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Background: Differences in medical treatment between women and men are common and involve out-of-hospital emergency care, the intensity of pain treatment, and the use of antifibrinolytic treatment in emergency trauma patients. If woman and man receive different antifibrinolytic treatment in highly-standardized major transplant surgery is unknown., Methods: We conducted a retrospective cohort study on patients who underwent liver transplantation at Heidelberg University Hospital, Heidelberg, Germany between 2004 and 2017. Logistic regression analyses were performed to determine if sex is associated with the administration of TXA during liver transplantation. Secondary endpoints included venous thrombotic complications, graft failure, mortality, myocardial infarction, hepatic artery thrombosis, and stroke within the first 30 days after liver transplant as well as length of hospital stay and length of intensive care unit stay., Results: Out of 779 patients who underwent liver transplantation, 262 patients received TXA. Female sex was not associated with intraoperative administration of TXA [adjusted OR: 0.929 (95% CI 0.654; 1.320), p  = 0.681]. The secondary endpoints graft failure (13.2% vs. 8.4%, women vs. men, p  = 0.039), pulmonary embolism (3.4% vs. 0.9%, women vs. men, p  = 0.012), stroke (1.7% vs. 0.4%, women vs. men, p  = 0.049), and deep vein thrombosis (0.8% vs. 0%, women vs. men, p  = 0.031) within 30 days after liver transplantation were more frequent in women. Mortality, myocardial infarction, and other secondary endpoints did not differ between groups. However, in women, the use of TXA was associated with a lower rate in thromboembolic complications., Conclusion: Our data indicate that different from other scenarios with massive bleeding complications the administration of TXA during liver transplantation is not associated with sex. However, sex is associated with the risk for complications, and in woman TXA might have a preventive effect on the rate of thromboembolic complications. Reasons underlying the observed sex bias rate remain uncertain., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dehne, Jackson-Gil, Riede, Feisst, Mehrabi, Michalski, Weigand, Decker and Larmann.)

Background: Intraoperative end-tidal carbon dioxide concentrations (EtCO 2 ) values are associated with recurrence-free survival after colorectal cancer surgery. However, it is unknown if similar effects can be observed after other surgical procedures. There is now evidence available for target EtCO 2 and its relation to surgical outcomes following pancreatic cancer surgery., Methods: In this single-center, retrospective cohort study, we analyzed 652 patients undergoing elective resection of pancreatic cancer at Heidelberg University Hospital between 2009 and 2016. The entire patient cohort was sorted in ascending order based on mean intraoperative EtCO 2 values and then divided into two groups: the high-EtCO 2 group and the low-EtCO2 group. The pre-specified primary endpoint was the assessment of recurrence-free survival up to the last known follow-up. Cardiovascular events, surgical site infections, sepsis, and reoperations during the hospital stay, as well as overall survival were pre-specified secondary outcomes., Results: Mean EtCO 2 was 33.8 mmHg ±1.1 in the low-EtCO 2 group vs. 36.8 mmHg ±1.9 in the high-EtCO 2 group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4) years. Recurrence-free survival did not differ among the high and low-EtCO 2 groups [HR = 1.043 (95% CI: 0.875-1.243), log rank test: p = 0.909]. Factors affecting the primary endpoint were studied via Cox analysis, which indicated no correlation between mean EtCO 2 levels and recurrence-free survival [Coefficient -0.004, HR = 0.996 (95% CI:0.95-1.04); p = 0.871]. We did not identify any differences in the secondary endpoints, either., Conclusions: During elective pancreatic cancer surgery, anesthesiologists should set EtCO 2 targets for reasons other than oncological outcome until conclusive evidence from prospective, multicenter randomized controlled trials is available., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dehne, Kirschner, Klotz, Kilian, Michalski, Hackert, Büchler, Weigand and Larmann.)

Background: Current clinical guidelines recommend antifibrinolytic treatment for liver transplantation to reduce blood loss and transfusion utilization. However, the clinical relevance of fibrinolysis during liver transplantation is questionable, a benefit of tranexamic acid (TXA) in this context is not supported by sufficient evidence, and adverse effects are also conceivable. Therefore, we tested the hypothesis that use of TXA is associated with reduced blood loss., Methods: We performed a retrospective cohort study on patients who underwent liver transplantation between 2004 and 2017 at Heidelberg University Hospital, Heidelberg, Germany. Univariable and multivariable linear regression analyses were used to determine the association between TXA administration and the primary end point intraoperative blood loss and the secondary end point intra- and postoperative red blood cell (RBC) transfusions. For further secondary outcome analyses, the time to the first occurrence of a composite end point of hepatic artery thrombosis, portal vein thrombosis, and thrombosis of the inferior vena cava were analyzed using a univariable and multivariable Cox proportional hazards model., Results: Data from 779 transplantations were included in the final analysis. The median intraoperative blood loss was 3000 mL (1600-5500 mL). Intraoperative TXA administration occurred in 262 patients (33.6%) with an average dose of 1.4 ± 0.7 g and was not associated with intraoperative blood loss (regression coefficient B, -0.020 [-0.051 to 0.012], P = .226) or any of the secondary end points (intraoperative RBC transfusion; regression coefficient B, 0.023 [-0.006 to 0.053], P = .116), postoperative RBC transfusion (regression coefficient B, 0.007 [-0.032 to 0.046], P = .717), and occurrence of thrombosis (hazard ratio [HR], 1.110 [0.903-1.365], P = .321)., Conclusions: Our data do not support the use of TXA during liver transplantation. Physicians should exercise caution and consider individual factors when deciding whether or not to administer TXA., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Study Objective: Higher levels of carbon dioxide (CO 2 ) increase the invasive abilities of colon cancer cells in vitro. Studies assessing target values for end-tidal CO 2 concentrations (EtCO 2 ) to improve surgical outcome after colorectal cancer surgery are lacking. Therefore, we evaluated whether intraoperative EtCO 2 was associated with differences in recurrence-free survival after elective colorectal cancer (CRC) surgery., Design: Single center, retrospective analysis., Setting: Anesthesia records, surgical databases and hospital information system of a tertiary university hospital., Patients: We analyzed 528 patients undergoing elective resection of colorectal cancer at Heidelberg University Hospital between 2009 and 2018., Interventions: None., Measurements: Intraoperative mean EtCO 2 values were calculated. The study cohort was equally stratified into low-and high-EtCO 2 groups. The primary endpoint measure was recurrence-free survival until last known follow-up. Groups were compared using Kaplan-Meier analysis. Cox-regression analysis was used to control for covariates. Sepsis, reoperations, surgical site infections and cardiovascular events during hospital stay, and overall survival were secondary outcomes., Main Results: Mean EtCO 2 was 33.8 mmHg ±1.2 in the low- EtCO 2 group vs. 37.3 mmHg ±1.6 in the high-EtCO 2 group. Median follow-up was 3.8 (Q1-Q3, 2.5-5.1) years. Recurrence-free survival was higher in the low-EtCO 2 group (log-rank-test: p = .024). After correction for confounding factors, lower EtCO 2 was associated with increased recurrence-free survival (HR = 1.138, 95%-CI:1.015-1.276, p = .027); the hazard for the primary outcome decreased by 12.1% per 1 mmHg decrease in mean EtCO 2 . 1-year and 5-year survival was also higher in the low-EtCO 2 group. We did not find differences in the other secondary endpoints., Conclusions: Lower intraoperative EtCO 2 target values in CRC surgery might benefit oncological outcome and should be evaluated in confirmative studies., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)