Abstract
This study was designed to evaluate the effect of transfusion guidelines on perioperative blood usage with a view to identifying a protocol for transfusion therapy in our hospital. Eighty consecutive patients with normal haemoglobin concentrations presenting for total hip arthroplasty were studied. The maximum allowable blood loss (MABL) was calculated for each patient using the formula of Kallos et al. Blood loss up to this value was replaced with Haemaccel. When the MABL was reached, a haematocrit (Hct) was performed and blood was given if the Hct was less than 30 in men and 27 in women. Otherwise replacement was with Haemaccel. All postoperative complications, duration of hospital stay, and physiotherapy compliance assessments were recorded. A discharge Hct > 36% was the criterion for overtransfusion. The results were compared with findings from a retrospective group before the introduction of these guidelines. Analysis of the data demonstrated a reduction in the frequency of transfusion (97% vs 32% P<0.05), the volume transfused (2.7 vs 1.3 units P < 0.05), and the incidence of overtransfusion (45% vs 5% P < 0.05) between the two groups of patients. There was no difference between the groups in complication rate, duration of hospital stay or physiotherapy scoring. We conclude that the introduction of guidelines for transfusion in total hip arthroplasty patients has produced a marked reduction in blood usage in our hospital without detrimental effect.
Résumé
Ce travail consiste à évaluer le résultat de l’utilisation de critères transfusionnels créés dans le but de rédiger un protocole régissant l’administration du sang dans notre hôpital. Font l’objet de l’étude, quatre-vingt patients consécutifs programmés pout prothèse totale de la hanche et présentant des concentrations normales d’hémoglobine. La perte sanguine maximale permise est calculée d’après la formule de Kallos et col. Le sang perdu est d’abord remplacé par de l’Hemaccel. Une fois la perte sanguine maximale permise atteinte, on mesure l’hématocrite est on administre du sang si l’hématocrite est inférieur à 30% chez les hommes et 27% chez les femmes. Sinon, on remplace par de l’Hemaccel. Les complications postopératoires, la durée du séjour hospitalier et l’évaluation de la tolérance à la physiothérapie sont enregistrées. Une mise en congé avec un hématocrite supérieur à 30% est considérée comme un critère de transfusion excessive. Les résultats sont comparés avec les constatations d’une étude rétrospective réalisée avant l’introduction de ces critères. L’analyse des données montre une diminution dans la fréquence des transfusions (97% vs 32%, P < 0,05), du volume transfusé (2,7 vs 1,31 unités, P < 0,05), et de l’incidence de transfusions inutiles (45% vs 5%, P < 0,05) entre les deux groupes de patients. On n’a pas trouvé de différence entre les groupes en ce qui a trait au pourcentage de complications, à la durée du séjour hospitalier et à la tolérance du patient pour la physiothérapie. Nous concluons que dans notre hôpital l’introduction de critères transfusionnels appliqués aux prothèses totales de la hanche permet une baisse considérable de l’utilisation du sang sans présenter d’effets nuisibles.
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McSwiney, M.M., O’Farrell, D., Joshi, G.P. et al. Blood transfusion in total hip arthroplasty: guidelines to eliminate overtransfusion. Can J Anaesth 40, 222–226 (1993). https://doi.org/10.1007/BF03037034
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DOI: https://doi.org/10.1007/BF03037034