Management of Blood Loss in Periacetabular Osteotomy

Abstract

The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre- and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively. A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.

Factors That Predict Blood Loss After Bernese Periacetabular Osteotomy

“…Although different blood-conserving strategies, including the use of predonated autologous blood, cell saver autotransfusion, and tranexamic acid, have been described to avoid allogeneic transfusion, there is no universally accepted protocol to manage blood loss associated with periacetabular osteotomy. 5,9,14,15 Periacetabular osteotomy increasingly has been performed with arthrotomy 11,13 or in combination with hip arthroscopy 12,21,22 because of evidence that femoroacetabular impingement adversely affects the outcome of periacetabular osteotomy [23][24][25] and because of the high prevalence of intra-articular pathology. 10,11 Findings on predictive factors associated with blood loss during periacetabular osteotomy are limited and conflicting, and this study was conducted to determine patient and procedure risk factors related to blood loss in a cohort of 41 young patients undergoing periacetabular osteotomy.…”

“…9 This is of great importance because now periacetabular osteotomy is more commonly performed with concomitant procedures to correct associated intra-articular pathology. [10][11][12][13] Several strategies, including autologous preoperative blood donation 5 and intraoperative use of cell saver systems, 9,14 have been reported for the management of blood loss associated with periacetabular osteotomy. Independent of the method used, the vast majority of patients require red blood cell transfusion.…”

“…Independent of the method used, the vast majority of patients require red blood cell transfusion. 5,9,14,15 Although allogeneic blood transfusion is currently accepted as a safe procedure, with minimal risk of transfusion-transmitted infection, transfusion-associated morbidity remains a concern. 16 Few studies have described blood conservation methods used during periacetabular osteotomy.…”

“…The proportion of patients who received allogeneic transfusion in this study was lower than in previous studies. 5,14,15 However, this study did not investigate factors associated with increased risk of transfusion because there were no specific trigger criteria for transfusion. However, this study identified factors associated with blood loss during surgery that are expected to affect the rate of postoperative transfusion.…”

“…3,4 Previous studies estimated blood loss of 300 to 4500 mL. 1,2,5 However, advances in surgical technique have led to less blood loss. [6][7][8] A recent study of complications after periacetabular osteotomy performed by a group of experi-…”