelet medication, blood transfusion, days of hospitalization, pre-/postoperative Japanese Orthopedic Association (JOA) score, and JOA recovery rate were compared. Results: A total of thirteen patients were included in the study. The average age, BMI, number of fused segments, operation time, estimated blood loss, and blood transfusion were 69.5 years, 23.3, 2.5, 250 min, 122 mL, and 230 mL, respectively. Five patients received anticoagulant or platelet therapy. Days of hospitalization, pre-/postoperative JOA score, and JOA recovery rate were 14.9 ± 5.1, 19.9 ± 2.7, and 18.0 ± 43.4%, respectively. The TBL and HBL were 688 and 797 mL, respectively. Stepwise multiple regression analysis revealed that younger age (p = 0.01), female sex (p = 0.01), and number of fused segments (p = 0.02) were significantly associated with higher HBL. Conclusions: The HBL in OLIF was 797 mL, which was more than other previously reported procedures. Therefore, OLIF may not be less invasive in terms of HBL. Blood loss after surgery should be considered, especially when patients are younger, are female, and have a greater number of fused segments. Full article