Transfusion Therapy in Elective Total Hip Arthroplasty G. P. Joshi, J. Brangan, C. P. Kelly, S. M. McCarroll.
Cappagh Orthopaedic tlospital, Dublin Abstract A retrospective audit of transfusion practice in 150 consecutive elective primary total hip arthroplasties was undertaken, to examine blood usage and to determine the potential for reduction in its use. Predetermined criteria were used to measure unnecessary transfusions. Transfusion was considered unnecessary if the discharge haematncrit exceeded 36%, or if patients who lost less than 30% of their estimated blood volume, were transfused. Using these criteria, overtransl'usion occurred in 42-45% patients. The intra-operative blood transfused correlated well with intra-operative blood lost. All other variables showed no significant correlation with both intra-operative and post-operative blood transfused. Females lost less and wereAransfused significantly more than males. The study corroborates previous reports of blood overuse. These results suggest that adopting standards of practice t0 measure and to monitor transfusion practice (quality assurance programmes) would be a worthwhile objective. Introduction Blood is a finite resource with a limited shelf life and is associated with high processing costs. Blood transfusion is not without hazard. Risks of homologous transfusion vary in type and severity and include transmission of infectious diseases such as Hepatitis C and A.!.D.S.; immanosuppression resulting in possible increased incidence of infection and tumour recurrence and various n0n-specific haemolytic and nonhaemolytic reactions~~. Transmission of infection is at present the major concern. Current screening methods do not eliminate completely the risk of these diseases as some donors are infectious prior to having positive serology. Blood transfusion was classified by the American Joint Commission on Accreditation of Hospitals as "high volume, high risk and error prone ''6. Utilisation of this valuable resource needs critical review to identify areas of over use and thus reduce risk to patient and also reduce hospital costs. Demands for blood can be reduced by studying blood utilisation (qualityassessment) and establishingguidelinesfor transfusion of elective surgical patients. The aims of our study were to evaluate transfasion practice in patients undergoing elective primary total hip arthr0plasty, to conduct quality assessment of blood transfusion practice by means of key usage indicators, to compare these results with other similar studies and to determine the potential for reduction in blood administration.
period, each admission was treated as a separate case. There were no changes in the surgicaltechnique or blood transfusion practice throughout ~ e period studied. All patients had a cemented Chamley total hip arthroplasty by the standard wans-trochanteric approach. The following data was recorded: age, sex, weight, diagnosis, anaesthetic technique, pre-operative hacmoglobin and haematocrit levels, 48 hour post-operative and discharge haemoglobin and haematocrit levels. Intra-opemtive blood loss was estimated by weighing swabs and measuring blood volume in the suction bottles. Total blood loss included intraoperative blood loss and blood in the suction drainage system (Redivac) up to the time of their removal usually 48 hours post-opa'atively. Blood transfused was recorded in units (whole blood or red cell concentrate). Blood given during the operation and in the recovery room was considered as intra-operative transfusion. A discharge hacmatocrit exceeding 36% was chosen as a criterion to identify unnecessary transfusion. The second criterion we used to analyse overtransfusion was blood transfusion in patients with blood loss o[ less than 30% Of their estimatedblood volume (EBV). Blood volume was estimated as 70 ml/kg body weight7. Patients with a pro-operative anaemia, that is haemoglobin of less than 13.0 gm/dl in males and 11.5 gm/dl in females were excluded from this analysis. A spread sheet and statistical soft ware was used for analysis of the data. Results between males and females were analy~d using students-t test and correlation coefficients. A p value of less than 0.05 was considered significant.
Methods A retrospective study was performed in which data was collected from the charts of 150 consecutivepatients who had an electivep r i m l y total hip arthroplasty (THA) between June 1989 and December 1989. If the patient had more than one admission for a primary total hip arthroplasty during the study
Results The demographic data recorded is displayed in Table I. The underlying pathology was osteoarthritis in 83%, rheumatoid "arthritis in 13.6% and 3.4% other diseases which included ankylosing spondylitis, trauma, congenital hip dislocation and acromegaly. Spinal anaesthesia was used in 137 (91.3%) patients, 12 (8.0%) had general anaesthesia and one (0.7%) had epidural anaesthesia.
Correspondence to: Dr. Girish P. Joshi, Visiting Assistant Prof., Dept. ef Anaes~esiolegy, Oregon Health Sciences University, School ef Medicine, 3181 Sam Jackson Carte Read, Portland, Oregon, 97201-3098, U.S.A. 404
Vok 161 ,
Transfusion therapy in total hip arthropldsty
No. 6
TABLE 1 Demographic and Clinical Data- Mean _+S.D. Males n Age (years) Weight (kgs) Pre-op Hb (gms/dl) Pre-op Hot (%) Discharge Hbj(gms/dl) Discharge Het (%)
was a statistically significant cliffetence in the total blood transfused between the males and the females (p
Cappagh Orthopaedic tlospital, Dublin Abstract A retrospective audit of transfusion practice in 150 consecutive elective primary total hip arthroplasties was undertaken, to examine blood usage and to determine the potential for reduction in its use. Predetermined criteria were used to measure unnecessary transfusions. Transfusion was considered unnecessary if the discharge haematncrit exceeded 36%, or if patients who lost less than 30% of their estimated blood volume, were transfused. Using these criteria, overtransl'usion occurred in 42-45% patients. The intra-operative blood transfused correlated well with intra-operative blood lost. All other variables showed no significant correlation with both intra-operative and post-operative blood transfused. Females lost less and wereAransfused significantly more than males. The study corroborates previous reports of blood overuse. These results suggest that adopting standards of practice t0 measure and to monitor transfusion practice (quality assurance programmes) would be a worthwhile objective. Introduction Blood is a finite resource with a limited shelf life and is associated with high processing costs. Blood transfusion is not without hazard. Risks of homologous transfusion vary in type and severity and include transmission of infectious diseases such as Hepatitis C and A.!.D.S.; immanosuppression resulting in possible increased incidence of infection and tumour recurrence and various n0n-specific haemolytic and nonhaemolytic reactions~~. Transmission of infection is at present the major concern. Current screening methods do not eliminate completely the risk of these diseases as some donors are infectious prior to having positive serology. Blood transfusion was classified by the American Joint Commission on Accreditation of Hospitals as "high volume, high risk and error prone ''6. Utilisation of this valuable resource needs critical review to identify areas of over use and thus reduce risk to patient and also reduce hospital costs. Demands for blood can be reduced by studying blood utilisation (qualityassessment) and establishingguidelinesfor transfusion of elective surgical patients. The aims of our study were to evaluate transfasion practice in patients undergoing elective primary total hip arthr0plasty, to conduct quality assessment of blood transfusion practice by means of key usage indicators, to compare these results with other similar studies and to determine the potential for reduction in blood administration.
period, each admission was treated as a separate case. There were no changes in the surgicaltechnique or blood transfusion practice throughout ~ e period studied. All patients had a cemented Chamley total hip arthroplasty by the standard wans-trochanteric approach. The following data was recorded: age, sex, weight, diagnosis, anaesthetic technique, pre-operative hacmoglobin and haematocrit levels, 48 hour post-operative and discharge haemoglobin and haematocrit levels. Intra-opemtive blood loss was estimated by weighing swabs and measuring blood volume in the suction bottles. Total blood loss included intraoperative blood loss and blood in the suction drainage system (Redivac) up to the time of their removal usually 48 hours post-opa'atively. Blood transfused was recorded in units (whole blood or red cell concentrate). Blood given during the operation and in the recovery room was considered as intra-operative transfusion. A discharge hacmatocrit exceeding 36% was chosen as a criterion to identify unnecessary transfusion. The second criterion we used to analyse overtransfusion was blood transfusion in patients with blood loss o[ less than 30% Of their estimatedblood volume (EBV). Blood volume was estimated as 70 ml/kg body weight7. Patients with a pro-operative anaemia, that is haemoglobin of less than 13.0 gm/dl in males and 11.5 gm/dl in females were excluded from this analysis. A spread sheet and statistical soft ware was used for analysis of the data. Results between males and females were analy~d using students-t test and correlation coefficients. A p value of less than 0.05 was considered significant.
Methods A retrospective study was performed in which data was collected from the charts of 150 consecutivepatients who had an electivep r i m l y total hip arthroplasty (THA) between June 1989 and December 1989. If the patient had more than one admission for a primary total hip arthroplasty during the study
Results The demographic data recorded is displayed in Table I. The underlying pathology was osteoarthritis in 83%, rheumatoid "arthritis in 13.6% and 3.4% other diseases which included ankylosing spondylitis, trauma, congenital hip dislocation and acromegaly. Spinal anaesthesia was used in 137 (91.3%) patients, 12 (8.0%) had general anaesthesia and one (0.7%) had epidural anaesthesia.
Correspondence to: Dr. Girish P. Joshi, Visiting Assistant Prof., Dept. ef Anaes~esiolegy, Oregon Health Sciences University, School ef Medicine, 3181 Sam Jackson Carte Read, Portland, Oregon, 97201-3098, U.S.A. 404
Vok 161 ,
Transfusion therapy in total hip arthropldsty
No. 6
TABLE 1 Demographic and Clinical Data- Mean _+S.D. Males n Age (years) Weight (kgs) Pre-op Hb (gms/dl) Pre-op Hot (%) Discharge Hbj(gms/dl) Discharge Het (%)
was a statistically significant cliffetence in the total blood transfused between the males and the females (p
