Skip to main content

Advertisement

SpringerLink
Log in

Prolonged operative time increases risk of blood loss and transfusion requirements in revision hip surgery

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Revision hip surgery is well documented to have a high association with substantial blood loss and the associated need for a blood transfusion. This exposes the patient to increased risk of transfusion reaction and blood borne infection. There are many strategies to minimize allogeneic transfusion rates in revision surgery such as pre-operative autologous donation, peri-operative tranexamic acid, thrombin sealants, normovolaemic haemodilution, intra-operative blood salvage and the use of post-operative autologous drains.

Patients and methods

We prospectively looked at 177 consecutive cases performed at one centre by a single surgical and anaesthetic team to identify which patient and operative factors were most significant in minimizing the requirement for an allogeneic blood transfusion.

Results

Our results identified the duration of surgery as being the only significant variable affecting the level of blood loss. We noted a 3% increase in the probability of massive blood loss (> 2000 mls) for every minute of increased surgical time in our series.

Conclusions

We conclude that measures to minimize the duration of surgery would be beneficial in reducing blood loss and the risks of requiring blood transfusions in revision hip surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. National Joint Registry for England and Wales. https://www.njrcentre.org.uk. Accessed July 2019

  2. Harkness M, Palmer JB, Watson D, Walsh TS (2008) A questionnaire-based survey of perioperative blood conservation practice for revision hip arthroplasty in Scotland. Transfus Med 18(5):296–301

    Article  CAS  Google Scholar 

  3. Herd JM, Joseph JJ, McGarvey M, Tsimbouri P, Bennett A, Meek RMD et al (2014) Intraoperative cell salvage in revision hip surgery. Ann Med Surg 3(1):8–12

    Article  CAS  Google Scholar 

  4. Park KJ, Couch CG, Edwards PK, Siegel ER, Mears SC, Barnes CL (2016) Tranexamic acid reduces blood transfusions in revision total hip arthroplasty. J Arthroplast 31(12):2850–2855.e1

    Article  Google Scholar 

  5. Muñoz M, García-Erce JA, Villar I, Thomas D (2009) Blood conservation strategies in major orthopaedic surgery: efficacy, safety and European regulations. Vox Sang 96(1):1–13

    Article  Google Scholar 

  6. Monsef J, Boettner F (2014) Blood management may have an impact on length of stay after total hip arthroplasty. HSS J 10(2):124–130

    Article  Google Scholar 

  7. Greenky M, Shaner J, Rasouli MR, Han S-B, Parvizi J, Hozack WJ (2014) Intraoperative blood salvage in revision total hip arthroplasty: who benefits most? J Arthroplast 29(6):1298–1300

    Article  Google Scholar 

  8. Walsh TS, Palmer J, Watson D, Biggin K, Seretny M, Davidson H et al (2012) Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion. Br J Anaesth 108(1):63–71

    Article  CAS  Google Scholar 

  9. Tornero E, Pereira A, Bravo J, Angulo S, Basora M, Marcos M et al (2016) Transfusion of packed red blood cells stored %3e14 days was associated with a higher risk of infection after hip revision arthroplasty. Hip Int J Clin Exp Res Hip Pathol Ther 26(2):132–137

    Google Scholar 

  10. Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA et al (2001) Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 83-A(11):1622–1629

    Article  Google Scholar 

  11. https://gettingitrightfirsttime.co.uk/wp-content/uploads/2017/06/GIRFT-National-Report-Mar15-Web.pdf. Accessed Dec 2019

  12. Carson JL, Terrin ML, Barton FB, Aaron R, Greenburg AG, Heck DA et al (1998) A pilot randomized trial comparing symptomatic vs. hemoglobin-level-driven red blood cell transfusions following hip fracture. Transfusion (Paris) 38(6):522–529

    Article  CAS  Google Scholar 

  13. Hogue CW, Goodnough LT, Monk TG (1998) Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy. Transfusion (Paris) 38(10):924–931

    Article  Google Scholar 

  14. Nielsen K, Johansson PI, Dahl B, Wagner M, Frausing B, Børglum J et al (2014) Perioperative transfusion threshold and ambulation after hip revision surgery—a randomized trial. BMC Anesthesiol 14:89

    Article  Google Scholar 

  15. Goodnough LT, Monk TG, Despotis GJ, Merkel K (1999) A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total knee arthroplasty. Vox Sang 77(1):11–16

    Article  CAS  Google Scholar 

  16. Rashiq SFB (2006) The effect of spinal anesthesia on blood transfusion rate in total joint arthroplasty. Can J Surg 49(6):391–396

    PubMed  PubMed Central  Google Scholar 

  17. Zarin J, Grosvenor D, Schurman D, Goodman S (2003) Efficacy of intraoperative blood collection and reinfusion in revision total hip arthroplasty. J Bone Joint Surg Am 85-A(11):2147–2151

    Article  Google Scholar 

  18. Garvin KL, Feschuk CA, Sekundiak TD, Lyden ER (2005) Blood salvage and allogenic transfusion needs in revision hip arthroplasty. Clin Orthop 441:205–209

    Article  Google Scholar 

  19. Bridgens JP (2007) Intraoperative red blood-cell salvage in revision hip surgery: a case-matched study. J Bone Joint Surg Am 89(2):270

    Article  CAS  Google Scholar 

  20. Phillips SJ (2006) Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery? J Bone Joint Surg Br Vol 88-B(9):1141–1142

    Article  Google Scholar 

  21. Ghoz A, Al-Khateeb H, Rajkumar S, Tavares S, Andrade A (2015) Use of a thrombin fibrin sealant in reducing blood loss in revision hip arthroplasty. Open Orthop J 9(1):511–514

    Article  Google Scholar 

  22. British National Formulary Online. Transexamic acid https://bnf.org/bnf/bnf/current/2829.htm. Accessed July 2019

  23. Kandemir T, Kandemir E, Askin T, Dal T, Kilic Y, Unver S (2016) massive blood transfusion during revision total hip arthroplasty under combined spinal epidural anaesthesia. Turk J Anesth Reanim 44(1):54–56

    Article  Google Scholar 

  24. Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A(6):1146–1152

    Article  Google Scholar 

  25. Walmsley PJ (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br Vol 87-B(10):1397–1401

    Article  Google Scholar 

  26. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E (2004) Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 86-A(1):57–61

    Article  Google Scholar 

Download references

Funding

None of the authors received funding or have any financial or non-financial interests in the results of this study. It was a retrospective review that did not require ethics committee approval.

Author information

Authors and Affiliations

  1. Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK

    Jonathan Manara

  2. Royal United Hospital, Combe Park, Bath, BA1 3NG, UK

    Harvey Sandhu

  3. Poole Hospital NHS Foundation Trust, Bournemouth University, Poole, BH15 2JB, UK

    Michael Wee

  4. Weston General Hospital, Grange Rd, Weston-super-Mare, BS23 4TQ, UK

    Adekoyejo Odutola

  5. Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB, UK

    Thomas Wainwright & Robert Middleton

  6. Barts and The London School of Medicine and Dentistry, 1st Floor, Abernethy Building, 2 Newark Street, London, E1 2AT, UK

    Charles Knowles

  7. Physiotherapy Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW, UK

    Thomas Wainwright

  8. Orthopaedic Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW, UK

    Robert Middleton

Authors
  1. Jonathan Manara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harvey Sandhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Wee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adekoyejo Odutola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Wainwright
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles Knowles
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Middleton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan Manara.

Ethics declarations

Conflict of interest

None of the above authors have anything to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manara, J., Sandhu, H., Wee, M. et al. Prolonged operative time increases risk of blood loss and transfusion requirements in revision hip surgery. Eur J Orthop Surg Traumatol 30, 1181–1186 (2020). https://doi.org/10.1007/s00590-020-02677-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-020-02677-4

Keywords

Search

Navigation