Risk of Sharp Device–Related Blood and Body Fluid Exposure in Operating Rooms

2008 ◽  
Vol 29 (12) ◽  
pp. 1139-1148 ◽  
Author(s):  
Douglas J. Myers ◽  
Carol Epling ◽  
John Dement ◽  
Debra Hunt
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Body Fluid ◽  
Operating Rooms ◽  
University Hospital ◽  
Operating Room Personnel ◽  
Surgical Equipment ◽  
Glove Perforation ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Objective.The risk of percutaneous blood and body fluid (BBF) exposures in operating rooms was analyzed with regard to various properties of surgical procedures.Design.Retrospective cohort study.Setting.A single university hospital.Methods.All surgical procedures performed during the period 2001–2002 (n = 60,583) were included in the analysis. Administrative data were linked to allow examination of 389 BBF exposures. Stratified exposure rates were calculated; Poisson regression was used to analyze risk factors. Risk of percutaneous BBF exposure was examined separately for events involving suture needles and events involving other device types.Results.Operating room personnel reported 6.4 BBF exposures per 1,000 surgical procedures (2.6 exposures per 1,000 surgical hours). Exposure rates increased with an increase in estimated blood loss (17.5 exposures per 1,000 procedures with 501–1,000 cc blood loss and 22.5 exposures per 1,000 procedures with >1,000 cc blood loss), increased number of personnel ever working in the surgical field (20.5 exposures per 1,000 procedures with 15 or more personnel ever in the field), and increased surgical procedure duration (13.7 exposures per 1,000 procedures that lasted 4–6 hours, 24.0 exposures per 1,000 procedures that lasted 6 hours or more). Associations were generally stronger for suture needle–related exposures.Conclusions.Our results support the need for prevention programs that are targeted to mitigate the risks for BBF exposure posed by high blood loss during surgery (eg, use of blunt suture needles and a neutral zone for passing surgical equipment) and prolonged duration of surgery (eg, double gloving to defend against the risk of glove perforation associated with long surgery). Further investigation is needed to understand the risks posed by lengthy surgical procedures.

scholarly journals Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Babatunde O. Akinbami ◽  
Bisola Onajin-Obembe
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Significant Relationship ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Care Center ◽  
Mean Value ◽  
Health Care Center ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3±(18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4±10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.

scholarly journals Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

2019 ◽  
Vol 81 (01) ◽  
pp. 017-027
Author(s):  
Michael Bender ◽  
Carolin Gramsch ◽  
Lukas Herrmann ◽  
Seong Woong Kim ◽  
Eberhard Uhl ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pain Score ◽  
Hospital Setting ◽  
University Hospital ◽  
Disk Herniation ◽  
Training Requirements ◽  
Lumbar Disk ◽  
Duration Of Surgery ◽  
Lumbar Disk Herniations

Abstract Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

scholarly journals Non Descent Vaginal Hysterectomy: A Rational Surgical Approach

KYAMC Journal ◽  
2017 ◽  
Vol 6 (2) ◽  
pp. 637-641
Author(s):  
Arifa Akter Zahan ◽  
Kh Shahnewaz ◽  
Ummay Salma
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Average Duration ◽  
Uterine Prolapse ◽  
Rational Approach ◽  
Medical College ◽  
Gynecological Disorders ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Aims: To evaluate the rational approach of non-descent vaginal hysterectomy in advancing gynaecology practice.Study Design: Retrospective study and period from 1st July 2013 to 31st June 2014. Setting Kumudini Women's Medical College & Hospital, Mirzapur, Tangail.Patients: All selective patients requiring hysterectomy for benign gynecological disorders who did not have any uterine prolapse were recruited for this study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus.Main outcome measures: Data regarding indication, age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded.Results: A total of 50 cases were selected for non-descent vaginal hysterectomy all of them successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 46%. All patients were parous. Uterus size was less then 8 wks 21 cases, 8wks to 12 wks in 27 cases, more then 12 wks 02 cases. Commonest indication was DUB of uterus (44%). Mean duration of surgery was 50.5 minutes. Mean blood loss was 100ml. Blood transfusion was required in four cases. Average duration of hospital stay was 3.1 days. Complications were minimal which included UTI and Vault infection.Conclusions: NDVH is safe feasible and patient friendly. We suggest that our modern gynecologist will be more expertise and familiar to this procedure in near future.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 637-641

Tissue Welding Forceps Usage in Superficial Parotidectomy: A Clinical Assessment

2008 ◽  
Vol 74 (1) ◽  
pp. 51-55
Author(s):  
Randall G. Michel ◽  
Kang Tsau ◽  
Bernard I. Weinstock
Keyword(s):  
Blood Loss ◽  
Blood Vessel ◽  
Surgical Procedures ◽  
Clinical Assessment ◽  
Facial Weakness ◽  
Facial Paresis ◽  
Superficial Parotidectomy ◽  
Safety And Efficacy ◽  
Tissue Welding ◽  
Estimated Blood Loss

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

scholarly journals The Effectiveness and Safety of Ultrasonic Bone Scalpel Versus Conventional Method in Cervical Laminectomy: A Retrospective Study of 311 Patients

2019 ◽  
Vol 10 (6) ◽  
pp. 760-766
Author(s):  
Bharat R. Dave ◽  
Ajay Krishnan ◽  
Ravi Ranjan Rai ◽  
Devanand Degulmadi ◽  
Shivanand Mayi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Conventional Method ◽  
Nerve Root ◽  
Surgical Complications ◽  
Nerve Root Injury ◽  
Cervical Laminectomy ◽  
C5 Palsy ◽  
Root Injury ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Study Design: Retrospective cohort study. Objectives: The aim of this study was to compare the results of cervical laminectomy (CL) performed with ultrasonic bone scalpel (UBS) or conventional method (CM). Method: This study comprised 311 CL performed by a single surgeon between January 2004 and December 2017. Group A (GpA) comprised 124 cases of CL performed using UBS, while Group B (GpB) comprised 187 cases of CL performed using CM. These 2 groups were compared in terms of demographic characteristics of patients, duration of surgery, estimated blood loss, and surgical complications. Results: GpA included 112 males and 12 females, mean age being 61.18 years. GpB comprised 166 males and 21 females, mean age being 62.04 years. Mean duration of surgery, estimated blood loss, and length of hospital stay was 65.52/70.87 minutes, 90.24/98.40 mL, and 4.80/4.87 days in GpA and GpB, respectively. Six patients were reported to have dural injuries in each group. In GpA, 2 cases of C5 palsy and 1 nerve root injury was observed, while in GpB, 3 cases of C5 palsy and no nerve root injury was reported. One patient had developed transient neurological deterioration postsurgery in GpA as against 11 patients in GpB. Conclusion: Neurological complications observed in CM leads to intensive care unit admission, additional morbidity, and additional expenditure, whereas UBS provides a safe, rapid, and effective means of performing CL, thereby decreasing the rate of surgical complications and postoperative morbidity.

scholarly journals Investigating Effective Factors on Estimated Hemorrhage Intraoperative in Brain Meningioma Surgery

2020 ◽  
Vol 11 (5) ◽  
pp. 631-638
Author(s):  
Alireza Tabibkhooei ◽  
◽  
Maziar Azar ◽  
Ahmad Alagha ◽  
Javad Jahandideh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Preoperative Imaging ◽  
Intracranial Meningioma ◽  
Cross Sectional ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
History Of ◽  
Main Determinants ◽  
Magnetic Resonance Imaging Mri ◽  
Meningioma Surgery

Introduction: The primary and definitive diagnosis of meningioma is based on histological assessment; however, employing imaging methods, like Magnetic Resonance Imaging (MRI) is very helpful to describe lesion’s characteristics. Accordingly, we decided to study the effect of imaging factors, like MRI data on the volume of hemorrhage (estimated blood loss) during meningioma surgery. Methods: This was a cross-sectional, retrospective, and analytical study. The eligible patients were those with meningioma who were candidates for surgery. A total of 40 patients with meningioma were selected and assessed. The preoperative imaging findings were recorded, then estimated blood loss during the surgery was determined Results: A reverse association was revealed between the degree of proximity to the nearest sinus and the rate of bleeding. Furthermore, the size of the mass was positively associated with the rate of bleeding; however, there was no significant correlation between the volume of bleeding and other parameters, including the degree of edema, the volume of mass, the site of the tumor in the brain, and the histological subtype of the tumor. The mean time of operation was strongly correlated with blood loss. The rate of bleeding was more expected in hypertensive versus normotensive patients. Conclusion: Bleeding in various volumes could be a frequent finding in intracranial meningioma surgery. Overall, tumor size, the duration of surgery, a history of hypertension, and distance to the nearest sinuses were the main determinants for the severity of hemorrhage in patients undergoing meningioma surgery.

scholarly journals Limiting blood loss in orthognathic surgery with Esmolol as a hypotensive agent

2017 ◽  
Vol 2 (2) ◽  
pp. 86
Author(s):  
Sailesh Kumar Mukul ◽  
Amit Kumar ◽  
Ejaz Ahmad Mokhtar ◽  
Shweta Pandey
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Orthognathic Surgery ◽  
Induced Hypotension ◽  
Hypotensive Anesthesia ◽  
Group I ◽  
Anesthesia Group ◽  
Duration Of Surgery ◽  
Group 2 ◽  
Fast Acting

Orthognathic surgery may be complicated by difficulty in achieving hemostasis because unlike soft tissue, the vessels traversing bone cannot be identified and isolated before osteotomy. In this study we evaluated the amount of blood loss and duration of surgery under deliberate hypotensive anesthesia in comparison to amount of blood loss and duration of surgery under normotensive anesthesia on patients undergoing orthognathic surgical procedures. A total of 16 cases undergoing orthognathic surgery were included in this clinical study.Patients were randomly grouped under normotensive (group I) or hypotensive group (group 2). Patients in hypotensive anesthesia group were given Esmolol to maintain mean arterial pressure in the range of 70-80 mm of Hg till osteotomy segments were fixed. There was more than 40% reduction in blood loss in orthognathic surgical procedures when induced hypotension was used, but there was not statistically significant (p=0.91) reduction in the operative time. Based on surgeons and anesthetist’s assessment fast acting agents like Esmolol can be used intraoperatively to induce hypotension as and when required.  

scholarly journals Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Gokhan Sami Kilic ◽  
Gradie Moore ◽  
Ayman Elbatanony ◽  
Carmen Radecki ◽  
John Y. Phelps ◽  
...  
Keyword(s):  
Blood Loss ◽  
Laparoscopic Hysterectomy ◽  
Vaginal Surgery ◽  
University Hospital ◽  
Perioperative Outcomes ◽  
Study Objective ◽  
Invasive Approach ◽  
Benign Pathology ◽  
Estimated Blood Loss ◽  
The Mean

Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program.Design. Prospectively comparative observational nonrandomized study.Design Classification. II-1.Setting. Tertiary caregiver university hospital.Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution.Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications.Measurements and Main Results. Operative times were minutes for laparoscopic, minutes for robotic, and minutes for vaginal (). Estimated blood loss for patients undergoing laparoscopic surgery was  cc,  cc for robotic surgery, and  cc for vaginal surgery (). The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight () among surgery methods.Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

Operating Room Management In Klaipėda University Hospital: Prospective Analysis In 2009

2016 ◽  
Vol 26 (5) ◽  
pp. 114-119
Author(s):  
Renata Paškevičiūtė ◽  
Geda Klimavičiūtė
Keyword(s):  
Operating Room ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Operating Rooms ◽  
Turnover Time ◽  
University Hospital ◽  
Time Variability ◽  
Procedure Time ◽  
High Turnover ◽  
Scheduled Time

Summary Background: Klaipeda University Hospital performs about 30000 surgical procedures every year. The operating room (OR) is a major production unit in hospital. The OR is very expensive to construct and to operate. The goal might be thought to be full utilization of all operating rooms during all hours that they are staffed and available for scheduling. Management is the ability to apply a diverse body of knowledge to accomplish planning, organizing, staffing, leading, and controling a work group. Methods: We decided accidentally to choose and to analyze OR utilization. We had analyzed central operating department consisting of 9 ORs with regularly scheduled time 8:00 AM to 4:00 PM (8 h), full staffed in 2009 four months period (78 workdays). Four months (78 workdays) of data were collected from the 9 operating rooms surveys. Holidays and weekends were excluded.The data was analyzed using “ Statistica” version 7.Results: There were performed 1982 surgical procedures (elective – 1807 (91,2%), urgent – 99 (5%), cancelled – 76 (3,8%)) during investigated period regularly scheduled time (8 h). Actually utilized OR time of all 9 ORs was 4648 h (82,76%), it was planned to work 5616 h. Our OR utilization was 82,76% during investigated period. Total under – utilized time was 968 h (17,36%). Surgeon estimated surgical procedure time was longer than actual surgical procedure time, variability of case duration between surgical teams was high. Turnover time mean duration was 28 min. Conclusions: Our study demonstrates that our central operating department have been worked efficiently (OR utilization was 82,76%, case cancellation rate was 3,8%, mean turnover time was 28 min, prolonged turnovers were less than 10%) in 2009 (four month period).

scholarly journals Low blood transfusion rate after implementation of tranexamic acid for fast- track hip- and knee arthroplasty. An observational study of 5205 patients

2021 ◽  
Vol 87 (1) ◽  
pp. 9-16
Author(s):  
Yoeri Bemelmans ◽  
Emil Van Haaren ◽  
Bert Boonen ◽  
Roel Hendrickx ◽  
Martijn Schotanus
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
Hip And Knee Arthroplasty

The purpose of this study was to retrospectively evaluate the efficacy of a tranexamic acid (TXA) perioperative protocol for primary hip- and knee arthroplasty, in terms of allogenic blood transfusion rates. A retrospective cohort study was conducted and included all primary hip and knee arthroplasty procedures in the period of 2014-2019. Patients who underwent surgery due to trauma or revision were excluded. A total amount of 5205 patients were eligible for inclusion. Two equal and weight depending doses of TXA were given, preoperative as an oral dose and intravenously at wound closure. The primary outcome was blood transfusion rate. Further analysis on patient characteristics (e.g. age, gender), blood loss, perioperative haemoglobin (Hb) levels and complication/readmission rate was performed. A total of 49 (0.9%) patients received perioperative allogenic blood transfusions. Mean age, distribution of gender, body-mass index, American Society of Anaesthesiologists score, duration of surgery, type of arthroplasty, estimated blood loss, perioperative Hb levels and length of stay were statistically significant different between transfused and not-transfused patients. The incidence of thromboembolic adverse events (e.g. deep vein thrombosis/lung embolism) was 0.5%. Low blood transfusion rate was found after implementation of a standardized perioperative TXA protocol for primary hip and knee arthroplasty.

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