Comprehensive Look at Blood Transfusion Utilization in Total Joint Arthroplasty at a Single Academic Medical Center under a Single Surgeon

Abstract

The utilization of autologous and allogeneic transfusions in total joint arthroplasties was to characterize patients who may benefit from giving preoperative blood donations. We conducted a retrospective chart review of 525 patients to document preoperative hematocrit, estimated blood loss, length of stay, transfusions, and medical comorbidities. Results of our review showed that total hip arthroplasty revision (THA-R) had the highest prevalence of transfusions (60%) followed by total hip arthroplasty (THA, 53%), total knee arthroplasty-revision (TKA-R, 33%), and total knee arthroplasty (TKA, 23%). There was significant waste of autologous donations: 92% of TKA patients, 64% of THA, and 33% of THA-R patients wasted on average 1.527, 1.321, and 1.5 autologous units, respectively. Pre-operative hematocrit was the strongest predictor of future transfusion need across all procedures, and primary THA had additional predictors in age and gender.

The Association between Hemoglobin Value and Estimation of Amount of Intraoperative Blood Loss

“…Therefore, we can predict possibly when patients will need to transfusion if we have basic Hb value. Robinson et al showed that intraoperative transfusion was highly related to primary hemoglobin [2].…”

“…Specialists have various opinions about this. This discrepancy leads to frequent and sometimes, unnecessary transfusions [1] [2]. Over decades, evidences showed that transfused patients expose with different adverse events (particularly, allogeneic blood) [1] [2] [3] [4] [5] such as postoperative pneumonia, sepsis and death [3].…”

“…This discrepancy leads to frequent and sometimes, unnecessary transfusions [1] [2]. Over decades, evidences showed that transfused patients expose with different adverse events (particularly, allogeneic blood) [1] [2] [3] [4] [5] such as postoperative pneumonia, sepsis and death [3]. American association of blood bank (AABB) recommended restricted transfusion [4] and many authors strictly appreciated on transfusion when Hb < 8 gr/dL (i.e.…”

Current Status of Blood Transfusion and Antifibrinolytic Therapy in Orthopedic Surgeries

“…The study concluded that better models are necessary to predict which patients are at an increased risk for a blood transfusion during the perioperative period. The collected data suggest that the preoperative hematocrit is the most important factor when assessing the need for blood transfusion, additional variables including age, race, gender, BMI, and comorbidities ( 31 ).…”

“…Multiple surveys addressed to Dutch and UK orthopedic surgeons within the last decade revealed an increased awareness and a positive attitude toward perioperative BSMs. The need for perioperative blood management directed toward improving patient outcome with reduced ABT is generally recognized ( 31 , 33 ). The hemoglobin threshold warranting transfusion continues to be debated among anesthesiologists and orthopedic surgeons ( 34 ).…”