Retrospective Audit of Blood Transfusion and Comparison with Haemoglobin Concentration in Patients Undergoing Elective Primary and Revision Lower Limb Arthroplasty

Abstract

We retrospectively audited the incidence of blood transfusion and related this to preoperative haemoglobin levels in 181 patients undergoing lower limb arthroplasty over a six-month period. This included 102 primary total knee replacements, 52 primary total hip replacements, 11 revision total knee replacements and 16 revision total hip replacements. The overall incidence of transfusion was 16.0%. The incidence in primary arthroplasty was 11% (9.8% for total knee replacements and 13.5% for total hip replacements), and in revision surgery was 44.4% (27.3% for total knee replacements and 56.3% for total hip replacements). Combining data for primary total knee replacements and primary total hip replacements, a preoperative haemoglobin threshold of 120 g/l divided patients into high and low risk groups for transfusion. Below or equal to this threshold the incidence of transfusion was 47.7%; above this threshold the incidence was 7.2%. We suggest that patients having primary lower limb arthroplasty with a preoperative haemoglobin of 120 g/l or less should undergo investigation of their anaemia and optimisation of erythropoeisis.

What Should Define Preoperative Anemia in Primary THA?

“…Previous studies have used other methods in evaluating cutoffs for preoperative Hgb in THA. Evans et al [10] retrospectively audited the incidence of blood transfusion in 181 patients undergoing primary and revision hip and knee arthroplasties. By combining data for patients undergoing primary THA and those undergoing TKA, they divided patients in low-and high-risk groups using a Hgb cutoff of 12 g/dL in which the incidence of transfusion below this cutoff was 48% and above 7% [10].…”

A pragmatic approach to embedding patient blood management in a tertiary hospital

“…Our results for the second half of 2011 show that transfusion rates in key orthopedic procedures have shown an accelerating decline in primary THA and primary and revision TKA as a result of the PBMP. In orthopedic procedures, surgical technique, anesthetic practices, and use of tranexamic acid along with an effective preoperative assessment to optimize Hb level contributed to the low transfusion rate …”

Anaemia in elective orthopaedic surgery – Royal Adelaide Hospital, Australia

“…Anaemia in elective surgery, including orthopaedic surgery, carries several risks . These include: increased transfusion rates increased length of stay increased mortality increased post operative infection …”

“…Anaemia in elective surgery, including orthopaedic surgery, carries several risks. 1 These include: • increased transfusion rates [2][3][4][5][6][7][8][9][10] • increased length of stay [9][10][11] • increased mortality 10,12,13 • increased post operative infection 14,15 For a patient with co morbidities, this is even more important. If a patient is anaemic and aged but has no cardiovascular disease, the increased risk of death is 1.4, but if the patient is severely anaemic and aged with cardiovascular disease, the increased risk of death is up to 12.3 times.…”