Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Quản lý máu bệnh nhân tốt hơn và tiết kiệm chi phí trong phẫu thuật thay khớp háng nhờ thực hiện bổ sung sắt Sucrosomial® trước phẫu thuật: một nghiên cứu đánh giá cải tiến chất lượng
International Orthopaedics - 2018
Tóm tắt
So sánh quá trình hồi phục sau phẫu thuật của bệnh nhân phẫu thuật khớp háng giả có hoặc không áp dụng bổ sung sắt với một chế phẩm sắt uống mới có khả năng hấp thu cao. Nghiên cứu đánh giá cải tiến chất lượng hồi cứu quan sát được thực hiện trên những bệnh nhân đã trải qua phẫu thuật khớp háng giả theo kế hoạch (cấy ghép đầu tiên) với ferritin < 100 mcg/dl và giá trị Hb từ 13 đến 14 g/dl đối với nam và từ 12 g/dl đến 13.5 g/dl đối với nữ, hoặc có mức ferritin > 100 mcg/dl nhưng protein C-reactive (CRP) > 3 mg/l và độ bão hòa transferrin (TSAT) < 20%, mà cùng nhau gợi ý cho tình trạng thiếu sắt chức năng. Phân tích so sánh một nhóm bệnh nhân không thiếu máu có mức ferritin > 100 mcg/l với hai nhóm bệnh nhân thiếu sắt, trong đó chỉ có một nhóm nhận được bổ sung sắt. Các chỉ số đo lường bao gồm mức hemoglobin, thời gian nằm viện và số bệnh nhân truyền máu/đơn vị máu. Bệnh nhân thiếu sắt được bổ sung Sideral® Forte so với những bệnh nhân không được bổ sung cho thấy giảm thiểu sự suy giảm Hb sau phẫu thuật (9.7 ± 1.24 g/dl so với 8.4 ± 0.6 g/dl), cần thời gian nằm viện ngắn hơn (4 so với 6.5 ngày) và ít truyền máu (0 ở nhóm bổ sung sắt so với 7 đơn vị ở nhóm không bổ sung sắt), đem lại tổng tiết kiệm là 1763.25 €/bệnh nhân. Bổ sung sắt sucrosomial trước phẫu thuật ít nhất 4 tuần cho bệnh nhân không thiếu máu giúp hạn chế sự giảm sút mức Hb sau phẫu thuật, dẫn đến mức hemoglobin hậu phẫu cao hơn, hồi phục sau phẫu thuật nhanh hơn, thời gian nhập viện ngắn hơn và giảm chi phí liên quan đến phẫu thuật.
Từ khóa
#bổ sung sắt #phẫu thuật khớp háng #quản lý máu bệnh nhân #tiết kiệm chi phí #hemoglobinTài liệu tham khảo
Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A et al (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378:1396–1407. https://doi.org/10.1016/S0140-6736(11)61381-0
Cuenca J, Garcia-Erce JA, Martinez F, Cardona R, Perez-Serrano L, Munoz M (2007) Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement. Inter J Surg 5:89–94. https://doi.org/10.1016/j.ijsu.2006.02.003
Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J et al (2004) The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Ortho Traum 18:369–374
Lasocki S, Krauspe R, von Heymann C, Mezzacasa A, Chainey S, Spahn D (2015) PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. EJA 32:160–167. https://doi.org/10.1097/EJA.0000000000000202
Munoz M, Gomez-Ramirez S, Kozek-Langeneker S (2016) Pre-operative haematological assessment in patients scheduled for major surgery. Anaesthesia 71(Suppl 1):19–28. https://doi.org/10.1111/anae.13304
Spahn DR (2010) Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology 113:482–495. https://doi.org/10.1097/ALN.0b013e3181e08e97
Barni S (2015) 3rd Mediterranean Multidisciplinary Course on Iron Anemia April, 17(th)-18(th) 2015, Rome, Italy. Expert Rev Hematol 8(Suppl 1):S1–S32 doi.org/10.1586/17474086.2015.1044965
Munoz M, Gomez-Ramirez S, Campos A, Ruiz J, Liumbruno G (2015) Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus 13:370–379. https://doi.org/10.2450/2015.0014-15
Vanderlinde ES, Heal JM, Blumberg N (2002) Autologous transfusion. Br Med J (Clin Res Ed) 324:772–775
Kendoff D, Tomeczkowski J, Fritze J, Gombotz H, von Heymann C (2011) Präoperative Anämie in der Orthopädie [Preoperative anemia in orthopedic surgery: clinical impact, diagnostics and treatment]. Der Orthopade 40:1018–1028 [article in German]
Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R (2017) Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. Int Orthop 41(7):1347–1353. https://doi.org/10.1007/s00264-016-3365-2
Villatte G, Engels E, Erivan R, Mulliez A, Caumon N, Boisgard S, Descamps S (2016) Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study. Int Orthop 40(11):2255–2260
Reina N, Fennema P, Hourlier H (2017) The impact of mild peri-operative hypothermia on the effectiveness of tranexamic acid in total hip arthroplasty. Int Orthop 41(1):55–60. https://doi.org/10.1007/s00264-016-3170-y
Sucher MG, Giordani M, Figoni A, Nedopil AJ (2016) Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid. Int Orthop 40(10):2019–2023
Falez F, Meo A, Panegrossi G, Favetti F, La Cava F, Casella F (2013) Blood loss reduction in cementless total hip replacement with fibrin spray or bipolar sealer: a randomised controlled trial on ninety five patients. Int Orthop 37(7):1213–1217. https://doi.org/10.1007/s00264-013-1903-8
Andrews CM, Lane DW, Bradley JG (1997) Iron pre-load for major joint replacement. Transfus Med 7:281–286
Lidder PG, Sanders G, Whitehead E, Douie W, Mellor N, Lewis S, Hosie K (2007) Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Ann R Coll Surg Engl 89:418–421. https://doi.org/10.1308/003588407X183364
Liumbruno GM, Vaglio S, Grazzini G et al (2015) Patient blood management: a fresh look at a fresh approach to blood transfusion. Minerva Anestesiol 81:1127–1137. https://doi.org/10.2450/2015.0171-15
Meybohm P, Herrmann E, Steinbicker AU et al (2016) Patient blood management is associated with a substantial reduction of red blood cell utilization and safe for patient’s outcome: a prospective, multicenter cohort study with a noninferiority design. Ann Surg 264:203–211. https://doi.org/10.1097/SLA.0000000000001747
WHO (2011) WHO Global Forum for Blood Safety: patient blood management. http://www.who.int/bloodsafety/events/gfbs_01_pbm/en/ [Last accessed 30.04.17]
Theusinger OM, Felix C, Spahn DR (2012) Strategies to reduce the use of blood products: a European perspective. Curr Opin Anaesthesiol 25:59–65. https://doi.org/10.1097/ACO.0b013e32834dec98
Brilli E, Romano A, Fabiano A, Zambito Y, Di Raimondo F, Tarantino G (2016) Sucrosomial® technology is able to promote ferric iron absorption: pre-clinical and clinical evidences. Blood J 128:3618
Giordano G, Mondello P, Tambaro R et al (2015) Biosimilar epoetin α is as effective as originator epoetin-α plus liposomal iron (Sideral®), vitamin B12 and folates in patients with refractory anemia: a retrospective real-life approach. Mol Clin Oncol 3:781–784. https://doi.org/10.3892/mco.2015.555
Locatelli F, Mazzaferro S, Yee J (2016) Iron therapy challenges for the treatment of nondialysis CKD patients. CJASN 11:1969–1980. https://doi.org/10.2215/CJN.00080116
Pisani A, Riccio E, Sabbatini M, Mi A, Del Rio A, Visciano B (2015) Effect of oral liposomal iron versus intravenous iron for treatment of iron deficiency anaemia in CKD patients: a randomized trial. Nephrol Dial Transplant 30:645–652. https://doi.org/10.1093/ndt/gfu357
Tarantino G, Brilli E, Zambito Y et al (2015) Sucrosomial Iron®: a new highly bioavaible oral iron supplement. Blood 126:4561
Macdougall IC (2011) Iron supplementation in nephrology and oncology: what do we have in common? Oncologist 16(Suppl 3):25–34. https://doi.org/10.1634/theoncologist.2011-S3-25
Confalonieri N, Manzotti A, Montironi F, Pullen C (2008) Tissue sparing surgery in knee reconstruction: unicompartmental (UKA), patellofemoral (PFA), UKA + PFA, bi-unicompartmental (bi-UKA) arthroplasties. J Orthop 9:171–177. https://doi.org/10.1007/s10195-008-0015-5
Pogliacomi F, De Filippo M, Paraskevopoulos A, Alesci M, Marenghi P, Ceccarelli F (2012) Mini-incision direct lateral approach versus anterior mini-invasive approach in total hip replacement: results 1 year after surgery. Acta Biomed: Atenei Parmensis 83:114–121
Repantis T, Bouras T, Korovessis P (2015) Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial. Eur J Orthop Surg Traumatol 25:111–116. https://doi.org/10.1007/s00590-014-1428-x
Scardino M, Martorelli F, Grappiolo G (2015) Evicel and bloodless protocol in orthopaedics surgery clinical evidence and cost-analysis: Italian Experience Humanitas Research Hospital. Value Health 18:A664. https://doi.org/10.1016/j.jval.2015.09.2417
Chow SC, Shao J, Wang H (2008) Sample size calculations in clinical research, 2nd edn. Dekker, New York. https://doi.org/10.1111/j.1541-0420.2008.01138_10.x
Foss NB, Kristensen MT, Kehlet H (2008) Anaemia impedes functional mobility after hip fracture surgery. Age Ageing 37:173–178. https://doi.org/10.1093/ageing/afm161
Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL (2003) Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 43:1717–1722
Madjdpour C, Heindl V, Spahn DR (2006) Risks, benefits, alternatives and indications of allogenic blood transfusions. Minerva Anestesiol 72:283–298. https://doi.org/10.1093/bja/aeh290
Giordano G (2016) High dose sucrosomial iron is safe and represent a valid alternative for a quick restore of hemoglobin levels. Multicentric randomized trial. EHA, Copenhagen
Mafodda A, Giuffrida D, Prestifilippo A, Azzarello D, Del Medico P, Mare M, Maisano R (2014) Randomized phase II trial of supplementation with oral liposomal iron versus intravenous iron in patients with chemotherapy-related anemia without Iron deficiency treated with darbepoetin alfa. Poster presented at the XVI annual conference of the Associazione Italiana Oncologia Medica (AIOM); Oct 24-26, Rome
Garrido-Martin P, Nassar-Mansur MI, de la Llana-Ducros R et al (2012) The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Interact Cardiovasc Thorac Surg 15:1013–1018. https://doi.org/10.1093/icvts/ivs344
ISS. Registro Italiano ArtroProtesi (RIAP) 2016 [last accessed April 7, 2017]; Available from: http://www.iss.it/riap/
Guerra R, Velati C, Liumbruno GM, Grazzini G (2016) Patient blood management in Italy. Blood Transfus 14:1–2. https://doi.org/10.2450/2015.0171-15
Jimenez-Garcia R, Villanueva-Martinez M, Fernandez-de-Las-Penas C et al (2011) Trends in primary total hip arthroplasty in Spain from 2001 to 2008: evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 12:43. https://doi.org/10.1186/1471-2474-12-43
Leahy M, Hofmann A, Towler S, Trentino K, Burrows S, Swain S et al (2017) Improved outcomes and reduced costs associated with a health-system–wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 57:1347–1358. https://doi.org/10.1111/trf.14006