Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss: An Observational Cohort Study of 81 Nontraumatic Amputations
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Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss : An Observational Cohort Study of 81 Nontraumatic Amputations. / Wied, Christian; Tengberg, Peter T; Kristensen, Morten T; Holm, Gitte; Kallemose, Thomas; Troelsen, Anders; Foss, Nicolai B.
I: Geriatric Orthopaedic Surgery & Rehabilitation, Bind 8, Nr. 3, 01.09.2017, s. 123-127.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Total Blood Loss After Transfemoral Amputations Is Twice the Intraoperative Loss
T2 - An Observational Cohort Study of 81 Nontraumatic Amputations
AU - Wied, Christian
AU - Tengberg, Peter T
AU - Kristensen, Morten T
AU - Holm, Gitte
AU - Kallemose, Thomas
AU - Troelsen, Anders
AU - Foss, Nicolai B
PY - 2017/9/1
Y1 - 2017/9/1
N2 - INTRODUCTION: Underestimation of the actual blood loss in patients undergoing nontraumatic transfemoral amputation (TFA) can impact negatively on outcome in these often frail patients, with very limited physiological reserves. The primary aim of this study is to estimate the total blood loss (TBL) after TFA, and second, to evaluate the impact of blood loss on 30-day mortality and medical complications.METHODS: A single-center retrospective cohort study conducted from 2013 to 2015. The TBL was calculated on the fourth postoperative day. It was based on the hemoglobin levels, transfusions, and the estimated blood volume.RESULTS: Eighty-one patients undergoing TFA were included for final analysis. The median TBL was 964 mL (interquartile range [IQR]: 443-1558). The intraoperative blood loss (OBL) was 400 mL (IQR: 200-500). The median difference between TBL and OBL was 688 mL (IQR: 124-1075). The patient received red blood cell (RBC) transfusion of a median amount of 2 units. Higher number of transfusions (>2) did not impact the outcome. From multivariable analysis, it was evident that the TBL increased significantly in patients with renal disease prior to surgery, (P = .034). The TBL itself was not independently associated with increased 30-day mortality or medical complications.CONCLUSION: The TBL after TFAs is significantly greater than the volume estimated intraoperatively and increases significantly in the presence of renal disease prior to surgery. An increased TBL and requirement for RBC transfusion is not directly associated with 30-day mortality or medical complications. A high vigilance for anemia seems advisable when planning for TFA surgery. Research on optimum blood conservation and transfusion strategies during TFA is warranted.
AB - INTRODUCTION: Underestimation of the actual blood loss in patients undergoing nontraumatic transfemoral amputation (TFA) can impact negatively on outcome in these often frail patients, with very limited physiological reserves. The primary aim of this study is to estimate the total blood loss (TBL) after TFA, and second, to evaluate the impact of blood loss on 30-day mortality and medical complications.METHODS: A single-center retrospective cohort study conducted from 2013 to 2015. The TBL was calculated on the fourth postoperative day. It was based on the hemoglobin levels, transfusions, and the estimated blood volume.RESULTS: Eighty-one patients undergoing TFA were included for final analysis. The median TBL was 964 mL (interquartile range [IQR]: 443-1558). The intraoperative blood loss (OBL) was 400 mL (IQR: 200-500). The median difference between TBL and OBL was 688 mL (IQR: 124-1075). The patient received red blood cell (RBC) transfusion of a median amount of 2 units. Higher number of transfusions (>2) did not impact the outcome. From multivariable analysis, it was evident that the TBL increased significantly in patients with renal disease prior to surgery, (P = .034). The TBL itself was not independently associated with increased 30-day mortality or medical complications.CONCLUSION: The TBL after TFAs is significantly greater than the volume estimated intraoperatively and increases significantly in the presence of renal disease prior to surgery. An increased TBL and requirement for RBC transfusion is not directly associated with 30-day mortality or medical complications. A high vigilance for anemia seems advisable when planning for TFA surgery. Research on optimum blood conservation and transfusion strategies during TFA is warranted.
KW - Journal Article
U2 - 10.1177/2151458517706595
DO - 10.1177/2151458517706595
M3 - Journal article
C2 - 28835867
VL - 8
SP - 123
EP - 127
JO - Geriatric Orthopaedic Surgery & Rehabilitation
JF - Geriatric Orthopaedic Surgery & Rehabilitation
SN - 2151-4585
IS - 3
ER -
ID: 185367774