Patient Blood Management in Craniosynostosis Surgery

2021

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Background Reported independent predictors of intraoperative and postoperative complications were Age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection. Objectives To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization. Methods Secondary analysis of the initial study. The Ethics Committee approved the study. Results There were 54 patients with a median age of 15.5[0–172] months. Thirty-seven (68.5%) patients had an intestinal resection, nine (16.7%) had an exploratory laparotomy and eight (16.8%) patients had a laparotomy for volvulus.

Section: Discussionsupporting

confidence: 63%

Exploratory Laparotomy, Intestinal Resection In Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021

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“…Intraoperative optimization with goal-directed therapies could contribute to upgrading postoperative outcomes in these surgical settings (11,12,13,14,15,16,17,18,19,20,21). Similar conclusions have been drawn in major surgical settings and where goal-directed therapies need to be developed and applied systematically to improve postoperative outcomes (22,23,24,25).…”

Section: Discussionsupporting

confidence: 59%

Exploratory Laparotomy and Intestinal Resection in Children: Intraoperative Goal Directed Therapy and Intraoperative and Postoperative Outcomes

2021

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Background: Reported independent predictors of intraoperative and postoperative complications were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection.Objectives: To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization.Methods: Secondary analysis of the initial study. The Ethics Committee approved the study.Results: There were 54 patients with a median age of 15.5[0-172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus.Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had intraoperative hemorrhagic shock. Two (3.7%) patients had postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had intraoperative transfusion. The in-hospital mortality rate was 3.7% in two patients.Conclusion: Intraoperative goal-directed therapies need to be developed and included in these surgical settings for intraoperative and postoperative optimization.

“…This implies the inclusion of transfusion guided with point-of-care tests, uid and hemodynamic therapy protocols for optimal intraoperative patient blood management and uid therapy in this surgical setting. As described in previous studies these goal-directed therapies have the objectives of improving postoperative outcome (10,11,12,13,14,15,16,17,18,19). Transfusion and intraoperative non-optimal hemodynamic parameters have been associated with adverse postoperative outcomes in surgical patients (8,9,19).…”

Section: Discussionmentioning

confidence: 98%

Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies In Children and In-Hospital Postoperative Outcome

2021

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Background Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. Objective We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative, postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management, fluid and hemodynamic therapy with the aims to implement optimization management protocols for postoperative outcome improvement. Methods Secondary analysis of patients who underwent femoral and pelvic osteotomy surgery included in the initial retrospective study. Results There were eighteen patients with a mean age of 104± 47.1 months. Four (22.2%) patients had intraoperative and or postoperative complications. One patient (5.6%) had intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure and one patient (5.6%) had postoperative wound sepsis. Transfusion rate was 50% in nine patients. Conclusion Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased thus this implies the necessity of global patient blood management protocol with point of care tests, with fluid and hemodynamic guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.