Perioperative Blood Transfusions and Delayed Wound Healing After Hip Replacement Surgery: Effects on Duration of Hospitalization

Abstract

Patients who receive allogeneic blood transfusions after orthopedic surgery have a longer duration of hospitalization, and this cannot be explained by a more frequent incidence of infections in transfused patients. To determine whether transfusion of allogeneic blood interferes with wound healing and therefore increases the duration of hospitalization, we performed an observational study in 444 consecutive patients scheduled for elective primary hip surgery. Transfusion, wound, and infection variables were collected at five time points during treatment. Of the 444 consecutive patients studied, 92 received blood transfusions during their perioperative course. Thirty-one percent of transfused patients developed wound-healing disturbances versus 18% of the nontransfused group (P < 0.05); allogeneic blood transfusion was the only significant predictor for development of minor wound-healing disturbances. Duration of hospitalization was prolonged in transfused patients (12.3 versus 9.8 days) and could be predicted by 4 significant variables: requirement for blood transfusion (adds 2.7 +/- 0.5 days), presence of wound-healing disturbances (adds 1.3 +/- 0.5 days), duration of surgery (adds 0.2 +/- 0.1 days/10 min), and patient's age (adds 0.9 +/- 0.2 days/10 yr). These data suggest that allogeneic blood transfusion is associated with an increased incidence of wound-healing disturbances and that prevention of allogeneic blood transfusion may be relevant in limiting the duration of admission after elective orthopedic surgery.

Transfusion Reduction in Orthopedic Surgery

“…al. find a longer healing process after usage of allogeneic blood transfusion, compared to a control group in which patients did not receive allogeneic blood transfusion (Weber et al, 2005).…”

“…The effect of hospital admission time has been made clear by Weber et al who described an increase of hospital admission time of 2.7 days (+/-0.5 days) per transfused unit of red blood cells in total hip arthroplasty patients (Weber et al, 2005). In a study we performed in 1,422 patients who received a total hip arthroplasty, we found the administration of allogeneic blood to be one of the independent variables in a stepwise regression analysis, for ASA-Classes: I: healthy individuals; II: patients with a mild systemic defect, without functional impairment; III: patients with a seriously impairing systemic defect; IV: patients with a systemic defect that poses a constant threat for life; V: patients who are moribund and who will, with or without operation, probably die within 24 hours.…”

“…Usage of intra-operative cell salvage also provides advantages regarding post-operative wound infections and the healing process of the wound (Duffy & Neal, 1996;Steinitz et al, 2001;Weber et al, 2005 ).…”

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

“…Allogenic blood transfusion may prolong the duration of hospital stays 5 and may adversely affect the outcomes of surgical patients by increasing the risk of surgical site infection and periprosthetic joint infection 6,7 . Therefore, great effort has been made to reduce the rate of allogenic blood transfusion by implementing various blood conservation strategies to reduce perioperative blood loss 4 .…”

Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril

“…A segurança do tratamento em estudo foi analisada por meio da perda sanguínea, que foi avaliada através dos seguintes critérios: a) queda de 2g/dl ou mais dos níveis de hemoglobina (Hb) do pré-operatório em relação ao pós (15)(16) ; b) necessidade de duas ou mais unidades de concentrado de hemácias (CHAD) (43)(44)(45)(46) . No grupo RIV, 14 pacientes necessitaram de transfusão de duas ou mais unidades de CHAD no pós-operatório; no grupo ENO, 12 pacientes necessitaram de transfusão de duas ou mais unidades de CHAD.…”