An analysis of blood management in patients having a total hip or knee arthroplasty

Three hundred and thirty orthopaedic surgeons in the United States particip ated in a study of transfusion requirements associated with total joint art hroplasty, A total of 9482 patients (3920 patients who had a total hip repl acement and 5562 patients who had a total knee replacement) were evaluated prospectively from September 1996 through June 1997. Of those patients, 440 9 (46 percent [57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement]) had a blood transfusio n. Two thousand eight hundred and ninety patients (66 percent) received aut ologous blood, and 1519 patients (34 percent) received allogenic blood. Ord ered logistic regression analysis showed the most important predictors of t he transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood. Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood; however, ineff iciencies in the procedures for obtaining autologous blood were identified. Sixty-one percent (5741) of the patients had predonated blood for autologo us transfusion, but 4464 (45 percent) of the 9920 units of the predonated a utologous blood were not used. Primary procedures and revision total knee a rthroplasty were associated with the greatest number of masted autologous u nits. Of the 5741 patients who had predonated blood, 503 (9 percent) needed a transfusion of allogenic blood. The frequency of allogenic blood transfu sion varied,vith respect to the type of operative procedure (revision total hip arthroplasty and bilateral total knee arthro plasty mere associated wi th the highest prevalence of such transfusions) and with a baseline hemoglo bin lever of 130 grams per liter or less. Transfusion of allogenic blood wa s also associated,vith infection (p less than or equal to 0.001), fluid ove rload (p less than or equal to 0.001), and increased duration of hospitaliz ation (p less than or equal to 0.01). These letter findings warrant further evaluation in controlled studies.