AUTOTRANSFUSION IN MAJOR ORTHOPEDIC-SURGERY - EXPERIENCE WITH 1785 PATIENTS

Using a prospective audit, we have evaluated the efficacy of an integr ated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We exami ned prospectively the records of 1785 patients (1198 females, 5867 mal es, mean age 62 (range 16-90) yr, preoperative haemoglobin concentrati on 13.4 (SD 1.4) g dl(-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD+THA, 1 8 patients), total knee athroplasty (TKA, 263 patients), revision surg ery of the hip (HR cup+stem revision, 197 patients; cup revision, 53 p atients; stem revision, 15 patients) and total knee revision (TKR, nin e patients). We estimated that the number of predonations (MSBOS=maxim um surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with f ixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions w ere carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of M SBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surger y, higher ASA rating and coexisting diseases such as coronary artery d isease.