Evaluation of tranexamic acid after total hip arthroplasty over 60 years old in China: a Systematic Review and Meta-analysis

Review question / Objective: The purpose of this meta-analysis was to evaluate the efficacy of tranexamic acid after total hip arthroplasty in patients older than 60 years old in China by meta-analysis. Participant or population: All trials included in our study meet the following criteria: (1) All studies were original RCTs; (2) The mean age of patients for each study was ≥ 60 years old; (3) Patients were received total hip arthroplasty in all studies; (4) All studies included oral and iv or topical groups, with a comparison of outcomes between the two groups; (5) The full text of the included literature can be obtained, and the measurement data of hemoglobin drop, total blood loss, transfusion rate, complication, length of stay can be extracted. The following studies were excluded from the meta-analysis: nonrandomized studies; the patients with age<60; studies not suitable with the inclusive criteria; and articles for which we were unable to obtain the full text and relevant data for pooled analysis.

The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

The purpose of this study was to investigate the safety of Simultaneous, bilateral TKA (SiTKA). Furthermore, we also assessed the cost reduction of SiTKA in comparison with Staged, bilateral TKA (StTKA). We retrospectively review all patients that underwent SiTKA or StTKA due to osteoarthritis (OA) or spontaneous osteonecrosis of the knee (SONK).We assessed length of stay, transfusion rate, early postoperative complications, 30-day and 90-day readmission rate, 1-year reoperation rate and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. A total of 2016 patients (1565 SiTKA and 451 StTKAs) were included in this study. There were no significant differences in terms of complication rates, 30-day and 90-day readmission, and 1-year reoperations between the two groups. The total length of stay was on average 5.0 days longer for StTKA (p<0.01). In terms of cost, all categories of medical costs were significantly lower in SiTKA, while the net hospital income was significantly higher for StTKA. In conclusion, SiTKA and StTKA have similar postoperative complication, readmission and reoperation rates, while SiTKA significantly reduces medical expenses for the patient and NHI. Level of evidence: level III, retrospective cohort study

Immediate Postoperative Single-Dose Intravenous Ferric Carboxymaltose After Autologous Free-Flap Breast Reconstruction: A Prospective Cohort Study With Propensity Score Matching

Intravenous ferric carboxymaltose (IV-FCM) can effectively correct perioperative anemia in patients undergoing major surgeries. However, its efficacy and side effects in patients undergoing free flap-based breast reconstruction are yet to be investigated. Starting from year 2020, patients with breast cancer undergoing abdominal free flap-based breast reconstruction were injected 500 mg of IV-FCM immediately post-operation. Propensity-matched 82 IV-FCM injected (study group) and 164 historical control group patients were analyzed for transfusion rates, changes in hematological parameters, and flap or donor-site related complications. The major and minor complication rates related to the operation site were similar between the two groups. There was no significant difference in the transfusion rate between the two groups (p = 0.71). However, the total amount of transfusion required was significantly higher in the historical control group (p = 0.02) than in the study group. Additionally, the historical control group showed a significantly higher drop in red blood cell count, hemoglobin, and hematocrit levels from postoperative days 1 to 2 and 2 to 3 compared to the study group. Immediate postoperative use of IV-FCM in free flap-based breast reconstruction was well tolerated by patients, reduced overall transfusion volume, and promoted faster postoperative recovery of hematological parameters.

Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer

Background. Prostate cancer (PC) is subdivided into risk categories according to patient prognosis. High-risk disease was previously typified by a higher risk of metastasis and mortality, which implied comprehensive treatment. Manifold studies have concluded that surgery is a key measure in such cases, even as monotherapy. Open radical prostatectomy (RP) was routinely performed in most high-risk PC patients until robot-assisted radical prostatectomy (RARP) had become a reasonable choice as improving outcomes in low- and intermediate-risk PC patients. Reliable RARP assessments in high-risk PC are still lacking. Th e review summarises published data on functional and oncological RARP outcomes in high-risk PC patients and analyses surgical inpatient cases at the BSMU Clinic for 2018—2021.Materials and methods. The surgical outcomes in high-risk PC inpatients were analysed retrospectively at the BSMU Clinic for 2018—June 2021. Among 540 RARPs performed, 199 PC patients were identified as high-risk in the D’Amico criteria.Results and discussion. Mean operation time was 100 min, blood transfusion rate — 3.5 %. Bladder catheterisation time was 5 days, average hospital stay — 7.1 days.Conclusion. RARP may facilitate optimal therapeutic efficacy and favour postoperative recovery as monotherapy or the first step in a multimodal treatment of high-risk PC patients.

A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

Objectives: While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database. Patients and methods: All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed. Results: Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach. Conclusion: Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon. Level of evidence: 4

To Investigate the Effect of Glucocorticoids on Blood Loss during and after First Total Hip Arthroplasty and Its Safety Meta-Analysis

Objective. To evaluate the efficacy and safety of topical glucocorticoids for total hip arthroplasty by meta-analysis. Methods. A computerized search of the Cochrane Library, MEDLINE, EMBASE, and PubMed English databases, as well as Chinese Biomedical Literature Database, vipu Chinese Science and Technology Journal Database, Wanfang database, and Chinese Knowledge Net Database, was performed to include all randomized controlled trials (RCTs) regarding topical glucocorticoid therapy for postoperative bleeding after THA according to the inclusion criteria. The quality evaluation criteria of RCTs, as stated in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.5, were adopted for evaluation, and the meta-analysis was performed using RevMan 5.3. Results. A total of 10 articles were included, including 1,112 patients: 566 in the topical glucocorticoid group and 546 in the control group. The transfusion rate was 8.43% for topical glucocorticoids and 30.05% for the control group ( P < 0.001 ), and topical glucocorticoids reduced 317.89 ml total blood loss and 76.82 ml invisible blood loss, with statistically significant differences ( P < 0.001 ). The amount of intraoperative blood loss was reduced by topical glucocorticoids, but the difference was not statistically significant ( P = 0.83 ), and the postoperative HB value was increased by topical glucocorticoids, although the difference was statistically significant ( P < 0.001 ). The incidence of DVT and PE after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%), the difference was not statistically significant ( P = 0.54 ), and the incidence of infection after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%). The difference was not statistically significant ( P = 0.39 ). Conclusions. Topical glucocorticoids can reduce the transfusion rate and blood loss in THA patients without increasing their risk of thrombosis.

The Effect of Tranexamic Acid and Epsilon-Aminocaproic Acid on Bleeding During Hip and Knee Arthroplasty：A Retrospective Study

PurposeTo compare the hemostatic effect and risk of thrombosis between tranexamic acid and epsilon-aminocaproic acid.MethodsA retrospective study of 140 cases of joint replacement, including 93 cases in the tranexamic acid (TXA) group and 47 cases in the epsilon-aminocaproic acid (EACA) group. TXA or EACA was injected intravenously 30 minutes before surgery, and TXA or EACA was infused into the joint cavity after the wound was closed. The drainage, blood loss and plasma albumin loss were observed after operation.ResultsThe postoperative hemoglobin loss in the two groups was 19.1±11.4g/L, 20.3±13.6g/L, P>0.05. However, the drainage volume of the TXA group was less than that of the EACA group, which were 103.3±92.1ml and 117.4±120.9ml, respectively, P<0.05. The blood transfusion rate in the TXA group was higher than that in the EACA group, 14% and 34%, respectively, P<0.05. The postoperative plasma albumin loss of the two groups of patients was 7.4±8.0g/L and 7.3±5.5g/L respectively, P=0.05.ConclusionsThe hemostatic effect of TXA was slightly better than that of EACA, and the proportion of transfusion of TXA was lower.Level of Evidence: Level III

Effect of nutritional status before femoral neck fracture surgery on postoperative outcomes: a retrospective study

Background Although nutritional status is crucial in gait recovery after femoral neck fracture surgery, the relationship between preoperative nutritional status and postoperative outcomes remains unknown. This study examined the effects of preoperative nutritional status on postoperative outcomes in patients undergoing femoral neck fracture surgery. Methods Data regarding the joints of 137 patients (29 men, 108 women) who underwent bipolar hemiarthroplasty for femoral neck fractures at our hospital from January 2015 to December 2019 were retrospectively examined. The Geriatric Nutritional Risk Index (GNRI), an index of nutritional status, was used to classify patients into two groups: a normal group (GNRI ≥92; n = 62) and an undernourished group (GNRI < 92; n = 75). The study endpoints included age at surgery, sex, Mini Mental State Examination (MMSE), American Society of Anesthesiologists Physical Status (ASA) classification, preoperative waiting period, intraoperative blood loss, surgery time, perioperative hemoglobin levels, blood transfusion rate, complication rate, 6-month mortality rate, transfer rate, percentage of patients unable to walk at discharge or transfer, and inability to walk 6 months postoperatively. Results The patients in the undernourished group was significantly older at surgery (p < 0.01) and had a lower perioperative hemoglobin levels (p < 0.01), a higher blood transfusion rate (p < 0.01), a lower MMSE (p < 0.01), a longer preoperative waiting period (p < 0.05), a higher transfer rate (p < 0.05), were more likely to be unable to walk 6 months postoperatively (p < 0.01), a higher complication rate (p < 0.05), and a higher 6-month mortality rate (p < 0.01) than the normal group. Patients in the undernourished group had worse rates of postoperative complications, transfer, mortality, and inability to walk 6-month after surgery than those in the normal group. Conclusions A poor nutritional status affects the gait function and systemic condition of patients undergoing femoral neck fracture surgery; therefore, early nutritional interventions may reduce mortality rates and shorten rehabilitation. These results suggest that the GNRI effectively predicts postoperative complications, mortality, and gait function.

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Background To investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture. Methods From our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression. Results A total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05). Conclusion Hypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion. Level of evidence Level III, retrospective study.