Necessity for autologous blood storage and transfusion in patients undergoing pancreatoduodenectomy

Purpose

To establish which patients undergoing pancreaticoduodenectomy (PD) need autologous blood storage and transfusion.

Methods

Autologous blood was collected and stored for 69 patients scheduled to undergo PD, and not used in 50 patients. Based on the use of the deposited autologous blood and the estimated postoperative hemoglobin (Hb) level when blood was not deposited, we divided the patients into a “transfusion necessary” group and a “transfusion unnecessary” group. By comparing the two groups, we proposed a method of scoring to predict the necessity for storing autologous blood.

Results

The “transfusion necessary” group comprised 6 patients (2 who received homologous blood transfusion and 4 with an estimated postoperative Hb of <8.0 g/dL) and the “transfusion unnecessary” group comprised 63 patients (24 whose autologous blood was discarded and 39 with an estimated Hb ≥8.0 g/dL). By analyzing the differences between the groups, including the preoperative hemoglobin level and the need for portal vein resection, we devised a scoring system to predict the necessity of collecting autologous blood. The scoring significantly correlated with the proportion of patients who did not require autologous blood storage and transfusion.

Conclusions

Not all patients benefited from autologous blood storage and transfusion. Our scoring system proved useful for identifying which patients required autologous blood storage and transfusion during PD.

     

Safety and usage of darbepoetin alfa in children with chronic kidney disease: prospective registry study

Background

Limited prospective data are available on the long-term safety of darbepoetin alfa (DA) for treating anemia in children with chronic kidney disease (CKD).

Methods

In this prospective, phase IV, observational registry study, children ≤16 years of age with CKD anemia and receiving DA were observed for ≤2 years. Adverse events (AEs), DA dosing, hemoglobin (Hb) concentrations, and transfusions were recorded.

Results

A total of 319 patients were included in the analysis (mean age, 9.1 years), 158 (49.5 %) of whom were on dialysis at study entry. Of 434 serious AEs reported in 162 children, the most common were peritonitis (10.0 %), gastroenteritis (6.0 %), and hypertension (4.1 %). Six patients (1.9 %) died (unrelated to DA). Four patients (1.3 %) experienced six serious adverse drug reactions. The geometric mean DA dose range was 1.4–2.0 μg/kg/month. Mean baseline Hb concentration was 11.1 g/dl; mean values for children receiving and not receiving dialysis at baseline ranged between 10.9 and 11.5 g/dl and 11.2–11.7 g/dl, respectively. Overall, 48 patients (15.0 %) received ≥1 transfusion.

Conclusions

No new safety signals for DA were identified in children receiving DA for CKD anemia for ≤2 years. Based on Hb concentrations and transfusion requirements, DA was effective at managing anemia in these patients.

     

Body mass index,risk of allogeneic red blood cell transfusion,and mortality in elderly patients undergoing hip fracture surgery

Summary

Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery.

Introduction

Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery.

Methods

This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005–2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8–30 days postsurgery) and long-term mortality (31–365 days postsurgery).

Results

Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR?=?1.11; CI 1.08–1.15), 42.1 % in overweight patients (adjusted RR?=?0.89; CI 0.86–0.91), and 42.2 % in obese patients (adjusted RR?=?0.87; CI 0.84–0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34–1.71), 0.70 (CI 0.61–0.80), and 0.58 (CI 0.43–0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33–1.57), 0.80 (CI 0.74–0.86), and 0.58 (CI 0.50–0.69). Similar association between BMI and mortality was observed also among non-transfused patients.

Conclusions

Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.

     

A comparative analysis of the role of Tranexamic acid as an independent variable in reducing intraoperative blood loss in patients undergoing conventional total knee arthroplasty versus computer-assisted total knee arthroplasty

Background

Blood loss in total knee arthroplasty (TKA) is an area of significant concern as it has an effect on patient morbidity and hospital stay. Among many different modalities to reduce blood loss, the use of Tranexamic acid has become a standard procedure nowadays. The aim of our study was to determine if Tranexamic acid alone decreases blood loss as an independent variable irrespective of other blood loss preserving measures.

Method

This prospective non-randomized study included patients undergoing unilateral TKA by conventional method (Group 1) and computer-assisted TKA (Group 2). All the patients in both groups received Tranexamic acid in a dose of 10 mg/kg body weight prior to inflation of tourniquet. Blood loss in both the groups was calculated using Nadler’s formula, and haemoglobin (Hb) level was calculated on day one and day three after surgery.

Results

The mean drop of Hb in Group 1 was 1.608 and 1.56 g/dl in Group 2 which was statistically significant (p < 0.001); however, none of the patients in either of the groups actually required any blood transfusion postoperatively. Although there was a significant drop in haemoglobin and haematocrit in both the groups, on comparison, there was no significant difference in blood loss and fall in Hb levels between the groups (p > 0.001).

Conclusion

Tranexamic acid decreases blood loss in patients undergoing TKA independent of all the other blood conserving procedures.

     

Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis

Purpose

The influence of allogenic blood transfusion on the postoperative outcomes of hepatocellular carcinoma (HCC) surgery remains controversial. This study aims to clarify the clinical impacts of perioperative allogenic blood transfusion on liver resection outcome in HCC patients.

Methods

We analyzed data collected over 5 years for 642 patients who underwent hepatectomy for HCC at one of the five university hospitals. We investigated the impact of allogenic blood transfusion on postoperative outcome after surgery in all patients and in 74 matched pairs, using a propensity score.

Results

Of the 642 patients, 198 (30.8%) received perioperative allogenic blood transfusion (AT group) and 444 (69.2%) did not (non-AT group). Overall survival was lower in the AT group than in the non-AT group in univariate (P < 0.001) and multivariate analyses (risk ratio 1.521, P = 0.011). After matching the different distributions using propensity scores, perioperative blood transfusion was found to be a poor prognostic factor for HCC patients.

Conclusions

In this multi-center study, perioperative blood transfusion was an independent factor for poor prognosis after curative surgery for primary HCC in the patient group and in pairs matched by propensity scores.

     

The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non-cardiac Surgery

Background

Patients with anemia frequently undergo surgery, as it is unclear at what threshold clinicians should consider delaying surgery for preoperative anemia optimization. The primary objective of this study was to determine whether there is an association of varying degrees of anemia and transfusion with 30-day mortality.

Methods

This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2013. Cohorts were analyzed based on preoperative hematocrit range—patients with: (1) no anemia, (2) hematocrit ≥33% and <36% in females or <39% in males, (3) hematocrit ≥30% and <33%, (4) hematocrit ≥27% and <30%, (5) hematocrit ≥24% and <27%, and (6) hematocrit ≥21% and less than 24%. Multivariable logistic regression was used to analyze the association of anemia and transfusion with 30-day in-hospital mortality.

Results

The odds for 30-day mortality increased incrementally as the hematocrit ranges decreased, in which preoperative hematocrit between 21 and 24% had the highest odds for this outcome (odds ratio [OR] 6.50, p < 0.0001) compared to the reference group (no anemia). The use of transfusion increased the odds of mortality even further (OR 5.57, p < 0.0001). Among patients that received an intra-/postoperative transfusion, preoperative anemia was not predictive of mortality.

Conclusions

Healthcare providers making preoperative clinical decisions for patients undergoing elective surgery should consider the degree of preoperative anemia and likelihood of perioperative transfusion.

     

The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients

Purpose

High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy.

Methods

Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP:PRBC ratio cut-offs (1:2 and 1:3) and adjusted mortality derived.

Results

Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP:PRBC ratios (45 % for ratio ≤1:8, 33 % for ratio >1:8 and ≤1:3, 27 % for ratio >1:3 and ≤1:2 and 25 % for ratio >1:2). Increasing FFP:PRBC ratio independently predicted survival (AOR [95 % CI]: 1.91 [1.35–2.71]; p < 0.001). Patients achieving a ratio >1:3 had improved survival (AOR [95 % CI]: 3.24 [1.24–8.47]; p = 0.016).

Conclusion

In non-trauma patients undergoing massive transfusion, increasing FFP:PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.

     

Clinical outcomes and nadir prostate-specific antigen (PSA) according to initial PSA levels in primary androgen deprivation therapy for metastatic prostate cancer

Purpose

To investigate the clinical outcomes of metastatic prostate cancer patients and the relationship between nadir prostate-specific antigen (PSA) levels and different types of primary androgen deprivation therapy (PADT). This study utilized data from the Japan Study Group of Prostate Cancer registry, which is a large, multicenter, population-based database.

Methods

A total of 2982 patients treated with PADT were enrolled. Kaplan–Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) in patients treated using combined androgen blockade (CAB) and non-CAB therapies. The relationships between nadir PSA levels and PADT type according to initial serum PSA levels were also investigated.

Results

Among the 2982 enrolled patients, 2101 (70.5 %) were treated with CAB. Although CAB-treated patients had worse clinical characteristics, their probability of PFS and OS was higher compared with those treated with a non-CAB therapy. These results were due to a survival benefit with CAB in patients with an initial PSA level of 500–1000 ng/mL. Nadir PSA levels were significantly lower in CAB patients than in non-CAB patients with comparable initial serum PSA levels.

Conclusions

A small survival benefit for CAB in metastatic prostate cancer was demonstrated in a Japanese large-scale prospective cohort study. The clinical significance of nadir PSA levels following PADT was evident, but the predictive impact of PSA nadir on OS was different between CAB and non-CAB therapy.

     

Relationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section

Purpose

During spinal anesthesia for cesarean section, cerebral oxygenation decreases may be related to an abrupt drop in cerebral blood flow due to hypotension. We measured the changes in maternal regional cerebral blood volume (rCBV) and oxygenation (rCBO) using near-infrared spectroscopy (NIRS) to evaluate whether a decrease in arterial blood pressure during spinal anesthesia diminishes rCBV and rCBO.

Methods

Forty patients scheduled for elective cesarean section under spinal anesthesia were monitored for mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and concentrations of oxy-hemoglobin (Hb), deoxy-Hb, total-Hb, and tissue oxygenation index (TOI), before spinal anesthesia (baseline) and for 20 min after intrathecal injection of bupivacaine. We investigated changes in the values from baseline and evaluated whether the maximum changes in total-Hb (Δ-total-Hb) and TOI (Δ-TOI) correlate with changes in MAP at the same time point.

Results

The mean oxy-Hb, total-Hb, TOI, and MAP significantly decreased from baseline after intrathecal injection of bupivacaine (P < 0.01). There were significant positive correlations between both Δ-total-Hb and Δ-TOI and the decrease in MAP (Δ-total-Hb: r = 0.53, P < 0.01; Δ-TOI: r = 0.59, P < 0.01).

Conclusions

Maternal rCBV and rCBO decrease significantly during spinal anesthesia for cesarean section. Reductions in rCBV and rCBO may be associated with the severity of hypotension induced by subarachnoid sympathetic block with bupivacaine.

     

Portion Control Eating—a Determinant of Bariatric Outcomes

Introduction

Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications.

Aims

To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients.

Methods

All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.

Results

Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99?±?5.6 kg/m² and % Excess weight loss (EWL) was 87.3?±?27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5?±?12.09 kg/m and % EWL was 94.32?±?33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study.

Conclusion

Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.

     

Tranexamic acid versus fibrin sealant in primary total hip replacement: a comparative study

Background

The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group.

Patients and methods

We prospectively studied 273 patients with primary hip osteoarthritis who underwent a THR between February 2012 and September 2013. The first 73 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray, and the last 100 patients received 1 g TA on induction.

Results

The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the three groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 and 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0 vs. 10%, p = 0.05). There was no significant difference between the groups with regard to proportion of patients with wound leaking problems.

Conclusion

Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.

     

Rationale and study design of a randomized controlled trial to assess the effects of maintaining hemoglobin levels using darbepoetin alfa on prevention of development of end-stage kidney disease in non-diabetic CKD patients (PREDICT Trial)

Background

Anemia associated with high mortality is a common complication of chronic kidney disease (CKD). Target hemoglobin (Hb) levels for CKD treatment remain controversial: Recent guidelines recommend a maximum of 13 g/dL to avoid increased risk of CVD. However, some smaller studies show slower progression of renal function loss with high Hb targets. Recently, darbepoetin alfa targeting Hb 11–13 g/dL was reported to improve renal composite outcome of Japanese patients compared with a low Hb group maintained at 9.0–11.0 g/dL using epoetin alfa (HR 0.66; 95 % CI 0.47–0.93). The high Hb group showed significant reduction of left ventricular mass index and improved quality of life. Sub-analysis revealed greater beneficial effects in non-diabetic stage 5 CKD patients. This randomized controlled trial, PREDICT, aims to confirm the impact of targeting Hb levels of 11–13 g/dL using darbepoetin alfa with reference to a low Hb target of 9–11 g/dL.

Methods

We calculated the number of subjects (N = 440) necessary to detect a statistically significant level of α = 0.05 (two-sided) and statistical power of 80 % for a minimum follow-up period of 2 years on the basis of a previous study.

Results

The study enrolled 498 non-diabetic Japanese patients with eGFR 8–20 mL/min/1.73 m². The primary outcome is a composite renal endpoint (starting chronic dialysis, transplantation, eGFR 6 mL/min/1.73 m² or less, 50 % decrease in eGFR). Average follow-up period is 2 years and the study ends in 2016.

Conclusion

PREDICT will determine the optimum target Hb for Japanese patients with non-diabetic CKD.(ClinicalTrials.gov No. NCT01581073).

     

Impact of preoperative hemoglobin and CRP levels on cancer-specific survival in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder: results of a single-center study

Purpose

Different blood parameters have shown to be associated with patient’s oncological outcome. There is only limited knowledge about the prognostic relevance of routine blood parameters in patients undergoing radical cystectomy for transitional cell carcinoma (TCC). Therefore, we retrospectively analyzed the influence of preoperative C-reactive protein (CRP) and hemoglobin (Hb) levels on overall survival (OS) and cancer-specific survival (CSS).

Materials and methods

Preoperative CRP and Hb levels were available in 664 patients who underwent RC due to TCC from 2004 to 2013 at our institution. More men than women (77 vs. 23 %) underwent surgery with a median age of 70 years (35–97). Median follow-up time was 24 months (max. 108). Outcome was analyzed using Kaplan–Meier method, log-rank test, and Cox regression models.

Results

Median CRP level was 0.5 mg/dl (0.1–28.3), and median Hb level was 13.4 g/dl (6.7–17.9). Patients with CRP value above the median died significantly earlier due to their disease than those with CRP below the median (median CSS 19 vs. 70 months; p < 0.001). Patients with preoperative Hb level below the median had significantly worse outcome than those with Hb level above the median (median CSS 25 vs. 78 months; p < 0.001). In multivariate analysis, CRP and Hb levels were independent prognostic parameters regarding CSS/OS (CRP p = 0.016/p = 0.004; Hb p = 0.006/p = 0.004, respectively).

Conclusions

In our single-center study, preoperative CRP and Hb levels were found to be independent prognostic factors, indicating impaired outcome in patients undergoing RC for TCC. These findings could be used for individual risk stratification and optimization of therapeutic strategies.

     

The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis

Purpose

Transfusion ratios approaching 1:1 FFP:PRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFP:PRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes.

Methods

This is a prospective, observational study of all trauma patients requiring a massive transfusion (≥10 PRBC in ≤24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFP:PRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality.

Results

The study population was predominantly male (89 %) with a mean age of 34.8 ± 16. On admission, 22 % had a systolic blood pressure ≤90 mmHg, 47 % had a heart rate ≥120, and 25 % had a GCS ≤8. The overall mortality was 33 %. The ratio of FFP:PRBC ≥ 1:1.5 was the second most important independent predictor of mortality for this population (R ² = 0.59). Survivors had a higher FFP:PRBC ratio at all times during the first 24 h of resuscitation.

Conclusions

Achieving a ratio of FFP:PRBC ≥ 1:1.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio <1:1.5.

     

Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia

Background

Hyperkalemia is prevalent in end-stage renal disease patients, being involved in life-threatening arrhythmias. Although polystyrene sulfonate (PS) is commonly used for the treatment of hyperkalemia, direct comparison of effects between calcium and sodium PS (CPS and SPS) on mineral and bone metabolism has not yet been studied.

Methods

In a randomized and crossover design, 20 pre-dialysis patients with hyperkalemia (>5 mmol/l) received either oral CPS or SPS therapy for 4 weeks.

Results

After 4-week treatments, there was no significant difference of changes in serum potassium (K) from the baseline (ΔK) between the two groups. However, SPS significantly decreased serum calcium (Ca) and magnesium (Mg) and increased intact parathyroid hormone (iPTH) values, whereas CPS reduced iPTH. ΔiPTH was inversely correlated with ΔCa and ΔMg (r = ?0.53 and r = ?0.50, respectively). Furthermore, sodium (Na) and atrial natriuretic peptide (ANP) levels were significantly elevated in patients with SPS, but not with CPS, whereas ΔNa and ΔANP were significantly correlated with each other in all the patients. We also found that ΔNa and Δ(Na to chloride ratio) were positively correlated with ΔHCO₃ ^?. In artificial colon fluid, CPS increased Ca and decreased Na. Furthermore, SPS greatly reduced K, Mg, and NH₃.

Conclusion

Compared with SPS, CPS may be safer for the treatment of hyperkalemia in pre-dialysis patients, because it did not induce hyperparathyroidism or volume overload.

     

Impact of hemoglobin levels on renal and non-renal clinical outcomes differs by chronic kidney disease stages: the Gonryo study

Background

Anemia greatly affects the development of renal and cardiovascular outcomes in chronic kidney disease (CKD) patients. However, the impact based on CKD stage remains unclear.

Methods

We prospectively followed 2,602 Japanese CKD patients under the care of nephrologists. CKD was defined according to cause, estimated glomerular filtration rate <60 mL/min, and/or proteinuria. Patient outcomes [primary end-points: cardiovascular events (CVEs), all-cause mortality, and end-stage kidney disease (ESKD) requiring renal replacement therapy] were assessed in association with basal hemoglobin (Hb) levels (<10, 10–12 and ≥12 g/dL), stratified by CKD stages.

Results

During follow-up, 123 patients developed CVEs, 41 died, and 220 progressed to ESKD. For stages G3, G4 and G5, ESKD frequencies were 2.8, 64.4, and 544.8 person-years, while CVEs and death were 25.6, 45.6, and 76.3 person-years, respectively. The combined endpoint rate was significantly higher in patients with Hb <10 versus Hb 10–12 g/dL, but a higher risk for CVEs and death with Hb <10 g/dL was found only in G3 [hazard ratio (HR) 4.49, (95 % confidence interval (95 % CI) 2.06–9.80)]. In contrast, risk for ESKD with Hb <10 g/dL was found only in G4 [HR 3.08 (95 % CI 1.40–6.79)] and G5 [HR 1.43 (95 % CI 1.01–2.05)]. No increased risks with higher Hb levels were found.

Conclusion

The impact of renal anemia of Hb <10 g/dL on clinical outcomes differed by CKD stage, with a significantly high risk for CVEs and all-cause mortality in G3 and progression to ESKD in G4 and G5.

     

Oncologic control provided by HIFU therapy as single treatment in men with clinically localized prostate cancer

Objective

To assess the long term oncologic results of high-intensity focused ultrasound therapy (HIFU) as a primary and single treatment for clinically localized prostate cancer.

Methods

A total of 119 patients with clinically localized prostate cancer underwent HIFU (Ablatherm^®, EDAP, France) as first-line treatment and were retrospectively reviewed. They were stratified according to risk groups proposed by D’Amico. No patient had undergone previous hormonal therapy. PSA level was monitored at 3, 6, 12, 18, 24 months and then yearly. According to the latest ASTRO criteria, failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. The biochemical-free survival rate (BFSR) was calculated.

Results

Mean patient age was 68 ± 7.8 years (46–83). Mean follow-up was 3.9 years (1–6.8). Overall 52 patients (43.7%) experienced a biochemical recurrence which included 26, 23 and 3 patients in the low, intermediate and high-risk groups, respectively. In univariate and multivariate analyses, there was a statistical association between preoperative PSA value > 10, a nadir PSA value > 1 and the risk of biochemical recurrence (P < 0.05). The 5-year BFSR rate was 30% with no statistical difference between low- and intermediate-risk patients. None of the 119 patients died of prostate cancer.

Conclusion

High-intensity focused ultrasound therapy provides efficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.

     

Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study

Purpose

Aspirin may prevent organ dysfunction in critically ill patients and mitigate transfusion associated acute lung injury. We hypothesized that aspirin use might be associated with decreased morbidity and mortality in massively transfused cardiac surgery patients.

Methods

A single center retrospective cohort study was performed using data from an 8.5-year period (2006–2014). Massive transfusion was defined as receiving at least 2400 ml (8 units) of red blood cell units intraoperatively. A propensity score model was created to account for the likelihood of receiving aspirin and matched pairs were identified using global optimal matching. The primary endpoint, in-hospital mortality, was compared between aspirin users and non-users. Secondary outcomes including: ICU hours, mechanical lung ventilation hours, prolonged mechanical lung ventilation (>24 h), pneumonia, stroke, acute renal failure, atrial fibrillation, deep sternal wound infection, and multiple organ dysfunction syndrome were also compared.

Results

Of 7492 cardiac surgery patients, 452 (6 %) were massively transfused and mortality was 30.6 %. There were 346 patients included in the matched cohort. No significant association was found between preoperative aspirin use and in-hospital mortality; absolute risk reduction with aspirin = 7.5 % (95 % CI ?2.0 to 16.9 %, p = 0.12). Preoperative aspirin use was associated with fewer total mechanical lung ventilation hours (p = 0.02) and less prolonged mechanical lung ventilation; absolute risk reduction = 11.0 % (95 % CI 1.1–20.5 %, p = 0.02).

Conclusions

Preoperative aspirin use is not associated with decreased in-hospital mortality in massively transfused cardiac surgery patients, but may be associated with less mechanical lung ventilation time.