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Mark P Figgie - One of the best experts on this subject based on the ideXlab platform.
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the efficacy of a thrombin based hemostatic agent in unilateral total knee arthroplasty a randomized controlled trial
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Han Jo Kim, Robson M Fraser, Barbara B Kahn, Stephen Lyman, Mark P FiggieAbstract:Introduction: Blood loss following total knee arthroplasty can lead to substantial morbidity and the need for blood transfusions. Hemostatic agents have been used to minimize blood loss and to decrease transfusion rates. Floseal is a thrombin-based hemostatic agent with unknown efficacy for achieving these goals in patients undergoing total knee arthroplasty. Methods: We performed a prospective randomized controlled trial on the use of Floseal in patients undergoing total knee arthroplasty, with the primary end point being blood loss as measured through Drain Output. Demographic characteristics, operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, adverse events, transfusion rates, and deviations from protocol were recorded. Results: A total of 196 patients were enrolled, with ninety-seven patients being randomized to the Floseal group and ninety-nine patients being randomized to the control group. There were no significant differences between the Floseal and control groups in terms of Drain Output at twenty-four hours (711 compared with 702 mL; p = 0.823). No differences were noted between the groups in terms of operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, or transfusion rates. Complications occurred infrequently. In the acute postoperative period, there were two cases of cellulitis (one in each group), two deep venous thromboses (one in each group), and one paralytic ileus (in the control group), all of which resolved with nonoperative measures. At the six-week follow-up, one patient in the Floseal group had died from a cause unrelated to surgery, two patients (one in each group) had suture abscesses with cellulitis that resolved with postoperative antibiotics, and four patients (two in each group) underwent knee manipulation under anesthesia to achieve improved knee motion. With the numbers available, there was no significant association between Floseal use and the occurrence of these adverse events. Conclusions: The present study showed that Floseal had no demonstrable effect on blood loss as measured through Drain Output following total knee arthroplasty. There were also no notable adverse events associated with its use. The usefulness of Floseal as a hemostatic agent in total knee arthroplasty remains unclear. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Steven J. Hattrup - One of the best experts on this subject based on the ideXlab platform.
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Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty
Journal of shoulder and elbow surgery, 2016Co-Authors: Jeffrey T. Abildgaard, Ryan Mclemore, Steven J. HattrupAbstract:Background Efficacy of tranexamic acid (TXA) remains unproven in the setting of shoulder arthroplasty. The purpose of this study was to determine the effects of TXA on perioperative blood loss and Drain Output in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods We conducted a retrospective comparison of 77 TSAs and 94 RTSAs performed in 168 patients. TXA was administered intravenously in 35 TSA and 42 RTSA patients. Changes in hemoglobin (Hgb), hematocrit (Hct), Drain Output, and total blood loss were reviewed with univariate analysis and additional multivariate regression examining the cofactors of age, body mass index, American Society of Anesthesiologists status, and gender of each patient. Results Use of TXA in TSA led to a significant decrease in total blood loss (679 mL vs. 910 mL; P P P P P P P P Conclusions Use of TXA perioperatively among patients undergoing primary shoulder arthroplasty can decrease perioperative blood loss, change in Hgb and Hct, and postoperative Drain Output.
Justin S. Smith - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis
Neurospine, 2020Co-Authors: Lauren K. Dunn, Ching-jen Chen, Davis G. Taylor, Kamilla Esfahani, Brian Brenner, Charles Luo, Thomas J. Buell, Sarah N. Spangler, Avery L. Buchholz, Justin S. SmithAbstract:OBJECTIVE This was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on Drain Output and transfusion requirements following adult spinal deformity surgery. METHODS One hundred forty-seven patients undergoing posterior instrumented thoracolumbar fusion of ≥ 3 vertebral levels at a single institution who received low-dose PTXA infusion (0.5-1 mg/kg/hr) for 24 hours were compared to 292 control patients who did not receive PTXA. The cohorts were propensity matched based on age, sex, American Society of Anesthesiologist physical status classification, body mass index, number of surgical levels, revision surgery, operative duration, and total intraoperative TXA dose (n = 106 in each group). Primary outcome was 72-hour postoperative Drain Output. Secondary outcomes were number of allogeneic blood transfusions. RESULTS There was no significant difference in postoperative Drain Output in the PTXA group compared to control (660 ± 420 mL vs. 710 ± 490 mL, p = 0.46). The PTXA group received significantly more crystalloid (6,100 ± 3,100 mL vs. 4,600 ± 2,400 mL, p < 0.001) and red blood cell transfusions postoperatively (median [interquartile range]: 1 [0-2] units vs. 0 [0-1] units; incidence rate ratio [95% confidence interval], 1.6 [1.2-2.2]; p = 0.001). Rates of adverse events were comparable between groups. CONCLUSION Continuous low-dose PTXA infusion was not associated with reduced Drain Output after spinal deformity surgery. No difference in thromboembolic incidence was observed. A prospective dose escalation study is warranted to investigate the efficacy of higher dose PTXA.
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Multiple-day Drainage when using bone morphogenic protein for long-segment thoracolumbar fusions is associated with low rates of wound complications.
World neurosurgery, 2012Co-Authors: Dwight Saulle, Christopher I Shaffrey, Justin S. SmithAbstract:Concerns over increased wound complication rates have been raised when bone morphogenic protein (BMP) is used as an adjunct for fusion in spinal surgery. This study evaluated 87 consecutive patients undergoing long-segment thoracolumbar spinal fusions with BMP to assess Drain Output and the rates of reoperation for infection or seroma. Inclusion criteria included patients undergoing 4 or more levels of posterior instrumented thoracolumbar fusion, use of BMP, age >18 years, and a perioperative follow-up of ≥60 days. Drain Output, length of time of Drainage, and need for reoperation for wound seroma or infection were reviewed. A total of 87 patients met inclusion criteria and had a mean age of 58.5 years (SD 16, range 20 to 81). The average number of levels instrumented and arthrodesed with BMP was 9.2 (SD 3.7; range 4 to 18), and the average dose of BMP used was 31.2 mg (SD 9.6, range 12 to 48) or 2.6 large sponges. Patients required Drainage for a mean of 4.9 days (SD 1.3, range 3 to 9). The average total Output was 1923 mL (SD 865, range 530 to 4310 mL). The wound infection rate was 2.3% (2 cases of deep wound infection that required reoperation). There was one (1.1%) hematoma, and one (1.1%) sterile seroma, both requiring evacuation. No other wound complications were noted. Use of BMP for long-segment posterior thoracolumbar fusions may be associated with significant Drain Output, requiring multiple days of Drainage. However, when Drained adequately, infections and seromas occur infrequently. Copyright © 2013 Elsevier Inc. All rights reserved.
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Multiple-day Drainage when using bone morphogenic protein for long-segment thoracolumbar fusions is associated with low rates of wound complications.
World Neurosurgery, 2012Co-Authors: Dwight Saulle, Christopher I Shaffrey, Justin S. SmithAbstract:Background Concerns over increased wound complication rates have been raised when bone morphogenic protein (BMP) is used as an adjunct for fusion in spinal surgery. This study evaluated 87 consecutive patients undergoing long-segment thoracolumbar spinal fusions with BMP to assess Drain Output and the rates of reoperation for infection or seroma. Methods Inclusion criteria included patients undergoing 4 or more levels of posterior instrumented thoracolumbar fusion, use of BMP, age >18 years, and a perioperative follow-up of ≥60 days. Drain Output, length of time of Drainage, and need for reoperation for wound seroma or infection were reviewed. Results A total of 87 patients met inclusion criteria and had a mean age of 58.5 years (SD 16, range 20 to 81). The average number of levels instrumented and arthrodesed with BMP was 9.2 (SD 3.7; range 4 to 18), and the average dose of BMP used was 31.2 mg (SD 9.6, range 12 to 48) or 2.6 large sponges. Patients required Drainage for a mean of 4.9 days (SD 1.3, range 3 to 9). The average total Output was 1923 mL (SD 865, range 530 to 4310 mL). The wound infection rate was 2.3% (2 cases of deep wound infection that required reoperation). There was one (1.1%) hematoma, and one (1.1%) sterile seroma, both requiring evacuation. No other wound complications were noted. Conclusions Use of BMP for long-segment posterior thoracolumbar fusions may be associated with significant Drain Output, requiring multiple days of Drainage. However, when Drained adequately, infections and seromas occur infrequently.
Han Jo Kim - One of the best experts on this subject based on the ideXlab platform.
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the efficacy of a thrombin based hemostatic agent in unilateral total knee arthroplasty a randomized controlled trial
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Han Jo Kim, Robson M Fraser, Barbara B Kahn, Stephen Lyman, Mark P FiggieAbstract:Introduction: Blood loss following total knee arthroplasty can lead to substantial morbidity and the need for blood transfusions. Hemostatic agents have been used to minimize blood loss and to decrease transfusion rates. Floseal is a thrombin-based hemostatic agent with unknown efficacy for achieving these goals in patients undergoing total knee arthroplasty. Methods: We performed a prospective randomized controlled trial on the use of Floseal in patients undergoing total knee arthroplasty, with the primary end point being blood loss as measured through Drain Output. Demographic characteristics, operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, adverse events, transfusion rates, and deviations from protocol were recorded. Results: A total of 196 patients were enrolled, with ninety-seven patients being randomized to the Floseal group and ninety-nine patients being randomized to the control group. There were no significant differences between the Floseal and control groups in terms of Drain Output at twenty-four hours (711 compared with 702 mL; p = 0.823). No differences were noted between the groups in terms of operative side, diagnosis, intraoperative details, implant choice, hospital course, laboratory values, visual analog scale pain scores, knee range of motion, or transfusion rates. Complications occurred infrequently. In the acute postoperative period, there were two cases of cellulitis (one in each group), two deep venous thromboses (one in each group), and one paralytic ileus (in the control group), all of which resolved with nonoperative measures. At the six-week follow-up, one patient in the Floseal group had died from a cause unrelated to surgery, two patients (one in each group) had suture abscesses with cellulitis that resolved with postoperative antibiotics, and four patients (two in each group) underwent knee manipulation under anesthesia to achieve improved knee motion. With the numbers available, there was no significant association between Floseal use and the occurrence of these adverse events. Conclusions: The present study showed that Floseal had no demonstrable effect on blood loss as measured through Drain Output following total knee arthroplasty. There were also no notable adverse events associated with its use. The usefulness of Floseal as a hemostatic agent in total knee arthroplasty remains unclear. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Jeffrey T. Abildgaard - One of the best experts on this subject based on the ideXlab platform.
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Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty
Journal of shoulder and elbow surgery, 2016Co-Authors: Jeffrey T. Abildgaard, Ryan Mclemore, Steven J. HattrupAbstract:Background Efficacy of tranexamic acid (TXA) remains unproven in the setting of shoulder arthroplasty. The purpose of this study was to determine the effects of TXA on perioperative blood loss and Drain Output in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods We conducted a retrospective comparison of 77 TSAs and 94 RTSAs performed in 168 patients. TXA was administered intravenously in 35 TSA and 42 RTSA patients. Changes in hemoglobin (Hgb), hematocrit (Hct), Drain Output, and total blood loss were reviewed with univariate analysis and additional multivariate regression examining the cofactors of age, body mass index, American Society of Anesthesiologists status, and gender of each patient. Results Use of TXA in TSA led to a significant decrease in total blood loss (679 mL vs. 910 mL; P P P P P P P P Conclusions Use of TXA perioperatively among patients undergoing primary shoulder arthroplasty can decrease perioperative blood loss, change in Hgb and Hct, and postoperative Drain Output.