Background: Total joint arthroplasty (TJA) is a very successful orthopedics procedure but associates with a significantly high transfusion rate.
Objective: In this study, we aimed to determine predictors of postoperative blood transfusion in patients undergoing elective hip and knee TJA patients and compare the accuracy of machine learning (ML) algorithms in predicting transfusion risk.
Methods: We utilized data from 12,642 patients undergoing primary unilateral TJA. Risk factors and demographic information were extracted, and predictive models were developed using seven ML algorithms. The area under the receiver operating characteristic curve was used to measure the predictive accuracy of each algorithm.
Results: The overall transfusion rate was 18.7%. Patient-related risk factors for transfusion included age 65-85 (Odds Ratio (OR): 1.175-1.222), female (OR: 1.246), American Society of Anesthesiologists grade Ⅱ or greater (OR: 1.264-2.758). Surgical factors included operation time (OR: 1.736), drain use (OR: 2.202) as well as intraoperative blood loss (OR: 7.895). Elevated preoperative Hb (OR: 0.615), Hct (OR: 0.800), BMI (≥24 kg/m) (OR: 0.613-0.731) and tranexamic acid use (OR: 0.375) were associated with decreased risk of postoperative transfusion. The long short-term memory networks (LSTM) and random forest (RF) models achieved the highest predictive accuracy (p < 0.001).
Conclusion: The risk factors identified in the current study can provide specific, personalized postoperative transfusion risk assessment for a patient considering lower limb TJA. Furthermore, the predictive accuracies of LSTM and RF algorithms were significantly higher than the others, making them potential tools for future personalized preoperative prediction of risk for postoperative transfusion.
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http://dx.doi.org/10.1016/j.ijsu.2021.106183 | DOI Listing |
Ultrasound Obstet Gynecol
January 2025
Division of Fetal Medicine, Department of Obstetrics and Gynecology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Objective: To determine consensus, using Delphi methodology, on the critical procedural steps for intravascular intrauterine transfusion (IUT) for the treatment of fetal anemia.
Methods: We conducted a two-part Delphi survey of international experts in fetal intervention. The first round of the survey proposed 32 potentially critical steps for the IUT procedure.
Neurosurg Focus
January 2025
1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran.
Objective: This study reports the authors' experience with surgical interventions for nonsyndromic craniosynostosis. They assessed open surgery and minimally invasive endoscopic suturectomy in terms of periprocedural outcomes and related risk factors for postoperative complications and reoperation. This study aimed to provide insights toward surgical approach decisions and lay the groundwork for future prospective studies in this field.
View Article and Find Full Text PDFIntroduction: Hereditary bleeding disorders stem from the absence or insufficient levels of particular clotting proteins, essential for facilitating coagulation in the clotting cascade. Among the most prevalent are hemophilia A (deficiency of Factor VIII), hemophilia B (deficiency of Factor IX), and von Willebrand disease. Management of pharmacoresistant epilepsy is more difficult in a patient with bleeding disorder due to increased risk of bleeding during surgery.
View Article and Find Full Text PDFDiscov Oncol
December 2024
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Introduction: Although giant cystic pheochromocytoma and paraganglioma (PPGL) are uncommon, they can be life-threatening when it occurs. Unfortunately, prior case reports have shown that giant cystic PPGLs are highly susceptible to diagnostic errors. Therefore, this study aimed to explore giant cystic PPGLs by comparing them with non-cystic PPGLs, defining the clinical features of the affected patients, and analyzing the characteristics of misdiagnosis and mistreatment associated with PPGLs.
View Article and Find Full Text PDFArch Orthop Trauma Surg
December 2024
Duke University Health System, Durham, USA.
Background: Jehovah's Witness patients refuse blood transfusion because of their religious beliefs making total hip arthroplasty (THA) challenging. This study aims to determine the safety of THA in Jehovah's Witness patients using standard perioperative protocols as well as evaluate the effectiveness of tranexamic acid (TXA) in controlling blood loss.
Methods: Databases from two tertiary academic centers were queried from 2003 to 2021 to identify THA patients.
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