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A randomized comparison of transfusion triggers in elective orthopaedic surgery using leucocyte‐depleted red blood cells
Author(s) -
SoOsman C.,
Nelissen R.,
Te Slaa R.,
Coene L.,
Brand R.,
Brand A.
Publication year - 2010
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/j.1423-0410.2009.01225.x
Subject(s) - medicine , randomized controlled trial , blood management , red blood cell transfusion , blood transfusion , elective surgery , red blood cell , arthroplasty , surgery , anesthesia , emergency medicine
Objective In elective orthopaedic hip‐ and knee replacement surgery patients, we studied the effect of implementation of a uniform transfusion policy on RBC usage. Study Design and Methods A randomized, controlled study. A new uniform, restrictive transfusion policy was compared with standard care, which varied among the three participating hospitals. Only prestorage leucocyte‐depleted RBC(s) were used. Primary end‐point was RBC usage, related to length of hospital stay. Secondary end‐points were Hb levels, mobilization delay and postoperative complications. Results Six hundred and three patients were evaluated. Adherence to the protocol was over 95%. Overall mean RBC usage was 0·78 U/patient in the new policy group and 0·86 U/patient in the standard care policy group (mean difference 0·08;95% CI [−0·3; 0·2]; P = 0·53). In two hospitals, the new transfusion policy resulted in a RBC reduction of 30% (0·58U RBC/patient) ( P = 0·17) and 41% (0·29 U RBC/patient) ( P = 0·05) respectively. In the third hospital, however, RBC usage increased by 39% (0·31 U RBC/patient) ( P = 0·02) with the new policy, due to a more restrictive standard care policy in that hospital. Length of hospital stay was not influenced by either policy. Conclusions Implementation of a uniform transfusion protocol for elective lower joint arthroplasty patients is feasible, but does not always lead to a RBC reduction. Length of hospital stay was not affected.