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Trial registered on ANZCTR
Registration number
ACTRN12623000161628
Ethics application status
Approved
Date submitted
20/01/2023
Date registered
17/02/2023
Date last updated
17/02/2023
Date data sharing statement initially provided
17/02/2023
Type of registration
Retrospectively registered
Titles & IDs
Public title
The impact of cell salvage on blood transfusion rates in major hepatobiliary surgery
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Scientific title
The impact of autologous blood transfusion on peri-operative allogenic blood transfusion in patients undergoing major hepatopancreatobiliary surgery: a retrospective cohort study.
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Secondary ID [1]
308804
0
None.
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Colorectal liver metastases
328755
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IMPN pancreas
328756
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HCC
328757
0
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Condition category
Condition code
Surgery
325760
325760
0
0
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Other surgery
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Blood
325761
325761
0
0
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Anaemia
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Cancer
325762
325762
0
0
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Biliary tree (gall bladder and bile duct)
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Cancer
325763
325763
0
0
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Liver
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Cancer
325764
325764
0
0
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Pancreatic
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Information from a prospective database of 501 patients undergoing major hepatobiliary and pancreatic (HPB) HPB resection (2015–2022) were analysed. Patients who received cell salvage (n=264) were compared with those who did not (n=237).
a) data including demographics (age/gender/BMI/preoperative haemoglobin, haematocrit), operation type, postoperative outcomes and transfusion rates were all collected
b) electronic medical records were used to obtain the above data. Participants were not actively involved in our data collection (i.e. did not fill out any surveys, nor did they visit a clinic for a consultation.
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Intervention code [1]
325254
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Not applicable
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
333607
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Transfusion rates (transfusion events, number of red cells per patient)
Collected from electronic medical records.
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Assessment method [1]
333607
0
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Timepoint [1]
333607
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5 days post op
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Primary outcome [2]
333608
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Correction of blood-loss tolerance breach
Calculated using Lemmens-Bernstein-Brodorsky formula
Data collected from electronic medical records.
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Assessment method [2]
333608
0
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Timepoint [2]
333608
0
5 days post op
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Secondary outcome [1]
417732
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Morbidity (Clavein-dindo complication rate)
Collected from electronic medical records, specifically post-operative ward round entries, and any complications or interventions recorded in the medical notes.
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Assessment method [1]
417732
0
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Timepoint [1]
417732
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Length of admission until date of discharge, or readmission with a direct complication of initial surgery.
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Eligibility
Key inclusion criteria
All HPB patients undergoing resection between 2015-2022
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Minimum age
23
Years
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Maximum age
78
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Nil (retrospective cohort study)
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Study design
Purpose
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Duration
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Selection
Defined population
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Timing
Retrospective
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Statistical methods / analysis
Non-autologous transfusion was assessed from the time of surgery to 5 days post-surgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with allogenic blood transfusion avoidance.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
1/09/2022
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Date of last participant enrolment
Anticipated
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Actual
1/10/2022
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Date of last data collection
Anticipated
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Actual
1/10/2022
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Sample size
Target
501
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Accrual to date
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Final
501
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Recruitment outside Australia
Country [1]
25220
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United Kingdom
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State/province [1]
25220
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Oxford
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Funding & Sponsors
Funding source category [1]
313125
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Self funded/Unfunded
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Name [1]
313125
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UNFUNDED
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Address [1]
313125
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UNFUNDED
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Country [1]
313125
0
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Primary sponsor type
Individual
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Name
Mr Alex Gordon-Weeks
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Address
Department of hepatobiliary surgery
Churchill hospital
Old Rd, Headington, Oxford
OX3 7LE
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Country
United Kingdom
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Secondary sponsor category [1]
314708
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Hospital
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Name [1]
314708
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Oxford University Hospitals
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Address [1]
314708
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Department of hepatobiliary surgery
Churchill hospital
Old Rd, Headington, Oxford
OX3 7LE
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Country [1]
314708
0
United Kingdom
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
312283
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Oxford University Hospitals NHS Foundation Trust Clinical Improvements Division, Ulysses
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Ethics committee address [1]
312283
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Clinical Improvements Division, Ulysses Oxford University Hospitals NHS Foundation Trust John Radcliffe Hospital Headley Way Headington Oxford OX3 9DU
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Ethics committee country [1]
312283
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United Kingdom
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Date submitted for ethics approval [1]
312283
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27/08/2022
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Approval date [1]
312283
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15/12/2022
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Ethics approval number [1]
312283
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Reference number 7809 Ver 1 Type 03 Approved Local Audit
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Summary
Brief summary
We believe that our work is of interest to the general surgical community as a whole, as it covers the topical issue of patient blood management in major abdominal surgery. In this retrospective cohort study we analyse the effect of cell salvage and intra-operative autologous blood transfusion on the outcome of 501 patients undergoing major hepatopancreatobiliary surgery. We find that use of cell salvage is associated with a significant reduction in absolute and average allogenic packed red cell transfusion and that both the use of cell salvage and correction of blood loss tolerance breach are independently associated with avoidance of transfusion. Our centre has developed a unique and highly specialised cell salvage service consisting of cell salvage practitioners whose sole task during surgery is to monitor blood loss, assess coagulopathy and return of blood aspirated from the operative field at regular intervals throughout surgery. This practice attempts to ensure that physiological levels of oxygen delivery are maintained throughout complex hepatobiliary procedures and we believe that the development of this practice is responsible for the significant avoidance in blood transfusion that we see in the cell salvage population presented here. The development of such a service is relatively unique to the UK and ours is, by some margin, the largest series to date analysing cell salvage use in hepatopancreatobiliary surgery. As such, despite its retrospective nature, this will be the highest level of published evidence demonstrating benefit of the routine use of cell salvage for major hepatopancreatobiliary resectional surgery.
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Trial website
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Trial related presentations / publications
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Public notes
Internal ethics approval sought and obtained, as this was a retrospective cohort research study, therefore, ethics approval was sought and obtained after "enrolment" of the first participant.
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Contacts
Principal investigator
Name
124098
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Mr Alex Gordon-Weeks
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Address
124098
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Department of hepatobiliary surgery
Churchill hospital
Old Rd, Headington, Oxford
OX3 7LE
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Country
124098
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United Kingdom
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Phone
124098
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+447808030432
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Fax
124098
0
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Email
124098
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[email protected]
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Contact person for public queries
Name
124099
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Alex Gordon-Weeks
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Address
124099
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Department of hepatobiliary surgery
Churchill hospital
Old Rd, Headington, Oxford
OX3 7LE
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Country
124099
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United Kingdom
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Phone
124099
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+44300 304 7777
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Fax
124099
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Email
124099
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[email protected]
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Contact person for scientific queries
Name
124100
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Alex Gordon-Weeks
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Address
124100
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Department of hepatobiliary surgery
Churchill hospital
Old Rd, Headington, Oxford
OX3 7LE
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Country
124100
0
United Kingdom
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Phone
124100
0
+447808030432
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Fax
124100
0
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Email
124100
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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