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Use of Allogenic Blood in Total Hip and Knee Arthroplasty: Need for a National Protocol
Author(s) -
Mangwani J.,
Gardiner M.,
Williams W. W.
Publication year - 2006
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2006.00694_24.x
Subject(s) - medicine , perioperative , blood transfusion , surgery , total hip replacement , arthroplasty , total knee replacement , knee replacement , blood management , significant difference , blood loss , anesthesia
Introduction Patients undergoing Total hip replacement (THR) and total knee replacement (TKR) surgery are usually elderly and have other co‐morbidities. This combined with the nature of the surgery ensures that a number will have postoperative blood transfusion. Blood transfusion carries a number of well document risks for the patient and is increasingly expensive. Strategies for reducing transfusion requirements can be divided into preoperative, perioperative and postoperative. The purpose of this study was to investigate our postoperative use of allogenic blood with a view to establish a new transfusion protocol. Patients and Methods We retrospectively reviewed records of all patients undergoing a primary THR or TKR at Broomfield Hospital between Aug 2004 and Jan 2005 (70 hips, 77 knees). Data recorded included: (i) patient details, (ii) operative details, (iii) preoperative haematological indices, (iv) intraoperative details including length and fluid infusion, (v) postoperative haemotalogical indices, (vi) transfusion requirements and, (vii) length of stay. Results There was no difference in the mean age between the transfusion and non‐transfusion groups. The mean preoperative haemoglobin (Hb) of THR patients who received a transfusion was significantly lower than those that did not ( P = 0.007). This was also found in the TKR patient group ( P = 0.035). There was a significant difference in operative time for THR and TKR patients that did not receive a transfusion ( U = 565.00, P = 0.02) but no significant difference between transfusion and non‐transfusion groups. The mean postoperative Hb was significantly lower in both the THR ( P = <0.01) and TKR ( P < 0.01) groups that received a transfusion. There was a significantly higher rate of transfusion in THR patients (49%) as compared to TKR patients (19%). The mean time between the operation and transfusion was 1.7 days for the THR group and 2.5 days for the TKR group. The mean length of stay was significantly longer in both the THR ( U = 441.50, P = 0.044) and TKR ( U = 194.50, P = 0.001) transfusion groups. Conclusion The use of allogenic blood can be improved. Two main strategies to achieve this goal include (i) Identifying high risk patients and, (ii) the introduction of a blood transfusion protocol. Identifying high risk patients will not only help preoperative optimisation but also help identify those who should be considered for intraoperative or postoperative cell salvage. The protocol will ensure that those patients who are likely to benefit from a transfusion will receive it as early as possible.