Perioperative protocol to reduce blood transfusions in total knee o hip replacement patients

Introduction Patient Blood Management (PBM) programs improve patient care and reduce health costs. It includes detection of presurgical anemia, reduction of blood loss and improvement of patient-specific anemic reserve. The aim of this study is to assess the effect of a PBM program on transfusion ra...

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Autores principales: Godoy, Alejandro, Gonzalez, Jaqueline, Becerra, Ana Florencia, Finola , Mariano, Faule, Facundo, Estrada , Carlos, Neder, Yamile, Albertini , Ricardo
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021
Materias:
arthroplasty replacement
blood transfusion
anemia
Tranexamic Acid
artroplastia de reemplazo
transfusión sanguínea
Ácido Tranexámico
artroplastia de substituição
transfusão de sangue;
Ácido Tranexâmico
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/30134
Aporte de:
Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
Descripción
Sumario:Introduction Patient Blood Management (PBM) programs improve patient care and reduce health costs. It includes detection of presurgical anemia, reduction of blood loss and improvement of patient-specific anemic reserve. The aim of this study is to assess the effect of a PBM program on transfusion rate, length of stay (LOS) and adverse events.    Methods We developed a retrospective observational study. We included patients who underwent total hip (THR) o knee replacement (TKR). Our PBM involved preoperative assessment, administration of 2 doses of tranexamic acid, application of restrictive transfusion criteria and use of IV iron. We compared results between the group of patients before and the one after the PBM implementation.   Results We included 179 patients (80 TKR and 99 THR) who underwent surgery before PBM implementation from January to December 2014 (Group A), and 187 patients (103 TKR and 84 THR) who underwent arthroplasty after PBM application from January to November 2016 (Group B). In Group A, hemoglobin drop was larger than in Group B, for TKR (5.1±1.2 vs. 4.2±1.2 g/dl; p<0,05) and for THR (4.7±1.3 vs. 3.8±1.3 g/dl; p<0,05). In group A, more patients were transfused (31.8% vs. 2.7%; p<0.001). LOS was longer for patients in group A, in both surgeries (for TKA, 3.98±1.4days vs. 2.99±0.95 days; p<0.0001; for THA 3.68±1.06days vs. 2.88±0.75days; p<0.0001). No significant differences were found regarding adverse events.   Conclusion Our PBM program saved transfusions after primary TKR and THR and lowered LOS, without risking patients to higher number of complications or death.

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