Tendencia transfusional en la artroplastia total de cadera tras la implantación de un protocolo de “Patient Blood Management”

Cristian Pinilla-Gracia; Carlos Martín-Hernández; Juan José Panisello Sebastiá; Jesús Javier Mateo Agudo

doi:10.31053/1853.0605.v77.n1.26515

Autores/as

Cristian Pinilla-Gracia Hospital Universitario Miguel Servet
Carlos Martín-Hernández
Juan José Panisello Sebastiá
Jesús Javier Mateo Agudo

DOI:

https://doi.org/10.31053/1853.0605.v77.n1.26515

Palabras clave:

cadera; transfusión sanguínea; artroplastia

Resumen

Introducción

La artroplastia total de cadera es un procedimiento quirúrgico exitoso y seguro, pero que conlleva una inherente perdida sanguínea asociada. Cuando esta cirugía se lleva a cabo de forma programada, la implantación de un abordaje multimodal de Patient Blood Management (PBM), permitirá reducir significativamente las necesidades transfusionales.

Objetivo

Presentar los resultados clínico-analíticos y la incidencia transfusional tras la implantación de un protocolo de PBM en aquellos pacientes que van a someterse a una cirugía protésica de cadera.

Material y métodos

Estudio restrospectivo, unicentrico, observacional y analítico, entre aquellos pacientes sometidos a una artroplastia primaria de cadera electiva entre enero de 2017 y Febrero de 2019. En todos ellos, se ha aplicado un protocolo de PBM, centrado en el desarrollo de un programa de optimización de la anemia preoperatoria, la utilización de ácido tranexámico tópico y la adopción de una política transfusional restrictiva.

Resultados

El estudio incluyó un total de 384 pacientes, donde únicamente 9 precisaron transfusión de sangre alogénica (Tasa transfusional: 2,34%). En el análisis de los pacientes transfundidos, se encontró que presentaban una mayor estancia hospitalaria (8 ±2,9 Vs 5,3 ±2,9 días; p=0,007) y un mayor índice de complicaciones (22,2% vs 3,9%; p=0,017), respecto a aquellos que eludieron la TSA.

Conclusión

La aplicación de un adecuado protocolo multimodal de PBM, nos acerca a la utopía de una cirugía sin sangre en la cirugía protésica, resultando un modelo costo-efectivo que permite reducir de forma significativa la TSA en la artroplastia primaria de cadera.

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Citas

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