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Blood transfusion requirements in lower limb arthroplasties might be dramatically reduced if orthopaedic surgeons were concerned about preoperative anaemia

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Background

The pre-operative blood haemoglobin concentration may affect the need for post-operative allogenic red blood cell transfusion. The prevalence of anaemia in patients undergoing major surgery is high, and orthopaedic surgeons are usually not aware of it. The aims of this study were to estimate the prevalence of pre-operative anaemia and to assess its impact on post-operative requirements for allogenic red blood cell transfusions (ARBCT) in the post-operative period following primary elective total knee and hip replacement.

Material and methods

We performed a retrospective study of consecutive patients who underwent primary knee and hip joint replacement between July 2010 and June 2011 in a tertiary referral centre for knee and hip replacement. According to the WHO, anaemia was defined as blood haemoglobin concentration <13 g/dL for men and <12 g/dL for women. In accordance with the blood transfusion protocol of our hospital, an allogenic red blood cell unit was indicated when blood haemoglobin concentration was <8 g/dL; or <8.5 g/dL in patients with heart disease or older than 70 years; or between 8.5 and 9 g/dL in patients who had poor orthostatic tolerance. The number of patients who received an allogenic red blood cell unit (300 mL) during the post-operative period (from surgery until discharge) was gathered.

Results

A total of 276 consecutive patients (28 % males, 72 % females) were included [mean (sd) age 72 years (10)]: 174 knees and 102 hips. The overall prevalence of pre-operative anaemia was 12 % (33/276, 95 % CI 8–16 %): 13 % (23/174, 95 % CI 9–19 %) in the knee group and 10 % (10/102, 95 % CI 5–17 %) in the hip group. The post-operative ARBCT rate was 31 % (85/276, 95 % CI 25–36 %): 22 % in the knee group (38/174, 95 % CI 16–29 %) and 46 % in the hip group (47/102, 95 % CI 36–56 %) (p < 0.001). Of the 33 pre-operative anaemic patients (23 knees, 10 hips), 22 (67 %, 95 % CI 48–82 %) received ARBCT: 12/23 (52 %) in the knee group and 10/10 (100 %) in the hip group (p = 0.002). Pre-operative anaemia was the main risk factor for requiring transfusion (p < 0.001).

Conclusion

Pre-operative anaemia has a clear and determinant impact on post-operative requirements for allogenic red blood cell transfusion in total knee and hip replacement. Treatment of pre-operative anaemia in joint replacements might reduce the allogenic red blood cell transfusion rate. Orthopaedic surgeons should be aware of the pre-operative haematological status of those patients who will undergo for an arthroplasty of the lower limb.

The protocol was approved by the ethics committee at Hospital de la Santa Creu i Sant Pau (code: IIBSP-ANE-2011-86).

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Acknowledgments

The authors express their gratitude to Carolyn Nephew for the translation of the manuscript and to Ignasi Gigh for the statistical analysis. Dr. Xavier Aguilera is a PhD candidate in the Department of Surgery, Universidad Autònoma de Barcelona, Spain.

Conflict of interest

None.

Ethical standard

The patients gave the informed consent prior being included into the study, and it was authorized by the local ethical committee and performed in accordance with the Ethical standards of the 1964 Declaration of Helsinki as revised in 2000.

Funding

No benefits or funds were received in support of this study.

Author information

Authors and Affiliations

  1. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Catalunya, Spain

    Luis Natera, Xavier Aguilera Roig & Jose Carlos González Rodriguez

  2. Hospital General de Catalunya, Street Pedro i Pons 1, 08190, Sant Cugat del Vallés, Catalunya, Spain

    Luis Natera

  3. CO+T-Clínica Ntra. Sra. Del Remei, Street Escorial 148, 08024, Barcelona, Catalunya, Spain

    Luis Natera

  4. Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Catalunya, Spain

    Adrià Font Gual

  5. Department of Haematology and Blood Bank, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Catalunya, Spain

    Alba Bosch Llobet

  6. Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Plaça de la Mercè 10-12, 08002, Barcelona, Catalunya, Spain

    Sebastià Videla Ces

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  1. Luis Natera
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Correspondence to Luis Natera.

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Natera, L., Roig, X.A., Rodriguez, J.C.G. et al. Blood transfusion requirements in lower limb arthroplasties might be dramatically reduced if orthopaedic surgeons were concerned about preoperative anaemia. Eur Orthop Traumatol 6, 107–113 (2015). https://doi.org/10.1007/s12570-015-0297-z

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  • DOI: https://doi.org/10.1007/s12570-015-0297-z

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