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Maximum surgical blood ordering schedules for revision lower limb arthroplasty

  • Orthopaedic Surgery
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Abstract

Background

Effective utilisation of blood products is fundamental. The introduction of maximum surgical blood ordering schedules (MSBOS) for operations has been shown to improve transfusion services. A retrospective analysis was undertaken to establish an evidence-based MSBOS for revision total hip replacement (THR) and total knee revision (TKR). The impact of this schedule on blood conservation was analysed.

Methods

A retrospective analysis was undertaken on 397 patients who underwent revision THR and TKR over a 4-year period. The cross-match-to-transfusion ratio (CTR) and transfusion index (TI) were calculated. A MSBOS protocol was created based on the TIs and its’ impact on transfusion services was assessed prospectively on 125 patients by comparing CTRs.

Results

In revision THR, TI was 1.19 for elective cases, 1.55 for emergency cases and 2.35 for infected cases. There was no difference in TI for revisions of cemented and uncemented components. Single component THR revision required less transfusion. In revision TKR, TI was 0.31 for elective cases, 2.0 for emergency cases and 1.23 for cases with infection. The introduction of the MSBOS protocol had resulted in a considerable improvement in blood ordering. Reductions in the CTR were seen for all types of revision surgery, but most evident in elective revision THR (3.24–2.18) and elective revision TKR (7.95–1.2).

Conclusions

Analysis confirmed that excessive cross-matching occurred for revision lower limb arthroplasty. The introduction of our MSBOS protocol promoted blood conservation and compliance with established national guidelines.

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References

  1. Sharma S, Cooper H, Ivory JP (2002) An audit on the blood transfusion requirements for revision hip arthroplasty. Ann R Coll Surg Engl 84(4):269–272

    Article  PubMed  CAS  Google Scholar 

  2. Bridgens JP, Evans CR, Dobson PMS, Hamer AJ (2007) Intraoperative red blood-cell salvage in revision hip surgery: a case-matched study. J Bone Joint Surg Am 89(2):270–275

    Article  PubMed  CAS  Google Scholar 

  3. Nicholis MD (1993) How safe is blood? Anaesth Intensive Care 21:13–14

    Google Scholar 

  4. Bird SM (2004) Recipients of blood or blood products ‘at vCJD risk’. BMJ 328(7432):118–119

    Article  PubMed  Google Scholar 

  5. National Blood Service (2004) UK blood services defer transfused blood donors [news release]. National Blood Service, Mar 16

  6. Clarke A, O’Malley M, Hegarty JF, Freeman BJC (2006) Blood audit evidence-based cross-match requesting for lumbar spine surgery. Spine 31(12):E373–E375

    Article  PubMed  Google Scholar 

  7. Rogers BA, Johnstone DJ (2006) Audit on the efficient use of cross-matched blood in elective total hip and total knee replacement. Ann R Coll Surg Engl 88(2):199–201

    Article  PubMed  CAS  Google Scholar 

  8. Hamer AJ, Dobson PMS, Earnshaw PH, Knowles S, Newman JH (2005) Blood conservation in elective orthopaedic surgery. Br Orthop Assoc, London

    Google Scholar 

  9. Voak D, Napier JAF, Boulton FE, Cann R, Finney RD, Fraser ID, Wagstaff W, Waters AH, Wood JK (1990) British Committee for Standards in haematology blood transfusion task force guidelines for implementation of a maximum surgical blood order schedule. Clin Lab Haematol 12:321–327

    Article  Google Scholar 

  10. Richardson NGB, Bradley WN, Donaldson DR, O’Shaughnessy DF (1998) Maximum surgical blood ordering schedule in a district general hospital saves money and resources. Ann R Coll Surg Engl 80(4):262–265

    PubMed  CAS  Google Scholar 

  11. Wilson WJ (1989) Intraoperative autologous transfusion in revision total hip arthroplasty. J Bone Joint Surg Am 71:8–14

    PubMed  CAS  Google Scholar 

  12. 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 85:2147–2151

    PubMed  Google Scholar 

  13. Semkiw LB, Schurman DJ, Goodman SB, Woolson ST (1989) Postoperative blood salvage using cell saver after total joint arthroplasty. J Bone Joint Surg Am 71:823–827

    PubMed  CAS  Google Scholar 

  14. Gehrke T (2005) Revision is not difficult!. In: Breusch SJ, Malchau H (eds) The well-cemented total hip arthroplasty: theory and practice. Springer, Berlin, pp 348–358

    Chapter  Google Scholar 

  15. Lemaire R (2008) Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br 90(B9):1128–1136

    PubMed  CAS  Google Scholar 

  16. 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 non-anemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 86(A1):57–61

    PubMed  Google Scholar 

  17. Guay J (2006) Postoperative pain significantly influences postoperative blood loss in patients undergoing total knee replacement. Pain Med 7(6):476–482

    Article  PubMed  Google Scholar 

  18. The Sanguis Study Group (1994) Use of blood products for elective surgery in 43 European hospitals. Transfus Med 4:251–268

    Google Scholar 

  19. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81:2–10

    PubMed  CAS  Google Scholar 

  20. Churchill WH, McGurk S, Chapman RH, Wallace EL, Bertholf MF, Goodnough LT et al (1998) The Collaborative Hospital Transfusion Study: variations in use of autologous blood account for hospital differences in red cell use during primary hip and knee surgery. Transfusion 38:530–539

    Article  PubMed  CAS  Google Scholar 

  21. Hatzidakis AM, Mendlick RM, McKillip T, Reddy RL, Garvin KL (2000) Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogeneic transfusion. J Bone Joint Surg Am 82:89–100

    PubMed  CAS  Google Scholar 

  22. Borghi B, Fanelli G, Celleno D (1999) Autotransfusion with predeposit-haemodilution and perioperative blood salvage: 20 years of experience Rizzoli Study Group on Orthopaedic Anesthesia. Int J Artif Organs 22:230–234

    PubMed  CAS  Google Scholar 

  23. Carson JL, Terrin ML, Magaziner J, Chaitman BR, Apple FS, Heck DA, Sanders D (2006) Transfusion trigger trial for functional outcomes in cardiovascular patients undergoing surgical hip fracture repair. Transfusion 46:2192–2206

    Article  PubMed  Google Scholar 

  24. Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? a meta-analysis and systematic review. Knee 17(2):141–147

    Article  PubMed  Google Scholar 

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Correspondence to Devendra Mahadevan.

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Mahadevan, D., Challand, C., Clarke, A. et al. Maximum surgical blood ordering schedules for revision lower limb arthroplasty. Arch Orthop Trauma Surg 131, 663–667 (2011). https://doi.org/10.1007/s00402-010-1204-2

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