Técnicas de ahorro de sangre en cirugía ortopédica

La cirugía ortopédica está asociada con frecuencia a la necesidad de transfusión de sangre homóloga, con los consiguientes riesgos que ello conlleva. En la actualidad se resalta la importancia de la disminución tanto de la transfusión como de la sobretransfusión en este tipo de cirugía. Dicho objetivo se puede alcanzar con el empleo de diversas técnicas de ahorro de sangre, que incluyan la potenciación del uso de sangre antóloga de métodos para disminuir el sangrado perioperatorio. La máxima eficacia para disminuir la necesidad de transfusión de sangre homóloga se deriva de la combinación de varias técnicas de ahorro, como son los programas de autotransfusión, la hipotensión controlada y el empleo de nuevos fármacos como eritropoyetina o aprotinina; todo ello sin olvidar la importancia de establecer unos criterios restrictivos, en consonancia con las directrices más actuales en este sentido, en el momento de indicar la necesidad de una transfusión sanguínea.Technique in orthopaedic surgery requires frequently transfusion of homologous blood which entails several risks. Nowadays, the importance of the decrease of both transfusion and overtransfusion has been proposed for this type of surgery. This aim can be reached by using different blood saving techniques including either the use of antologous blood or methods to minimize perioperative bleeding. The highest efficacy in order to diminish homologous blood transfusion combines several savings techniques as autotransfusion programs, controlled hypotension, and the use of new drugs such as erytropoyetin and aproinin. Restrictive criteria have to be established according to the more recent guidelines for blood transfusion

Thromboembolism in Orthopedic Surgery

The book reviews the main topics in thromboprophylaxis around orthopedic surgery, from a general scope of the problems with the disease highlighting them in orthopedics to the new speci fi c protocols involving, for example, new oral anticoagulants. The prevalence of the venous thromboembolism in each procedure (from “easy” to “hard” surgeries, with different rates of related thrombosis) and the risk factors to bear in mind in each one (related and nonrelated with the orthopedic procedure) are also revised. A chapter focuses on the diagnosis and treatment of venous thromboembolism, which is commonly “forgotten” in many books addressed to orthopedic surgeons and anesthesiologists. The methods for thromboprophylaxis have three speci fi c chapters: the most common drugs used and recommended when pharmacological prophylaxis is needed, new drugs which are arising day by day and which management will be of main importance in a close near future, and mechanical methods, recommended both as additional when possible and for sole indications when the risk of bleeding could move us to minimize the real risk of thrombosis. Anesthetic implications for thromboprophylaxis and, also, main implications of the application of antithrombotic protocols in the anesthetic practice are covered by another chapter. In our opinion, it was very important to divide the orthopedic procedures according to their own thrombotic risk, so having their own protocols for thromboprophylaxis, high-risk, day surgery procedures, and “special” surgical procedures are included in three different chapters, from three different authors with complementary views. Finally, in the last chapter, we review the problems involving the perioperatory management of anti-aggregated and anticoagulated patients, with a special part in hip fracture surgery. So, a wide scope of the topic was made with a great effort from all the authors and the invaluable support from Springer

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1-2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08-1.15) and the HR for discharge was 0.78 (95% CI: 0.74-0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05-1.15) and HR for discharge was 0.82 (95% CI: 0.78-0.87). Pre-operative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.</p

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended