Tendência da transfusão na artroplastia total do quadril após a implementação de um protocolo "Patient Blood Management"
DOI:
https://doi.org/10.31053/1853.0605.v77.n1.26515Palavras-chave:
quadril; transfusão de sangue; artroplastiaResumo
Introdução
A artroplastia total do quadril é um procedimento cirúrgico bem-sucedido e seguro, mas envolve uma perda de sangue associada. Quando esta cirurgia é realizada de forma programada, o implante de uma abordagem multimodal de “Patient Blood Management” (PBM) reduzirá significativamente as necessidades de transfusão.
Objetivo
Apresentar os resultados clínico-analíticos e a incidência de transfusões após o implante de um protocolo PBM nos pacientes submetidos à cirurgia protética do quadril.
Material e métodos
Estudo retrospectivo, unicêntrico, observacional e analítico, entre os pacientes submetidos à artroplastia primária eletiva do quadril entre janeiro de 2017 e fevereiro de 2019. Em todos eles, foi aplicado um protocolo PBM, focado no desenvolvimento de um programa de otimização anemia pré-operatória, uso de ácido tranexâmico tópico e adoção de política restritiva de transfusão.
Resultados
O estudo incluiu um total de 384 pacientes, sendo que apenas 9 necessitaram de transfusão de sangue alogênico (taxa de transfusão: 2,34%). Na análise dos pacientes transfundidos, constatou-se maior tempo de internação (8 ± 2,9 Vs 5,3 ± 2,9 dias; p = 0,007) e maior taxa de complicações (22,2% vs. 3, 9%; p = 0,017), em relação aos que evitaram a TSA.
Conclusão
A aplicação de um protocolo multimodal adequado da PBM nos aproxima da utopia da cirurgia sem sangue na cirurgia protética, resultando em um modelo de baixo custo que reduz significativamente o TSA na artroplastia primária do quadril.
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