Transfusion Thresholds for Major Orthopedic Surgery: A Systematic Review and Meta-analysis

Mitchell, Matthew D.; Betesh, Joel; Ahn, Jaimo; Hume, Eric; Mehta, Samir; Umscheid, Craig A.

doi:10.1016/j.arth.2017.06.054

Cited by 47 publications

(42 citation statements)

References 22 publications

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“…Of note, our findings are supported by two recently published systematic reviews with meta-analyses on blood transfusion regimens within the scope of major orthopaedic surgeries [31,32] that did not find significant differences between the restrictive and the liberal treatment regimen regarding primary outcomes either.…”

Section: Discussionsupporting

confidence: 76%

“…Based on data originating from 8 RCTs, the results of this systematic review do not suggest an increased risk associated with either a restrictive or a more liberal transfusion regimen in patients undergoing major orthopaedic surgery which is in line with previous publications on this topic, including the 2015 Cochrane review on hip fracture surgery patients by Brunskill et al [13] and the aforementioned systematic reviews published in 2017 [31,32]. In this context, it is important to realise that our findings cannot easily be transferred to lower thresholds.…”

Section: Resultssupporting

confidence: 68%

“…Of note, we identified a 50% reduction in the risk of receiving RBCs in the restrictive regimen group (in line with Mitchell et al [32]. Under this aspect, restrictive guidelines definitely contribute to a more conscious use of RBCs without reducing the standard of patient care.…”

Section: Discussionsupporting

confidence: 67%

See 2 more Smart Citations

Mortality, Morbidity and Related Outcomes Following Perioperative Blood Transfusion in Patients with Major Orthopaedic Surgery: A Systematic Review

Müller

Oberle

Drechsel-Bäuerle

et al. 2018

Transfus Med Hemother

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Background: Benefits and risks of liberal and restrictive transfusion regimens are under on-going controversial discussion. This systematic review aimed at assessing both regimens in terms of pre-defined outcomes with special focus on patients undergoing major orthopaedic surgery. Methods: We performed a literature search for mortality, morbidity and related outcomes following peri-operative blood transfusion in patients with major orthopaedic surgery in electronic databases. Combined outcome measure estimates were calculated within the scope of meta-analyses including randomised clinical trials comparing restrictive versus liberal blood transfusion regimens (e.g. MH risk ratio, Peto odds ratio). Results: A total of 880 publications were identified 15 of which were finally included (8 randomised clinical trials (RCTs) with 3,693 patients and 6 observational studies with 4,244,112 patients). Regarding RCTs, no significant differences were detected between the transfusion regimes for all primary outcomes (30-day mortality, thromboembolic events, stroke/transitory ischaemic attack, myocardial infarction, wound infection and pneumonia) and a secondary outcome (length of hospital stay), whereas there was a significantly reduced risk of receiving at least one red blood concentrate under a restrictive regimen. Conclusion: The results of this systematic review do not suggest an increased risk associated with either a restrictive or a liberal transfusion regimen in patients undergoing major orthopaedic surgery.

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Section: Discussionsupporting

confidence: 76%

Section: Resultssupporting

confidence: 68%

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Mortality, Morbidity and Related Outcomes Following Perioperative Blood Transfusion in Patients with Major Orthopaedic Surgery: A Systematic Review

Müller

Oberle

Drechsel-Bäuerle

et al. 2018

Transfus Med Hemother

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“…Por último, el tercer pilar de este PBM, abarca mejorar la tolerancia fisiológica de la anemia en el paciente quirúrgico, optimizando de forma perioperatoria el transporte de oxígeno a los tejidos. En este punto, toma importancia la implementación de una política transfusional restrictiva (12), en la que trabajos recientes (13), sitúan una Hb < 7gr/dl como referencia de "trigger transfusional" en el paciente sano, teniendo en cuenta que estos criterios son laxos y que la necesidad transfusional cuando la Hb se encuentra entre 7 y 10 gr/dl debe estar basada en el riesgo potencial de presentar complicaciones relacionadas con un transporte de oxígeno deficitario. Nuestro objetivo es mostrar los resultados clínico-analíticos y la tendencia transfusional en nuestro centro, tras la aplicación de un abordaje multimodal y multidisciplinar de "Patient Blood Management (PBM)" en la ATC electiva.…”

Section: Introductionunclassified

Tendencia transfusional en la artroplastia total de cadera tras la implantación de un protocolo de “Patient Blood Management”

Pinilla-Gracia

Martín-Hernández²,

Sebastiá³

et al. 2020

Rev Fac Cien Med Univ Nac Cordoba

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Introducción La artroplastia total de cadera es un procedimiento quirúrgico exitoso y seguro, pero que conlleva una inherente perdida sanguínea asociada. Cuando esta cirugía se lleva a cabo de forma programada, la implantación de un abordaje multimodal de Patient Blood Management (PBM), permitirá reducir significativamente las necesidades transfusionales. Objetivo Presentar los resultados clínico-analíticos y la incidencia transfusional tras la implantación de un protocolo de PBM en aquellos pacientes que van a someterse a una cirugía protésica de cadera. Material y métodos Estudio restrospectivo, unicentrico, observacional y analítico, entre aquellos pacientes sometidos a una artroplastia primaria de cadera electiva entre enero de 2017 y Febrero de 2019. En todos ellos, se ha aplicado un protocolo de PBM, centrado en el desarrollo de un programa de optimización de la anemia preoperatoria, la utilización de ácido tranexámico tópico y la adopción de una política transfusional restrictiva. Resultados El estudio incluyó un total de 384 pacientes, donde únicamente 9 precisaron transfusión de sangre alogénica (Tasa transfusional: 2,34%). En el análisis de los pacientes transfundidos, se encontró que presentaban una mayor estancia hospitalaria (8 ±2,9 Vs 5,3 ±2,9 días; p=0,007) y un mayor índice de complicaciones (22,2% vs 3,9%; p=0,017), respecto a aquellos que eludieron la TSA. Conclusión La aplicación de un adecuado protocolo multimodal de PBM, nos acerca a la utopía de una cirugía sin sangre en la cirugía protésica, resultando un modelo costo-efectivo que permite reducir de forma significativa la TSA en la artroplastia primaria de cadera.

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“…7 Rapid blood loss during surgery may disturb patient hemodynamics, imposing them to hypoxia and ischemia, and increased risk for morbidity and mortality. 6,8,9 On the other hand, ensuring blood availability requires complex management, and if blood product remains unused until it reaches its expiry date, it goes to waste. This waste accounted for a loss of US$ 400,000 in January-July 2017 in our hospital, where only 3,000 packs were used out of roughly 7,000 packs that were prepared for surgery.…”

Section: Introductionmentioning

confidence: 99%

Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors

Auerkari¹,

Tantri²,

Alatas³

2019

bjoa

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Background: Over half of soft tissue tumor surgeries require intraoperative packed red cell (PRC) transfusion. Several factors that can be identified in the preoperative period have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion. Methods: A retrospective cohort was analyzed on 84 records of orthopedic soft tissue tumor surgery during 2014-2018. Data were analyzed by linear regression and multivariate analysis. Conclusion: tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.

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Transfusion Thresholds for Major Orthopedic Surgery: A Systematic Review and Meta-analysis

Cited by 47 publications

References 22 publications

Mortality, Morbidity and Related Outcomes Following Perioperative Blood Transfusion in Patients with Major Orthopaedic Surgery: A Systematic Review

Mortality, Morbidity and Related Outcomes Following Perioperative Blood Transfusion in Patients with Major Orthopaedic Surgery: A Systematic Review

Tendencia transfusional en la artroplastia total de cadera tras la implantación de un protocolo de “Patient Blood Management”

Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors

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