Perioperative Patient Blood Management

A special issue of Surgeries (ISSN 2673-4095).

Deadline for manuscript submissions: 20 September 2024 | Viewed by 25018

Special Issue Editor


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Guest Editor
Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Campus Prater, Vienna, Austria
Interests: perioperative bleeding; perioperative thromboprophylaxis; patient blood management; red cell deformability; microparticles; glycocalyx shedding; perioperative anxiety; perioperative quality of life; perioperative telemedicine

Special Issue Information

Dear Colleagues,

While allogeneic blood transfusions are generally very safe and have saved millions of lives, they carry a small risk of serious side effects. Transfusion can trigger an immune response to the donated blood. The severity of this response can range from mild to life-threatening, with an increased risk of death even many years after allogeneic transfusion. These risks can be lessened using patient blood management (PBM), a series of evidence-based interventions that seek to minimize blood loss, prevent anemia, and reduce the need for allogeneic transfusion before, during, and after major surgery. If PBM is successfully implemented, it can improve the outcome for an individual patient. At the same time, PBM can help to address another important concern: shortages of donated blood. The use of PBM can help to reduce the demand for donor blood, ensuring that supplies are available for those patients most in need. Finally, PBM can help to reduce healthcare costs by minimizing the costs for treating complications arising from major surgery.

The uptake of perioperative PBM is spreading out worldwide. The speed of implementation, however, is slow, and potential win-win-win situations for patients, for doctors’ therapeutic outcomes, for healthcare systems are not being put into effect. Traditions, historical reasons, and misconceptions among doctors, patients, and societies may be stumbling blocks. PBM can best be promoted through knowledge transfer to all stakeholders, by providing resources and infrastructures, carefully checking outcome parameters and quality indicators, and increasing the body of evidence for PBM.

The aim of our Special Issue in Surgeries is to summarize experiences and research trends in perioperative PBM. Experts in the field are warmly encouraged to submit manuscripts before September 2021.

Prof. Dr. Sibylle Kietaibl
Guest Editor

Manuscript Submission Information

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Keywords

  • patient blood management
  • perioperative anemia
  • perioperative bleeding
  • perioperative transfusion

Published Papers (7 papers)

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Research

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8 pages, 254 KiB  
Article
Evaluation of the Use of Blood Products in ICU Hospitalized COVID-19 Patients
by Branislava Vasiljević-Jovanović, Marija Milenković, Lidija Mijović, Zoran Bukumirić, Milena Šantrić-Milićević, Miloš Božanić, Vojislava Milutinović and Marija Zdravković
Surgeries 2021, 2(4), 391-398; https://doi.org/10.3390/surgeries2040039 - 20 Nov 2021
Viewed by 2641
Abstract
(1) Background: The COVID-19 pandemic tested the public health system’s readiness for crises and highlighted the importance of knowing the demand for blood products and the maintenance of the blood supply chain. The aim of this study was to evaluate blood product usage [...] Read more.
(1) Background: The COVID-19 pandemic tested the public health system’s readiness for crises and highlighted the importance of knowing the demand for blood products and the maintenance of the blood supply chain. The aim of this study was to evaluate blood product usage in a series of patients that were hospitalized due to COVID-19 and to analyze their demographics and clinical characteristics. (2) Methods: In this retrospective cohort study, we analyzed data from transfused COVID-19 patients that were treated in the University Hospital Medical Center Bezanijska Kosa in Belgrade, Serbia during the second wave of the epidemic. (3) Results: This study included 90 patients. The median age of the patients was 72 (range 23–95) years. The median time of hospitalization was 23 days (range 3–73 days). In intensive care units (ICUs) the median time of hospitalization was 9 days (range 0–73). One or more comorbidities were observed in 86 individuals (95.6%). The total number of transfused red blood cell concetrates (RBC) was 304 (139 in ICU, 165 in other wards), with a mean of 3 units/patient (range 1–14). Comorbidities, severity of illness and hospital duration in the ICU were statistically significant predictors of higher RBC use. (4) Conclusion: Knowledge of the transfusion profile of COVID-19 patients allowed better management of the hospital’s blood stocks during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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12 pages, 403 KiB  
Article
Using of Intraoperative Cell Salvage and Tranexamic Acid as Protective Factor for Postoperative Anemia Appearance in Patients with Total Hip or Knee Arthroplasty
by Svetislav Matić, Mira Vuković and Aleksandar Vukićević
Surgeries 2021, 2(3), 308-319; https://doi.org/10.3390/surgeries2030031 - 16 Aug 2021
Cited by 1 | Viewed by 3085
Abstract
(1) Background: The purpose of this study was to investigate intraoperative pharmacological and nonpharmacological methods and techniques in reducing blood loss in patients following total hip or knee arthroplasty. (2) Methods: A retrospective cross-sectional study was conducted in patients undergoing TKA or THA [...] Read more.
(1) Background: The purpose of this study was to investigate intraoperative pharmacological and nonpharmacological methods and techniques in reducing blood loss in patients following total hip or knee arthroplasty. (2) Methods: A retrospective cross-sectional study was conducted in patients undergoing TKA or THA surgery, electively performed at the General Hospital Valjevo, Valjevo, Serbia, in 2014 when the principles of patient blood management (PBM) were not applied at all or in part, and in 2019 when PBM principles were applied as standard. (3) Results: This study includes 197 patients, of whom 83.8% developed postoperative anemia (PA defined by haemoglobin < 12 g/dL in both sexes). Using multivariate logistic regression and ROC curve analysis, it was shown that the use of tranexamic acid (TXA) with intraoperative cell salvage (ICS) in patients without preoperative anemia reduced the incidence of PA (odds ratio = 0.081). (4) Conclusions: Preoperative diagnosis and treatment of anemia are necessary in orthopedic patients since the use of TXA with ICS strongly reduces PA in patients without preoperative anemia. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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Review

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13 pages, 2905 KiB  
Review
Pseudoaneurysm after Radical Prostatectomy: A Case Report and Narrative Literature Review
by Marcello Della Corte, Daniele Amparore, Michele Sica, Erica Clemente, Daniela Mazzuca, Matteo Manfredi, Cristian Fiori and Francesco Porpiglia
Surgeries 2022, 3(3), 229-241; https://doi.org/10.3390/surgeries3030025 - 18 Aug 2022
Cited by 4 | Viewed by 2251
Abstract
(1) Background: We report a very unusual presentation of pseudoaneurysm developed following a robot-assisted radical prostatectomy (RARP) with bilateral pelvic lymph node dissection. The patient was a 66-year-old male, admitted at the Emergency Department 20 days after discharge from RARP due to chest [...] Read more.
(1) Background: We report a very unusual presentation of pseudoaneurysm developed following a robot-assisted radical prostatectomy (RARP) with bilateral pelvic lymph node dissection. The patient was a 66-year-old male, admitted at the Emergency Department 20 days after discharge from RARP due to chest pain, lipothymia and occult bleeding, necessitating a blood transfusion and a moderate increase of serum troponin. Angiography showed a pseudo-aneurysm involving the inferior-epigastric artery pubic branch. The patient underwent percutaneous embolization with complete resolution. The aim of this study is to offer an overview on pseudoaneurysms developed as radical prostatectomy complications; (2) Methods: A literature search was conducted on Scopus and PubMed for pseudoaneurysms after RARP to analyze all the previously published cases. The search terms used were “pseudoaneurysm” and “prostatectomy” using the Boolean Operator “AND”. We used the default search strategy “all fields”; (3) Results: Herein, a narrative review is proposed to facilitate the approach to this emerging clinical challenge, due to both an implementing in diagnosis imaging techniques and a spread of robotic surgery in prostate cancer; (4) Conclusions: The management of radical prostatectomy complications still remains barely uniformed and needs to be precisely calibrated as the initial cure approach itself. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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20 pages, 711 KiB  
Review
Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma
by Lidia Mora Miquel, Susana Manrique Muñoz and Marc Maegele
Surgeries 2022, 3(1), 44-63; https://doi.org/10.3390/surgeries3010007 - 14 Feb 2022
Cited by 2 | Viewed by 5792
Abstract
Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient [...] Read more.
Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient selection criteria are needed. The main concerns in the case of oncological surgery are the reinfusion of tumour cells, thereby increasing the risk of metastasis. This threat could be minimized, which may help to rationalize its indication. In severe peripartum haemorrhage, cell salvage has not proven cost-effective, damage control techniques have been developed, and, given the risk of fetomaternal alloimmunization and amniotic fluid embolism, it is increasingly out of use. In trauma, bleeding may originate from multiple sites, coagulopathy may develop, and it should be evaluated whether re-transfusion of autologous blood collected from uncontaminated organ cavities would be feasible. General safety measures include washing recovered blood and its passage through leukocyte depletion filters. To date, no well-defined indications for cell salvage have been established for these pathologies, but with accurate case selection and selective implementation, it could become safe and effective. Randomized clinical trials are urgently needed. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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28 pages, 1327 KiB  
Review
Fibrinogen and Bleeding in Adult Cardiac Surgery: A Review of the Literature
by Višnja Ikić
Surgeries 2021, 2(4), 409-436; https://doi.org/10.3390/surgeries2040041 - 27 Nov 2021
Cited by 4 | Viewed by 5823
Abstract
Background: Fibrinogen is a substrate for blood clots formation. In cardiac surgery, a number of different mechanisms lead to a decrease in fibrinogen levels and consequent impaired haemostasis. Patients undergoing cardiac surgery are therefore frequently exposed to blood loss and allogeneic blood transfusion, [...] Read more.
Background: Fibrinogen is a substrate for blood clots formation. In cardiac surgery, a number of different mechanisms lead to a decrease in fibrinogen levels and consequent impaired haemostasis. Patients undergoing cardiac surgery are therefore frequently exposed to blood loss and allogeneic blood transfusion, which are risk factors associated with morbidity and mortality. Thus, particular efforts in fibrinogen management should be made to decrease bleeding and the need for blood transfusion. Therefore, fibrinogen remains an active focus of investigations from basic science to clinical practice. This review aims to summarise the latest evidence regarding the role of fibrinogen and current practices in fibrinogen management in adult cardiac surgery. Methods: The PubMed database was systematically searched for literature investigating the role and disorders of fibrinogen in cardiac surgery and diagnostic and therapeutic procedures related to fibrinogen deficiency aimed at reducing blood loss and transfusion requirements. Clinical trials and reviews from the last 10 years were included. Results: In total, 146 articles were analysed. Conclusion: The early diagnosis and treatment of fibrinogen deficiency is crucial in maintaining haemostasis in bleeding patients. Further studies are needed to better understand the association between fibrinogen levels, bleeding, and fibrinogen supplementation and their impacts on patient outcomes in different clinical settings. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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10 pages, 862 KiB  
Review
Clinical Impact of Preoperative Anemia in Patients Undergoing Peripheral Vascular Interventions: A Systematic Review
by Rafael M. Linhares, Carlos Darcy A. Bersot, José Eduardo G. Pereira, Carlos Galhardo, Jr., Marcos Adriano Lessa and Sibylle Kietaibl
Surgeries 2021, 2(3), 268-277; https://doi.org/10.3390/surgeries2030027 - 2 Aug 2021
Cited by 2 | Viewed by 2967
Abstract
Introduction: This systematic review aims to summarize the existing evidence relating to preoperative anemia and clinical outcomes in peripheral vascular surgery patients. Methods: The following databases were searched—PubMed, COCHRANE, LILACS, and Science Research—from 1 January 2010 up to 8 May 2020, with the [...] Read more.
Introduction: This systematic review aims to summarize the existing evidence relating to preoperative anemia and clinical outcomes in peripheral vascular surgery patients. Methods: The following databases were searched—PubMed, COCHRANE, LILACS, and Science Research—from 1 January 2010 up to 8 May 2020, with the last search performed on 1 January 2021. An additional manual search for potential primary studies was conducted on major journals (e.g., Anesthesiology, the British Journal of Anesthesia and the European Journal of Anaesthesiology) and reference lists of included studies. Google Scholar was also checked for additional eligible studies. Reviewers independently screened potentially eligible articles and extracted data from included studies on populations, interventions, comparisons, and outcomes. This review was registered at PROSPERO as CRD 180954. Results: In total, 6 observational studies with a combined total of 87,327 participants were analyzed. Data collected in this review suggest that preoperative anemia, especially when hemoglobin is <10 g/dL, is associated with an increased risk of red blood cell transfusions (OR: 7.5; 95% CI 6.3–8.9, p < 0.0001), limb amputation (OR: 5.2; 95% CI 3.1–8.6, p < 0.0001), and death (p < 0.0031). Conclusions: These data suggest an association between preoperative anemia, blood transfusion requirements, and other adverse clinical outcomes among patients subjected to peripheral vascular interventions. However, further investigations, particularly randomized controlled trials, are warranted to better understand the association between preoperative anemia and patients’ prognosis. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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Other

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8 pages, 2469 KiB  
Case Report
Urethral Sheath to Evacuate Blood Clots through Mitrofanoff Appendicovesicostomy
by Marcello Della Corte, Erica Clemente, Mattia Sibona, Elisa Cerchia, Berenice Tulelli, Paolo Gontero and Simona Gerocarni Nappo
Surgeries 2023, 4(2), 293-300; https://doi.org/10.3390/surgeries4020030 - 16 Jun 2023
Viewed by 1067
Abstract
Background: the Mitrofanoff appendicovesicostomy provides a catheterizable submucosal tunnel between umbilicus and bladder (or neobladder). In patients with a closed bladder neck, the Mitrofanoff channel is the only way to access the bladder. We describe our case of a 17 year-old girl with [...] Read more.
Background: the Mitrofanoff appendicovesicostomy provides a catheterizable submucosal tunnel between umbilicus and bladder (or neobladder). In patients with a closed bladder neck, the Mitrofanoff channel is the only way to access the bladder. We describe our case of a 17 year-old girl with a Mitrofanoff appendicovesicostomy and a previous surgical closure of the bladder neck and who developed a large bladder clot due to hematuria after a surgical cystolithotomy in an augmented bladder; Methods: after an unsuccessful trans-appendicovesicostomy bladder washing, the endoscopic evaluation was performed using a 14 Ch rigid cystoscope and surrounded by its own urethral sheath. The clot was progressively fragmented through the cystoscope under direct vision. Clot fragments were aspirated to obtain a complete evacuation; Results: the urethral sheath prevented damages to the appendicovesicostomy, allowing at the same time repeated accesses of the cystoscope into the neobladder and ensuring the procedural success. The postoperative period was uneventful, and the neobladder catheter was removed after two days. Neither channel stenosis nor anastomosis dehiscence nor incontinence were reported after five months; Conclusions: the use of urethral sheath 14 Ch through an appendicovesicostomy preserves both the stoma and the channel, making possible endoscopic procedures such as blood clot evacuation into the neobladder. Full article
(This article belongs to the Special Issue Perioperative Patient Blood Management)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Tentative Title: The benefit of using intraoperative cell salvage and tranexamic acid in patients with total knee arthroplasty
Author: Dr.  Svetislav Matic

Tentative Title: Clinical impact of preoperative anemia in patients undergoing peripheral vascular interventions: A systematic review
Author: Dr.  Rafael M. Linhares

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