• anemia
• blood transfusion
• endovascular aneurysm repair
• erythrocyte transfusion
• hemoglobins
• mortality
• postoperative complications
• vascular surgical procedures

• Humans
• Anemia/therapy
• Anemia/complications
• Vascular Surgical Procedures/adverse effects
• Vascular Surgical Procedures/trends
• Blood Transfusion/trends
• Blood Transfusion/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prognosis
• Cardiovascular Diseases/surgery
• Cardiovascular Diseases/diagnosis

• amputation
• limb ischemia
• peripheral vascular disease
• transfusion
• vascular surgery

• Humans
• Retrospective Studies
• Risk Factors
• Aftercare
• Patient Discharge
• Amputation, Surgical
• Lower Extremity/surgery
• Lower Extremity/blood supply
• Hemoglobins/analysis

• humans
• amputation, surgical
• amputation, surgical/adverse effects
• blood loss, surgical
• blood loss, surgical/prevention & control
• lower extremity
• lower extremity/surgery
• peripheral arterial disease
• peripheral arterial disease/surgery
• postoperative complications
• postoperative complications/epidemiology
• randomized controlled trials as topic

• Humans
• Blood Loss, Surgical/prevention & control
• Peripheral Arterial Disease/surgery
• Amputation, Surgical/adverse effects
• Postoperative Complications/epidemiology
• Lower Extremity/surgery
• Randomized Controlled Trials as Topic

• Chief Scientist Office

• adult
• humans
• aprotinin
• blood transfusion
• deamino arginine vasopressin
• deamino arginine vasopressin/therapeutic use
• fibrin tissue adhesive
• hemorrhage
• hemorrhage/etiology
• hemorrhage/prevention & control
• network meta-analysis
• tranexamic acid
• tranexamic acid/therapeutic use

• Adult
• Humans
• Aprotinin
• Blood Transfusion
• Deamino Arginine Vasopressin/therapeutic use
• Fibrin Tissue Adhesive
• Hemorrhage/etiology
• Hemorrhage/prevention & control
• Network Meta-Analysis
• Tranexamic Acid/therapeutic use

• Chief Scientist Office

• Bleeding
• Carotid body tumor
• Embolization
• Paraganglioma
• Primary tumor

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.

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.

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.

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.

• intraoperative blood loss
• lower extremity amputation
• total blood loss
• transfemoral amputation
• transfusion strategy

To investigate the total blood loss (TBL) and the safety with respect to the re-amputation rate after transtibial amputation (TTA) conducted with and without a tourniquet.

The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed with sagittal flaps. The pneumatic tourniquet, when used, was inflated around the femur to a pressure of 100 mmHg above the systolic blood pressure. The number of blood transfusions within the first four postoperative days was recorded. The intraoperative blood loss (OBL), which is defined as the volume of blood lost during surgery, was determined from the suction volume and by the weight difference of the surgical dressings. The trigger for a blood transfusion was set at a decrease in the Hgb level < 9.67 g/dL (6 mmol/L). Transfusions were performed with pooled red blood cells containing 245 mL per portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d.

Seventy-four out of 86 consecutive patients who underwent TTA within the two-year study period were included in the analysis. Of these, 38 were operated on using a tourniquet and 36 were operated on without using a tourniquet. There were no significant preoperative differences between the groups. The patients in both groups had a postoperative decrease in their Hgb level compared with preoperative baseline values. The patients operated on using a tourniquet received approximately three millilitres less blood transfusion per kilogram body weight compared with patients operated on without a tourniquet. The duration of surgery was shorter and the OBL was less for the tourniquet group than the non-tourniquet group, whereas no significant difference was observed for the TBL. The TBL median was 859 mL (IQR: 383-1315) in the non-tourniquet group vs 737 mL (IQR: 331-1218) in the tourniquet group (P = 0.754). Within the 30-d follow-up period, 9 patients in the tourniquet group and 11 in the non-tourniquet group underwent a re-amputation at the trans-femoral level. The use of a tourniquet showed no statistically significant association with the 30-d re-amputation at the femur level in the multiple logistic regression model (P = 0.78). The only variable with a significant association with re-amputation was age (OR = 1.07; P = 0.02).

The results indicate that tourniquets do not cause severe vascular damage with an increased postoperative bleeding or failure rate as the result.

• Total blood loss
• Intraoperative blood loss
• Transtibial amputation
• Lower extremity amputation
• Pneumatic tourniquet
• Re-amputation

Patients undergo cardiac preoperative evaluation to identify those at risk of adverse perioperative cardiac events. The Revised Cardiac Risk index is commonly used for this task, although it is unable to accurately risk stratify in all patients. This may be partly a result of intraoperative events which significantly modify preoperative risk.

We conducted a systematic review to identify independent intraoperative predictors of adverse cardiac events in patients undergoing non-cardiac surgery. Four databases (Ovid Healthstar 1966 to Jan 2012, Ovid Medline 1946 to 6 March 2012, EMBASE 1974 to March 05 2012 and The Cochrane Library to March 06 2012) were searched.

Fourteen eligible studies were identified. The need for intraoperative blood transfusion (odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.3), vascular surgery (OR, 2.3; 95% CI, 1.2-3.4) and emergent/urgent surgery (OR, 2.3; 95% CI, 1.1-3.5) were the only independent intraoperative risk predictors identified in more than study. Other independent intraoperative factors identified included a >20 mmHg fall in mean arterial blood pressure for > 60 min (OR, 3.0; 95% CI, 1.8-4.9), >30% increase in baseline systolic pressure (OR, 8.0; 95% CI, 1.3-50), tachycardia in the recovery room (>30 beats per min (bpm) from baseline for >5 min) (OR, 7; 95% CI, 1.9-26), new onset atrial fibrillation (OR, 6.6; 95% CI, 2.5-20), hypothermia (OR, 2.2; 95% CI, 1.1-5) and remote ischemic preconditioning (OR, 0.22; 95% CI, 0.07-0.67). Other markers of surgical complexity were not independently associated with postoperative adverse cardiac outcomes. None of these studies controlled for blood transfusion.

Intraoperative events significantly increase the risk for postoperative cardiac complications, although only intraoperative blood transfusion has strong evidence supporting this finding. It is possible that modification of these intraoperative risk factors by anesthetists and surgeons may reduce postoperative cardiac events and improve outcome. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study will add important information to understanding intraoperative risk factors for adverse cardiac events.

• allogeneic blood transfusion
• red blood cell
• haemoglobin
• guidelines

• Blood Banks/standards
• Blood Transfusion/methods
• Blood Transfusion/standards
• Critical Care/methods
• Critical Care/standards
• Erythrocyte Transfusion/methods
• Erythrocyte Transfusion/standards
• Humans
• Blood Banking/methods