Intraoperativna autotransfuzija pri elektivnoj otvorenoj rekonstrukciji abdominalne aorte kao pokazatelj kvalitete transfuzijskog liječenja

master's thesis

• Title (english): Intraoperative autologous transfusion during elective open abdominal aortic reconstruction as quality indicator of bloodtransfusion practices
• Author: Dalibor Zovko
• Mentor: Branka Golubić Ćepulić (mentor)
• Committee member: Bojan Biočina
• Committee member: Goran Tešović
• Committee member: Branka Golubić Ćepulić
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2015-08-27, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Cilj istraživanja: Svrha ovog rada je ocijeniti uspješnost intraoperativne autologne transfuzije pri elektivnoj otvorenoj rekonstrukciji abdominalne aorte u dvije skupine bolesnika; s aneurizmatskom bolesti aorte (AAA) i s aorto-ilijačnom okluzivnom bolesti (AOD).
Ispitanici i metode rada: Retrospektivnom studijom obuhvaćeno je 286 pacijenata, operiranih u Magdaleni – klinici za kardiovaskularne bolesti, podijeljenih u dvije skupine: 204 bolesnika u skupini s AAA i skupina od 82 pacijenta s AOD. U svih pacijenata rutinski je korišten uređaj za IAT Medtronic AutoLog System prema standardiziranom postupku koji se primjenjuje u Klinici Magdalena. Isključujući kriteriji bili su: hitni operativni zahvati (disekcija ili ruptura aorte) i smrtni ishod, zbog njihovog pretpostavljenog utjecaja na promatrane perioperativne parametre. Podaci o količini transfundirane autologne krvi kao i homolognih krvnih pripravaka prikupljeni su iz medicinske dokumentacije. U studiji su također uspoređene vrijednosti preoperativnog komorbiditeta i procijene općeg stanja bolesnika prema ASA klasifikaciji; hematokrita i hemoglobina u četiri točke perioperativnog tijeka; pojavnost postoperativnih komplikacija te dužina boravka pacijenata u JIL-u i u bolnici. Zbog odmaka od normalne distribucije u analizi su primijenjeni neparametrijski analitički postupci (Yates i Pearson X2 test i Mann-Whitney U test).
Rezultati: U studiji nalazimo statistički značajnu međugrupnu razliku u količini intraoperativnog gubitka volumena eritrocita s očekivanim višim vrijednostima u skupini bolesnika s AAA (Mann- Whitney U test; P < 0,001). Veći perioperativni gubitak eritrocita u ovih bolesnika praćen je i statistički značajno većom nadoknadom eritrocita autologne krvi u ovoj skupini (Mann-Whitney U test; P < 0,001) za razliku od nadoknade transfundiranih koncentrata eritrocita homologne krvi gdje statistički značajna međugrupna razlika nije utvrđena (Mann-Whitney U test; P = 0,46). Usporedbom dužine boravka u JIL-u i bolnici te postoperativnih komplikacija ne nalazimo statistički značajnih razlika među uspoređivanim skupinama.
Zaključak: Analiza pokazuje da je IAT sigurna i učinkovita metoda koja smanjuje upotrebu homologne transfuzije, osobito u bolesnika s AAA. Primjena ''Stand by'' modaliteta preporuča se za sve bolesnike s elektivnom otvorenom rekonstrukcijom aorte.

Abstract (english)

Aim: The aim of the research is to evaluate the efficiency of intraoperative autologous transfusion in elective open abdominal aortic repairbetween the two patient groups – abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AOD) group.
Patients and Methods: This retrospective study involved 286 patients treated in the Magdalena - Clinic for cardiovascular disease. According to the clinical diagnosis patients were devided intotwo groups – 204 patients in one group (AAA) and 82 patients in second group (AOD). In all patients we routinely used Medtronic AutoLog System, intraoperative autotransfusion device, according to a standardized proceduresapplicable in Magdalena Clinic. Excluding criteria were:
emergency surgery (dissection or rupture of the abdominal aorta) and mortality, due to their perceived impact on the observed perioperative parameters. Data on the amount of transfused autologous blood and homologous blood products were collected from the official Magdalena Clinic databases. The study also compared the value of preoperative comorbidities and physical status (ASA classification); hematocrit and hemoglobin values in four points of perioperative
period; the incidence of postoperative complications and length of stay of patients in the ICU and in the hospital. The data were analyzed using descriptive statistics and statistical methodes which included Yates and Pearson 2 test and Mann-Whitney U test.
Results: The study found statistically significant differences between groups in the total amount of intraoperative loss of RBC volume with the expected higher values in AAA patients gruop (Mann-Whitney U test, P < 0.001). The higher perioperative loss of RBC volume in these patients was accompanied by significantly higher autologous RBC volumetransfused in this group (Mann-Whitney U test, P < 0.001). Statistically significant difference between groupsin
homologous RBC transfusion was not found (Mann Whitney U-test; P = 0.46). By comparing postoperative complications and the length of stay in ICU and in hospital we do not find statistically significant differences among compared groups.
Conclusion: The analysis showed that IAT appears to be safe and useful strategy to minimase use of homologous blood transfusion especially in elective AAA repairs. We suggest that IAT device should be set on stand by in all elective open abdominal aortic repair procedures.

• Keywords: intraoperativna autotransfuzija; cell saver; patient blood management; aneurizma aortalne aorte; aorto-ilijacna okluzivna bolest.
• Keywords (english): intraoperative autotransfusion; cell saver; patient blood management; abdominal aortic aneurysm; aortoiliac occlusive deisease.
• Language: croatian
• URN:NBN: urn:nbn:hr:105:272728
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-04-25 12:04:11