Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality

Article Abstract:

Concerns about the availability of blood and the potential of transfusion-related disease transmission require that we review our current use of blood transfusion. It is common practice to transfuse a patient prior to surgery if the hemoglobin level is less than 10 grams/100 milliliters of blood. (Hemoglobin, the iron-containing pigment of red blood cells, carries oxygen from the lungs to the tissues.) It has been suggested that for some patients there is virtually no increase in postoperative risk of death if the preoperative hemoglobin is 10 or less. In order to clarify the relationship between preoperative hemoglobin level, blood loss at surgery, and mortality, a group of 107 Jehovah's Witness patients were studied. These patients underwent a total of 113 elective operations, none of which were minor surgical procedures. Twenty of these patients had preoperative hemoglobin levels between 6 and 10 gm/100 ml of blood. The mortality for those with hemoglobin levels of 10 or more was 3.2 percent; for those with hemoglobin levels of 6 to 10, mortality was 5 percent. No deaths occurred if the blood loss at surgery was less than 500 ml, even if there had been a low preoperative hemoglobin. The key to safety appears to be careful surgical technique, including extensive use of electrocautery, and immediate attention to bleeding vessels. The results indicate that, in elective surgery, mortality is more dependent on operative blood loss than on the preoperative hemoglobin level. Surgery can be safely performed on patients with hemoglobin levels as low as 6 gm/100 ml of blood, if the operative blood loss is kept under 500 ml. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Case studies, Measurement, Preoperative care, Hemorrhage, Hemoglobin, Hemoglobins, Blood transfusion

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General surgical problems requiring operation in postoperative vascular surgery patients

Article Abstract:

Following vascular surgery, complications such as bleeding and thrombosis (clot formation) may occur. Occasionally, a patient who has undergone vascular surgery may require additional surgery. Generally, this surgery is related to the stomach, intestines, liver, gallbladder or problems with the wound from the vascular surgery. A study was undertaken to review the results of major surgery performed within a month after a major vascular operation. During a four-year period, 1,236 patients underwent major vascular operations; 15 patients required subsequent general surgery. The average patient age was 71.3 years. Surgery was performed for the following problems: perforated duodenal ulcer (two patients), perforated diverticular disease (two patients); evisceration and wound dehiscence (two patients); liver infarction (one patient); gangrenous inflammatory gallbladder disease (one patient); clostridial myonecrosis, a bacterial infection causing muscle tissue death, (one patient); and small bowel obstruction (four patients). The death rate for the 15 patients was high, at 47 percent. If the vascular procedure was an emergency operation, the death rate was 100 percent. All seven patients who did not survive died from sepsis (system-wide infection). These findings indicate that there is a very high risk of death for patients who undergo major general surgery following vascular surgery; if the vascular surgery is an emergency operation, subsequent major surgery almost always results in death. Elderly patients with many medical problems appear unable to fight off sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Blood vessels, Septicemia, Vascular surgery

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