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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(04): 569-576
DOI: 10.1055/s-0041-1731359
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Reducing Blood Transfusions in Primary Total Hip Replacement Patients: Effectiveness of Near-patient Testing and a Dedicated Preoperative Anemia Clinic[*]

Article in several languages: português | English
Darren Sandean 
1   Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
,
Michail Samaras
1   Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
,
Urjit Chatterji
1   Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
,
Richard Power
1   Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
,
Hafiz Qureshi
1   Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
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Abstract

Objective Preoperative anemia in orthopedic patients is associated with higher allogeneic blood transfusion rates and poorer outcomes. Up to 25% of the patients listed for major orthopedic surgery have some degree of anemia. Good perioperative patient blood management is essential to reduce the sequelae of anemia and the need for transfusions. We assessed the efficacy of rapid near-patient testing in conjunction with a dedicated preoperative anemia clinic for screening and treating primary total hip replacement (THR) patients for anemia.

Methods A comparison of overall allogeneic blood transfusion rates was made for patients undergoing primary total hip replacement before and after the implementation of near-patient testing and of a dedicated preoperative anemia clinic over 1 year. A comparison was also performed between anemic patients who were referred to the clinic with those who were not referred. Preoperative hemoglobin levels, allogeneic blood transfusion rates and clinic treatment for 1,095 patients were reviewed.

Results There was a significant decrease in transfusion rates in patients undergoing primary THR from 10.0 to 6.2% (p < 0.05; χ2 test) after the implementation of near-patient testing and of a dedicated preoperative anemia clinic pathway. The allogeneic blood transfusion rate for anemic patients who were treated in the clinic was 6.7% compared with 26.9% for patients who were anemic preoperatively but were not treated in the clinic (p < 0.05; Fisher exact test). On average, treatment in the pathway increased the hemoglobin of the patients by 20 g/L, from 104 g/L to 124 g/L (p < 0.001).

Conclusions Near-patient testing, in conjunction with a dedicated preoperative anemia clinic, reduces perioperative allogenic blood transfusion requirements for patients undergoing primary THR by providing rapid identification and effective treatment of preoperative anemia.

Keywords

blood transfusion - anemia - arthroplasty, replacement, hip - preoperative period

Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Study developed at University Hospitals of Leicester, Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW.




Publication History

Received: 15 July 2020

Accepted: 01 December 2020

Article published online:
01 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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