April 1, 2014
Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland.
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Discussion
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Implication
Observational study reveals that patient blood management reduces transfusion rates and blood loss in orthopaedic surgery, indicating the efficacy of multidisciplinary blood-saving protocols.
Key Points
- To assess the effect of implementing a systematic Patient Blood Management programme on immediate pre-operative anaemia, red blood cell mass loss, and transfusion requirements in elective orthopaedic surgery.
- Analysed 8,871 elective orthopaedic operations (hip, n=3,062; knee, n=2,953; spine, n=2,856) conducted between 2008 and 2011 at a university hospital in Zurich, Switzerland.
- Compared outcomes between Period 1 (2008, before programme implementation) and Period 2 (2009–2011, after implementation of pre-operative anaemia treatment, surgical blood-saving techniques, and standardized transfusion triggers).
- In knee surgery, pre-operative anaemia declined from 15.5% to 7.8% (p<0.001), red blood cell mass loss decreased from 573±355 to 476±365 mL (p<0.001), transfusion rates fell from 19.3% to 4.9% (p<0.001), and transfused red blood cell units dropped from 0.53±1.27 to 0.16±0.90 units (p<0.001).
- In hip surgery, pre-operative anaemia decreased from 17.6% to 12.9% (p<0.001) and transfusion rate fell from 21.8% to 15.7% (p<0.001), while red blood cell mass loss (626±434 vs 635±450 mL; p=0.974) and units transfused (p=0.761) remained unchanged.
- In spine surgery, pre-operative anaemia was unchanged (p=0.113), but red blood cell mass loss dropped from 551±421 to 404±337 mL (p<0.001), transfusion rates declined from 18.6% to 8.6% (p<0.001), and units transfused fell from 0.66±1.80 to 0.22±0.89 units (p=0.008).
Cite This Study
Theusinger et al. (2014) studied this question.