Rezultātu salīdzinājums pacientiem ar drenāžu un bez drenāžas pēc totālas gūžas endoprotezēšanas
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Osteoartrīta pacientu aprūpes optimizēšana ir vērsta uz progresu un jaunu ārstēšanas standartu attīstību, piemēram, minimāli invazīvām operācijām, kā arī pirms un pēcoperācijas aprūpes un rehabilitācijas programmām. Ķirurgi cenšas palielināt pacientu komfortu, kā arī pašu procedūru efektivitāti. To var paveikt samazinot pēcoperācijas uzturēšanos laiku slimnīcās, pārlieto asins daudzumu un uzlabojot pacienta vispārējo labsajūtu. Slēgtās atsūkšanas drenāžas sistēma jau ilgu laiku tiek izmantota visās ķirurģijas jomās, lai nodrošinātu optimālu brūču sadzīšanu, samazinātu hematomu veidošanos, kā arī sāpes. Tomēr drenāža var kalpot par iemeslu palielinātam postoperatīvam asins zudumam un ir viens no potenciāliem baktēriju retrogrādās migrācijas ceļiem, tādējādi palielinot operācijas brūces infekciju risku. Mēs izvirzījām savu hipotēzi: “Pilna gūžas atroplastika, kas tiek veikta, neizmantojot slēgtas atsūkšanas drenāžas sistēmu, ir droša un samazina perioperatīvo asins zudumu, pārlieto asins daudzumu un hospitalizācijas ilgumu”.
Metodes: Šī pētījuma dizains ir prospektīva gadījumu kontrole. Kopumā piedalījās 67 dalībnieki (34 bez un 33 ar drenāzas sistēmas). Pacientu dati kā vecums, dzimums, augums un svars, blakus-slimības, pulss, kā arī asinsspiediens un ķirurģiski saistīti parametri – perioperatīvs Hb līmenis, operācijas indikācija, perioperatīvs asins zudums, implanta tips, transfūzijas vienību skaits, nozīmīgu hematomu klātbūtne un citu post-operatīvu komplikāciju novērošana, kā arī hospitalizācijas ilgums, tika savākti un analizēti ar statistikas metodēm. Statistiski nozīmīgu atšķirību līmenis tika noteikts kā p < 0,05. Lai kontrolētu asiņošanu 1g TXA i.v. tika ievadīts intra-operatīvi, trombozes un trombemboliju profilakse tika veikta, administrējot 10mg Xarelto p.o. vienu reizi dienā 28 dienu periodā.
Rezultāti: pacientu grupai, kurai netika lietota drenāža , tika novērots mazāks Hb līmeņa kritums (1,8 g/dl- ar terapiju; 2,93 g/dl- kontrole; p= 0,002), mazāks perioperatīvs asins zudums (361,74 ml- ar terapiju; 992,42 ml- kontrole; p=0,01), mazāks asins komponentu transfūziju skaits (161,67 ml- ar terapiju; 553,06 ml- kontrole; p= 0,000001) un īsāks hospitalizācijas laiks (8,59 dienas- ar terapiju; 12,06 dienas- kontrole; p= 0,0004). Tādas komplikācijas kā hematoma vai brūces infekcijas terapijas grupā neparādījās, vienam pacientam kontroles grupā tika novērota klīniski nozīmīga hematoma.
Secinājumi: Pētījumā izdevās apstiprināt hipotēzi un pierādīt, ka totāla gūžas locītavas artroplastija operācija bez slēgtas atsūkšanas drenāžas sistēmas pielietošanas ir droša, neatkarīgi no ar pacientu saistītiem perioperatīviem faktoriem.
Background: Optimizing the care of osteoarthritis patients is directed towards the progress and development of new standards in treatment such as minimally invasive surgeries, as well as pre- and postoperative care and rehabilitation programs. Surgeons are trying to increase patients comfort as well as the efficiency of the procedure itself, by means of postoperative days of hospital stay, amount of blood transfused and overall wellbeing and acceptance of the patients. The use of a closed suction drainage has been historically used for long time in all fields of surgery in order to provide an optimal wound healing, reduce hematoma formation as well as pain. However, drains may act as a port for increased postoperative blood loss and in addition to that as a potential route of retrograde migration for bacteria into the operation field and thereby increase the risk of a surgical site infections. We set our hypothesis: “THA performed without using a CSD-system is safe and reduces perioperative blood loss, transfusion rates and duration of hospitalization”. Methods: The study is designed as a retrospective case- control study. A total number of 67 participants was assigned (34 without and 33 with a drainage system). Several patient related data such as patients age, sex, height and weight, comorbidities and pulse as well as blood pressure, but also surgery related data such as perioperative hemoglobin levels, reason for the THA, perioperative blood loss, type of implant, amount of blood products transfused and the development of a significant hematoma and other complications and duration of hospitalization were collected and statistically analysed. The statistically significant difference level was set for p< 0,05. For bleeding control 1g TXA i.v. was administered intraoperatively, thrombosis and embolism prophylaxis was realized by 10mg Xarelto p.o. once a day over a period of 28 days. Results: Patients of the treatment group, not receiving a CSD- system, overall showed a lower drop of hemoglobin levels (1,8 g/dl- treatment; 2,93 g/dl- control; p= 0,002), a decreased perioperative blood loss (361,74 ml- treatment; 992,42 ml- control; p=0,01), a lower blood product transfusion rate (161,67 ml- treatment; 553,06 ml- control; p= 0,000001) and shorter duration of hospitalization (8,59 days- treatment; 12,06 days- control; p= 0,0004). No complications regarding hematoma formation or wound infections raised in the treatment group, however one patient of the control group developed a clinically significant hematoma. Conclusion: We were able to retain our hypothesis and prove that THAs performed without a drainage are safe, independent from patient-related and perioperative factors
Background: Optimizing the care of osteoarthritis patients is directed towards the progress and development of new standards in treatment such as minimally invasive surgeries, as well as pre- and postoperative care and rehabilitation programs. Surgeons are trying to increase patients comfort as well as the efficiency of the procedure itself, by means of postoperative days of hospital stay, amount of blood transfused and overall wellbeing and acceptance of the patients. The use of a closed suction drainage has been historically used for long time in all fields of surgery in order to provide an optimal wound healing, reduce hematoma formation as well as pain. However, drains may act as a port for increased postoperative blood loss and in addition to that as a potential route of retrograde migration for bacteria into the operation field and thereby increase the risk of a surgical site infections. We set our hypothesis: “THA performed without using a CSD-system is safe and reduces perioperative blood loss, transfusion rates and duration of hospitalization”. Methods: The study is designed as a retrospective case- control study. A total number of 67 participants was assigned (34 without and 33 with a drainage system). Several patient related data such as patients age, sex, height and weight, comorbidities and pulse as well as blood pressure, but also surgery related data such as perioperative hemoglobin levels, reason for the THA, perioperative blood loss, type of implant, amount of blood products transfused and the development of a significant hematoma and other complications and duration of hospitalization were collected and statistically analysed. The statistically significant difference level was set for p< 0,05. For bleeding control 1g TXA i.v. was administered intraoperatively, thrombosis and embolism prophylaxis was realized by 10mg Xarelto p.o. once a day over a period of 28 days. Results: Patients of the treatment group, not receiving a CSD- system, overall showed a lower drop of hemoglobin levels (1,8 g/dl- treatment; 2,93 g/dl- control; p= 0,002), a decreased perioperative blood loss (361,74 ml- treatment; 992,42 ml- control; p=0,01), a lower blood product transfusion rate (161,67 ml- treatment; 553,06 ml- control; p= 0,000001) and shorter duration of hospitalization (8,59 days- treatment; 12,06 days- control; p= 0,0004). No complications regarding hematoma formation or wound infections raised in the treatment group, however one patient of the control group developed a clinically significant hematoma. Conclusion: We were able to retain our hypothesis and prove that THAs performed without a drainage are safe, independent from patient-related and perioperative factors
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Rezultātu salīdzinājums pacientiem ar drenāžu un bez drenāžas pēc totālas gūžas endoprotezēšanas, Closed suction drainage versus no drainage in total hip arthroplasty