medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2012, Number 2

<< Back Next >>

An Med Asoc Med Hosp ABC 2012; 57 (2)

Prognostic factors of blood transfusion in patients undergone total hip replacement

Verdugo HA, Pérez SMD, Castañeda LP

Language: Spanish
References: 24
Page: 112-117
PDF size: 45.92 Kb.


ABSTRACT

Introduction: Total hip replacement is a procedure which is associated with a high rate of perioperative blood transfusions. There are many factors which are involved, including age, weight, sex, the general state of health, bleeding times, the presence of high blood pressure, the type of anesthesia and the actual procedure. Objective: to determine the factors which predispose patients to require a blood transfusion after a total hip replacement. Patients and methods: A retrospective study was undertaken including all patients who underwent a primary total hip replacement between December 1, 2001 and December 1, 2010. We included 613 patients (385 women and 258 men) who met the inclusion criteria. The following variables were analyzed: sex, age, body mass index, preoperative hemoglobin levels, the presence of high blood pressure, the type of anesthesia employed and the surgical blood loss. Statistical analysis was carried out using the Chi squared, Student T and Mann-Whitney U tests, results are presented as the mean and standard deviation. Results: 421 (69%) patients required a transfusion. Of the 385 women, 261 (68%) required a transfusion, whereas of the 258 men, only 160 (62%) required a transfusion. The mean preoperative hemoglobin level for the group not requiring a transfusion was 14.2 g/dL, compared with 13.1 g/dL for the group requiring a transfusion. The mean body mass index for the group not requiring a transfusion was 24.7 kg/m2, whereas it was 28.5 kg/m2 for the group requiring a transfusion. Two hundred and four patients had high blood pressure and of these, 179 (88%) required a transfusion. The mean surgical blood loss for the group not requiring a transfusion was 508 mL, compared to 689 mL for the group requiring a transfusion. Conclusion: Female sex, a body mass index greater than 26 kg/m2, the presence of high blood pressure and surgical blood loss greater than 600 mL, are independent factors associated with a greater need for blood transfusion after a total hip replacement.


REFERENCES

  1. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004; 86-A(1): 57-61.

  2. Kendall SJ, Weir J, Aspinall R, Henderson D, Rosson J. Erythrocyte transfusion causes immunosuppression after total hip replacement. Clin Orthop Relat Res 2000; 381: 145-155.

  3. Lemos MJ, Healy WL. Current concepts review- blood transfusion in orthopaedic operations. J Bone and Joint Surg Am 1996; 78(8): 1260-1271.

  4. Keating EM. Current options and approaches for blood management in orthopaedic surgery. Instr Course Lect 1999; 48: 655-665.

  5. Hatzidakis AM, Mendlick RM, McKillip T, Reddy RL, Garvin KL. Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion. J Bone Joint Surg Am 2000; 82(1): 89-100.

  6. Wilson WJ. Intraoperative autologous transfusion in revision total hip arthroplasty. J Bone Joint Surg Am 1989; 71(1): 8-14.

  7. Helm AT, Karski MT, Parsons SJ, Sampath JS, Bale RS. A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. Audit of an algorithm for arthroplasty of the lower limb. J Bone Joint Surg Br 2003; 85(4): 484-489.

  8. Dillon MF, Collins D, Rice J, Murphy PG, Nicholson P, Mac Elwaine J. Preoperative characteristics identify patients with hip fractures at risk of transfusion. Clin Orthop Relat Res 2005; 439: 201-206.

  9. Millett PJ, Porramatikul M, Chen N, Zurakowski D, Warner JJ. Analysis of transfusion predictors in shoulder arthroplasty. J Bone Joint Surg Am 2006; 88(6): 1223-1230.

  10. National Heart, Lung and Blood Institute Expert Panel on the Use of Autologous Blood. Transfusion alert: use of autologous blood. Transfusion 1995; 35: 703-711.

  11. Adams RC, Lundy JS. Anesthesia in cases of poor surgical risk. Some suggestions for decreasing the risk. Surg Gynec and Obstet 1942; 74: 1011-1019.

  12. American Society of Anesthesiology. “Practice guidelines for blood component therapy: A report by the American Society of Anesthesiologists task force on blood component therapy”. Anesthesiology 1996; 84: 732-747.

  13. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81(1): 2-10.

  14. Bezwada HP, Nazarian DG, Henry DH, Booth RE Jr. Preoperative use of recombinant human erythropoietin before total joint arthroplasty. J Bone Joint Surg Am 2003; 85-A(9): 1795-1800.

  15. Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco TP. Blood management after bilateral total knee arthroplasty. Clin Orthop Relat Res 2003; 410: 254-261.

  16. Carson JL, Russell LB, Taragin MI, Sonnenberg FA, Duff AE, Bauer S. The risks of blood transfusion: the relative influence of acquired immunodeficiency syndrome and non-A, non-B hepatitis. Am J Med 1992; 92(1): 45-52.

  17. Control, Centers for Disease. “Mortality attributable to HIV infections/AIDS-United States 1981-2003”. Am Med Assn 2004; 265: 848-849.

  18. Hager T, Ganong WF. Hemoglobin 2005 (accessed 2007).

  19. Blundell J. Experiments on the transfusion of blood by the syringe. Medico-Chirurg Trans 1818; 9: 56-92.

  20. American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann Intern Med 1992; 116: 403-406.

  21. Pierson JL, Hannon TJ, Earles DR. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surg Am 2004; 86-A(7): 1512-1518.

  22. Rashiq S, Shah M, Chow AK, O’Connor PJ, Finegan BA. Predicting allogeneic blood transfusion use in total joint arthroplasty. Anesth Analg 2004; 99(4): 1239-1244. Table of contents.

  23. Salido JA, Marín LA, Gómez LA, Zorrilla P, Martínez C. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am 2002; 84-A(2): 216-220.

  24. Woolson ST, Marsh JS, Tanner JB. Transfusion of previously deposited autologous blood for patients undergoing hip-replacement surgery. J Bone Joint Surg Am 1987; 69(3): 325-328.




2020     |     www.medigraphic.com