Transfusion trends in hip arthroplasty in Korea: a nationwide study by the Korean National Health Insurance Service

Suh, You-Sung; Lee, Jeong Jae; Nho, Jae‐Hwi; Lee, Jae‐Jun; Won, Sung Hun; Yang, Hyeon‐Jong

doi:10.1111/trf.15330

Cited by 12 publications

(14 citation statements)

References 31 publications

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“…Regarding residential area, an island geography and the lowest number of hospitals and hospital beds per person may explain the highest transfusion rate in liver transplantation in Jeju-do compared to other areas. For kidney transplantation, we found no reason for the higher transfusion rates observed in Busan and Gyeongsangnam-do, but a previous study on hip arthroplasty also showed a higher transfusion rate in these regions [27]. Therefore, further studies are required to reveal the reasons for the higher transfusion rates in relatively simple surgeries such as hip arthroplasty or kidney transplantation in these regions.…”

Section: Discussioncontrasting

confidence: 51%

Transfusion Status in Liver and Kidney Transplantation Recipients—Results from Nationwide Claims Database

Park

Yoon

Kim

et al. 2020

JCM

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Background: This study analyzed the status and trends of transfusion and its associated factors among liver and kidney transplantation recipients. Methods: A total of 10,858 and 16,191 naïve liver or kidney transplantation recipients from 2008 to 2017 were identified through the National Health Insurance Service database. The prescription code for transfusion and the presence, number, and amount of each type of transfusion were noted. The odds ratios and 95% confidence intervals were determined to identify significant differences in transfusion and blood components by liver and kidney transplantation recipient characteristics. Results: In this study, 96.4% of liver recipients and 59.7% of kidney recipients received transfusions related to the transplantation operation, mostly platelet and fresh frozen plasma. Higher perioperative transfusion in women and declining transfusion rates from 2008 to 2017 were observed in both liver and kidney recipients. In liver recipients, the transfusion rate in those who received organs from deceased donors was much higher than that in those who received organs from living donors; however, the mortality rate according to transfusion was higher only in recipients of deceased donor organs. In kidney recipients, a higher mortality rate was observed in those receiving transfusion than that in patients without transfusion. Conclusions: In Korea, the transfusion rates in liver and kidney recipients were relatively higher than those in other countries. Sociodemographic factors, especially sex and year of transplantation, were associated with transfusion in solid organ recipients, possibly as surrogates for other causal clinical factors.

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Section: Discussioncontrasting

confidence: 51%

Transfusion Status in Liver and Kidney Transplantation Recipients—Results from Nationwide Claims Database

Park

Yoon

Kim

et al. 2020

JCM

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“…19) Preoperative allogeneic blood transfusions have often been performed to maintain hemoglobin levels before and after fracture operations. 1,20) However, orthopedic surgeons and their patients have been plagued by transfusion in the perioperative period. 2,15,[21][22][23] Hence, surgery without transfusion is of interest, especially for the elderly who often carry multiple comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…4) Therefore, allogeneic blood transfusion is generally required in elderly patients undergoing hip fracture surgery. 1,6) The level of preoperative hemoglobin is a major predictor of the need for transfusion following orthopedic surgery. 2,6) A few studies reported that elective surgery could be done safely in patients with a preoperative hemoglobin level above 10 g/dL if the estimated blood loss was greater than 500 mL.…”

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confidence: 99%

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

et al. 2021

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Backgroud Hip fracture surgery is associated with blood loss, which may lead to adverse patient outcomes. The hemoglobin level declines gradually in most hip fracture cases involving femoral neck fractures and intertrochanteric fractures. It decreases further after hip fracture surgery due to perioperative bleeding. We developed a protocol, which avoids transfusion in hip fracture surgery, and reviewed the hemodynamic outcomes of patients with hemoglobin less than 10 g/dL without transfusion. Methods From 2014 to 2019, we retrospectively recruited 34 patients with hip fractures and a hemoglobin level less than 10 g/dL, who refused to undergo transfusion. There were 19 patients with femoral neck fractures and 15 patients with intertrochanteric fractures. Our patient blood management (PBM) protocol involving 4,000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) was applied to all included patients. Intraoperatively, a cell saver and tranexamic acid were used. Postoperatively, the protocol was maintained until the patients' hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications, and hemodynamic changes. Results Nineteen patients with femoral neck fractures underwent bipolar hemiarthroplasty and 15 patients with intertrochanteric fractures underwent internal fixation with a cephalomedullary nail. The mean hemoglobin level was 8.9 g/dL (range, 7.3–9.9 g/dL) preoperatively, 7.9 g/dL (range, 6.5–9.3 g/dL) immediately postoperatively, 7.7 g/dL (range, 4.3–9.5 g/dL) on postoperative day 1, 7.4 g/dL (range, 4.2–9.4 g/dL) on postoperative day 3, 8.1 g/dL (range, 4.4–9.7 g/dL) on postoperative day 5, 8.5 g/dL (range, 4.5–9.9 g/dL) on postoperative day 7, and 9.9 g/dL (range, 5.7–11.1 g/dL) on postoperative day 14. The average intraoperative bleeding was 206.2 ± 78.7 mL. There was no case associated with complications of anemia. Conclusions Hip fracture surgery in patients with hemoglobin less than 10 g/dL was feasible without the need for transfusion using our PBM protocol in 34 patients. Using this protocol, the operation was conducted safely despite the anemic condition of patients with fractures whose hemoglobin was less than 10 g/dL.

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“… 19 , 20 The lower transfusion rates observed in our cohort likely reflect the implementation of strategies to mitigate perioperative transfusion including preoperative anaemia correction, advances in surgical technique, changes to transfusion thresholds, and the use of tranexamic acid. 7 , 20 , 22 , 28 , 31 , 34 , 41 Using contemporary data, we have reported modern informative estimates of surgery-specific transfusion rates (e.g. hip fracture surgery compared to hip arthroplasty), and of increased transfusion risk for urgent/emergent fracture-related surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…18 Published data describing transfusion practices in orthopaedic surgery are variable. Over the past two decades, the reported frequency of RBC transfusion ranged from 19% to 57% in elective hip and knee arthroplasty, 19 - 26 54% to 83% in revision hip arthroplasties, 27 , 28 and 42% to 56% in hip fracture surgeries. 29 , 30 Previously published studies do not reflect present-day efforts to minimize perioperative transfusion, such as preoperative anaemia correction, modification of surgical techniques, changes to transfusion thresholds, or the use of pharmacological therapies to minimize bleeding, such as tranexamic acid.…”

Section: Introductionmentioning

confidence: 99%

Transfusion in orthopaedic surgery

et al. 2021

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Aims Orthopaedic surgeries are complex, frequently performed procedures associated with significant haemorrhage and perioperative blood transfusion. Given refinements in surgical techniques and changes to transfusion practices, we aim to describe contemporary transfusion practices in orthopaedic surgery in order to inform perioperative planning and blood banking requirements. Methods We performed a retrospective cohort study of adult patients who underwent orthopaedic surgery at four Canadian hospitals between 2014 and 2016. We studied all patients admitted to hospital for nonarthroscopic joint surgeries, amputations, and fracture surgeries. For each surgery and surgical subgroup, we characterized the proportion of patients who received red blood cell (RBC) transfusion, the mean/median number of RBC units transfused, and exposure to platelets and plasma. Results Of the 14,584 included patients, the most commonly performed surgeries were knee arthroplasty (24.8%), hip arthroplasty (24.6%), and hip fracture surgery (17.4%). A total of 10.3% of patients received RBC transfusion; the proportion of patients receiving RBC transfusions varied widely based on the surgical subgroup (0.0% to 33.1%). Primary knee arthroplasty and hip arthroplasty, the two most common surgeries, were associated with in-hospital transfusion frequencies of 2.8% and 4.5%, respectively. RBC transfusion occurred in 25.0% of hip fracture surgeries, accounting for the greatest total number of RBC units transfused in our cohort (38.0% of all transfused RBC units). Platelet and plasma transfusions were uncommon. Conclusion Orthopaedic surgeries were associated with variable rates of transfusion. The rate of RBC transfusion is highly dependent on the surgery type. Identifying surgeries with the highest transfusion rates, and further evaluation of factors that contribute to transfusion in identified at-risk populations, can serve to inform perioperative planning and blood bank requirements, and facilitate pre-emptive transfusion mitigation strategies. Cite this article: Bone Jt Open 2021;2(10):850–857.

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Transfusion trends in hip arthroplasty in Korea: a nationwide study by the Korean National Health Insurance Service

Cited by 12 publications

References 31 publications

Transfusion Status in Liver and Kidney Transplantation Recipients—Results from Nationwide Claims Database

Transfusion Status in Liver and Kidney Transplantation Recipients—Results from Nationwide Claims Database

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

Transfusion in orthopaedic surgery

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