Effect of Electrosurgery on Blood Loss and Intraoperative Transfusions in Musculoskeletal Tumor Surgery

Study Overview
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Brief Summary
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Resection of malign musculoskeletal tumors and reconstruction with large tumor prostheses often results in relevant blood loss requiring hemodynamic stabilization and transfusion. The use of novel electrosurgical electrodes is assessed retrospectively regarding the potential to reduce blood loss and the need for transfusions.

Detailed Description
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Background Resection of malign musculoskeletal tumors and reconstruction with large tumor prostheses often result in relevant blood loss requiring hemodynamic stabilization and transfusion. Since machine autotransfusion is contraindicated in tumor surgery, other measures are necessary to reduce intraoperative blood loss. Objectives Tungsten needle electrodes can be used to simultaneously cut skin and seal bleeding vessels for superficial dissection. Spatula electrodes coated with Teflon (polytetrafluoroethylene PTFE) are used for coagulation and dissection of deeper tissues. The coating reduces eschar build-up and thus smoke creation compared to conventional stainless-steel electrodes. This study assesses the effect of these novel electrodes on blood loss and transfusion rates. Methods: The investigators retrospectively investigate all cases of tumor resection and reconstruction with tumor prostheses that were operated five years before the introduction of the new electrodes (2012-2016) and five years after (2018-2021) by one single surgeon with over 25 years of experience. Data are extracted from digital patient records and analyzed by descriptive statistics and t-test for normally distributed data or Mann-Whitney test in case of non-normal distribution.

Official Title
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Effect of Monopolar Tungsten Needle Electrodes and Teflon Coated Spatula Electrodes on Blood Loss and Intraoperative Transfusions in Musculoskeletal Tumor Surgery Compared to Conventional Surgical Knives and Stainless-Steel Electrodes

Conditions
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Blood Loss, Surgical, Transfusion Rate, Electrosurgery, Tumororthopaedics

Intervention / Treatment
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* Device: Application of novel electrodes


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who received hemipelvectomy, hip disarticulation, or major tumor prosthesis implantation at our hospital between 2010 and 2021 Operated by one single surgeon Exclusion Criteria: - Implantation of a Megaprosthesis without history of tumor

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Tungsten/Teflon +<br>Dissection with novel electrodes (Tungsten needle electrode + Teflon coated Spatula electrode) | Device: Application of novel electrodes<br>* Application of novel electrodes since 2017 for the dissection of extremity tumors in tumororthopedics<br>|
| Tungsten/Teflon -<br>Dissection without novel electrodes (Scalpel + Steel Spatula Electrode) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood loss | monitored during surgery in the anaesthesiology protocol | during surgery | 
| Transfusion of red packed blood cells | number of intraoperative units of packed red blood cells | during surgery | 
| Transfusion of red packed blood cells | number of intraoperative units of packed red blood cells | 14 days post surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| post surgical wound drainage | assessed via recorded volume | 5 days post surgey |