Transfusion trend in total hip arthroplasty following the implementation of a Patient Blood Management protocol
DOI:
https://doi.org/10.31053/1853.0605.v77.n1.26515Keywords:
hip; blood transfusion ; arthroplastyAbstract
Introduction
Total hip arthroplasty is a successful and safe surgical procedure, but it involves an associated blood loss. When this surgery is carried out on a scheduled basis, the implantation of a multimodal approach of Patient Blood Management (PBM) will significantly reduce transfusion needs.
Objective
To present the clinical-analytical results and the transfusion incidence after the implantation of a PBM protocol in those patients who are going to undergo prosthetic hip surgery.
Material and methods
Restrospective, unicentric, observational and analytical study, among those patients undergoing primary elective hip arthroplasty between January 2017 and February 2019. In all of them, a PBM protocol has been applied, focused on the development of an optimization program of preoperative anemia, the use of topical tranexamic acid and the adoption of a restrictive transfusion policy.
Results
The study included a total of 384 patients, where only 9 required allogeneic blood transfusion (transfusion rate: 2.34%). In the analysis of transfused patients, they were found to have a longer hospital stay (8 ± 2.9 Vs 5.3 ± 2.9 days; p = 0.007) and a higher rate of complications (22.2% vs. 3, 9%; p = 0.017), with respect to those who avoided the TSA.
Conclusion
The application of an adequate multimodal protocol of PBM, brings us closer to the utopia of bloodless surgery in prosthetic surgery, resulting in a cost-effective model that significantly reduces the TSA in primary hip arthroplasty.
Downloads
References
1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS, 2007; 89(4), 780-785.
2. Ram GG, Suresh P, Vijayaraghavan PV. Surgeons often underestimate the amount of blood loss in replacement surgeries. Chin J Traumatol. 2014; 17(4):225-8.
3. Ugbeye ME, Lawal WO, Ayodabo OJ, Adadevoh IP, Akpan IJ. An Evaluation of Intra and Post operative Blood Loss in Total Hip Arthroplasty at the National Orthopaedic Hospital, Lagos. Nigerian Journal of Surgery, 2017; 23(1), 42-46.
4. Nuttall GA, Santrach PJ, Oliver WC Jr, Horlocker TT, Shaughnessy WJ, Cabanela ME, Bryant S. The predictors of red cell transfusions in total hip arthroplasties. Transfusion. 1996 Feb; 36(2):144-9.
5. Spahn DR. Anemia and patient blood management in hip and knee surgery a systematic review of the literature. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2010; 113(2), 482-495.
6. Prieto M, Banchs RJ. Riesgos de la transfusión sanguínea alogénica. En: Tratado de medicina transfusional perioperatoria. Llau JV, Basora M, Gómez A, Moral V, editores. Elsevier España SL. Barcelona, pp: 263-269, 2010. 28. Raw J. The silent risks of blood transfusion. Curr Opin Anaesth 21:664-8, 2008.
7. Shander A, Van Aken H, Colomina MJ, Gombotz H, Hofmann A, Krauspe R, Spahn D R. Patient blood management in Europe. British journal of anaesthesia, 2012; 109(1), 55-68.
8. World Health Organisation, United Nations Children’s Fund, United Nations University. Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva: World Health Organisation; 2001.
9. Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: Aretrospective cohort study. Lancet. 2011; 378:1396–407.
10. Muñoz M, Gómez-Ramírez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfusion, 2015; 13(3), 370.
11. Muñoz M, Laso-Morales MJ, Gómez-Ramírez S, Cadellas M, Nuñez-Matas MJ, García-Erce JA. Pre-operative haemoglobin levels and iron status in a largemulticentre cohort of patients undergoing major elective surgery. Anaesthesia.2017; 72:826–34.
12. Okamoto S, Sato S, Takada Y, Okamoto U. An active stereo-isomer (trans-form) of AMCHA and its antifibrinolytic (antiplasminic) action in vitro and in vivo. Keio J Med. 1964; 13:177-85.
13. Alvarez JC, Santiveri FX, Ramos I, Vela E, Puig L, Escolano F. Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied. Transfusion. 2008; 48(3):519-25.
14. Johansson T, Pettersson LG, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop. 2005; 76(3):314-9.
15. Moskal JT, Capps SG. Meta-analysis of intravenous tranexamic acid in primary total hip arthroplasty. Orthopedics, 2016; 39: e883-92.
16. Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J. 2014; 96-B(8):1005-15.
17. Luo, Z. Y., Wang, H. Y., Wang, D., Zhou, K., Pei, F. X., & Zhou, Z. K. Oral vs intravenous vs topical tranexamic acid in primary hip arthroplasty: a prospective, randomized, double-blind, controlled study. The Journal of arthroplasty, 2018; 33(3), 786-793.
18. Mitchell MD, Betesh JS, Ahn J, Hume EL, Mehta S, Umscheid CA. Transfusion thresholds for major orthopedic surgery: a systematic review and meta-analysis. The Journal of arthroplasty, 2017; 32(12), 3815-3821.
19. Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016; 316:2025–2035.
20. Sebastiá JJP, Martín AM, Rodríguez AH, Cortés VC, Arce JG. Efectividad de un programa de ahorro de sangre en prótesis total de cadera electiva. Revista española de cirugía osteoarticular, 2003; 38(215), 135-139.
21. Pérez-Jimeno N, Muñoz M, Mateo J, Mayoral AP, Herrera A. Efficacy of topical tranexamic acid within a blood-saving programme for primary total hip arthroplasty: a pragmatic, open-label randomised study. Blood Transfusion, 2018; 16(6), 490.
22. Ripollés-Melchor J, et al. Del ahorro de sangre al patient blood management. Med Clin (Barc), 151, 368-373. 2017.
23. Holt JB, Miller B J, Callaghan JJ, Clark CR, Willenborg MD, Noiseux NO. Minimizing blood transfusion in total hip and knee arthroplasty through a multimodal approach. The Journal of arthroplasty. 2016; 31(2), 378-382.
24. Soril LJ, Noseworthy TW, Dowsett LE, Memedovich K, Holitzki HM, Lorenzetti D L, Clement FM. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis. BMJ open. 2018; 8(5), e019912.
25. Faulds J, Whately‐Smith C, Clarke K. Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service: a single‐Centre retrospective study. Transfusion Medicine, 2019.
26. Jans Ø, Kehlet H, Hussain Z, Johansson PI. Transfusion practice in hip arthroplasty–a nationwide study. Vox sanguinis, 2011; 100(4), 374-380..
27. Friedman R, HomeringM, Holberg G, Berkowitz SD. Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am. 2014 Feb 19; 96(4):272-8.
28. Everhart JS, Sojka JH, Mayerson JL, Glassman AH, Scharschmidt TJ. Perioperative allogeneic red blood-cell transfusion associated with surgical site infection after total hip and knee arthroplasty. JBJS. 2018; 100(4), 288-294.
29. Wong S, Tang H, de Steiger R. Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion. ANZ J Surg 2015; 85:461–465.
30. Kopanidis P, Hardidge A, McNicol L, Tay S, McCall P, Weinberg L. Perioperative blood management programme reduces the use of allogenic blood transfusion in patients undergoing total hip and knee arthroplasty. J Orthop Surg Res. 2016; 11: 28.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The generation of derivative works is allowed as long as it is not done for commercial purposes. The original work may not be used for commercial purposes.
How to Cite
