Anaesthetic challenges for pelvic reconstruction with custom three-dimensional-printed titanium implants: A retrospective cohort study

Custom 3D printed titanium implant pelvic reconstructive surgery was implemented as a novel technique at our institutions in the last five years. It provided an option for pelvic bone malignancy patients who were previously deemed unsuitable for re-implantation of irradiated resected bone segments,...

Full description

Saved in:
Bibliographic Details
Published in:Anaesthesia and intensive care 2019-07, Vol.47 (4), p.368-377
Main Authors: Chua, Alfred WY, Chua, Matthew J, Kam, Peter CA, Broekhuis, Demien, Karunaratne, Sascha, Stalley, Paul D
Format: Article
Language:English
Subjects:
Amputation
Anemia
Anesthesia
Blood transfusions
Cancer
Catheters
Chemotherapy
Classification
Cohort analysis
Compartment syndrome
Compression therapy
Endoscopy
Hospitals
Infections
Intensive care
Joint surgery
Laboratories
Narcotics
Patients
Pelvis
Plastic surgery
Radiotherapy
Surgery
Surgical outcomes
Three-dimensional printing
Thrombosis
Titanium
Tomography
Transplants & implants
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Custom 3D printed titanium implant pelvic reconstructive surgery was implemented as a novel technique at our institutions in the last five years. It provided an option for pelvic bone malignancy patients who were previously deemed unsuitable for re-implantation of irradiated resected bone segments, as well as in revision total hip arthroplasty associated with excessive acetabular bone loss. A retrospective cohort study of the anaesthetic management of patients who underwent pelvic reconstructive surgery using custom 3D printed titanium implants from August 2013 to July 2018 was conducted. Twenty-seven patients were included in the study; 23 patients completed single-stage procedures with a mean (standard deviation) duration of surgery of 7.5 (3.3) hours (median 6.8, range 3.0-15.8 hours), and mean intraoperative blood loss of 5400 (3100)mL (median 6000, range 1400-10,000 mL). Surgery involving the sacrum (n1/47) was associated with longer intensive care stay, longer total length of hospital stay and, in three cases, unplanned two-stage procedures. The twenty procedures not involving the sacrum were successfully completed in a single stage. The major anaesthetic challenges included massive blood loss, prolonged surgery, interventions to prevent calf compartment syndrome, and perioperative thromboembolism. Preoperative pelvic radiotherapy, malignant tumours, and procedures involving the sacrum were associated with massive intraoperative blood loss and more prolonged surgery.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X19864599