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- 저자 : Gwo-Chin Lee (검색결과 2 건)
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Saline-Coupled Bipolar Sealing in Simultaneous Bilateral Total Knee Arthroplasty
Atul F. Kamath,Daniel C. Austin,Peter B. Derman,R. Carter Clement,Jonathan P. Garino,Gwo-Chin Lee 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3
Background: The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported. Methods: This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin. Variables of interest included blood loss, transfusion requirements, and operative characteristics. Results: In comparison to patients treated with conventional electrocautery, those treated with the bipolar sealer were 35% less likely to require transfusion. The median number of transfusions per case was also significantly lower in the experimental group. Hemoglobin change, total blood loss, and length of stay were not significantly different between the groups. The experimental group had longer operative times. Conclusions: Bipolar sealing shows promise as a blood loss reduction tool in simultaneous bilateral TKA. The marginal savings attributed to reduced transfusion rates with use of the bipolar sealer did not exceed the additional per-case expense of using the device. The decision to use the device with the goal of less blood loss must come with the additional expense associated with its use.
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Atul F. Kamath,Daniel C. Austin,Peter B. Derman,R. Carter Clement,Jonathan P. Garino,Gwo-Chin Lee 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.1
We thank the readers for their letter to the editor, and for interest in our manuscript published in 2014. Issues surrounding blood management continue to be an important part of the global care of total joint arthroplasty patients as we move into 2017. In addition to our group’s multiple studies on the use of bipolar sealing devices in joint arthroplasty, 1,2) we continue to examine our blood management and transfusion practices. We now routinely employ the use of tranexamic acid, which has further allowed a reduction in transfusion requirements. This may account for some of the differences between contemporary rates of transfusion, and historical rates presented before the routine use of tranexamic acid. We thank the readers for inquiring about the transfusion reduction rates as presented in our manuscript. The absolute reduction in transfusion rate was 83% to 55%, a difference of 28% points. The relative reduction as a percentage of the original transfusion rate of 83% would be approximately 35%. In a simpler comparison, for example, if the transfusion rate was reduced from 10% to 5%, we would have stated that there was an absolute reduction of 5% but a 50% reduction from the baseline rate (5%/10% = 0.5). In our manuscript, we acknowledge some of the limitations discussed by the readers’ letter to the editor. This study was not a prospective randomized controlled trial, and therefore issues of blinding and randomization do not apply. Rather, our study has important applications for real-world transfusion scenarios based on clinical scenario and patient comorbid conditions. We thank the readers for sharing their own data and algorithm for management, which, like our practice, involves careful evaluation of “comorbidity and cardiorespiratory risk, ongoing blood loss, and symptoms related to anaemia.” Likewise, confounders of age and dilutional anaemia are important considerations in any study of blood management, but are not controlled for in our clinical practice review. Again, we thank the readers for their letter to the editor, as well as their own institutional efforts to examine transfusion thresholds, understand adjunctive tools in blood management, and further the perioperative care of total joint patients.
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