CHANGING TRANSFUSION PRACTICES IN HIP AND KNEE ARTHROPLASTY

BACKGROUND: This study was designed to examine changes in perioperativ e transfusion practices after the introduction of autologous blood con servation strategies into routine clinical practice. STUDY DESIGN AND METHODS: The existing medical records of all patients undergoing total hip or knee arthroplasty at Mayo Clinic in Rochester, MN, who resided in Olmsted County, were reviewed over three periods: 1981-82 (232 pro cedures), 1987-88 (269 procedures), and 1993-94 (398 procedures). RESU LTS: The proportion of patients receiving any perioperative red cell ( RBC) units significantly decreased (from 85% in 1981-82 to 65% in 1993 -94). The timing of transfusion also changed; the proportion of RBC un its transfused in the preoperative or intraoperative periods decreased from 68 percent in 1981-82 to 38 percent in 1993-94, with the balance of RBC units transfused in the postoperative period. Although the num ber of RBC units utilized per procedure in the intraoperative period s ignificantly decreased, the number of RBC units transfused in the post operative period significantly increased (from 0.6 +/- 1.0 to 1.1 +/- 1.4 units per procedure in 1981-82 and 1993-94, respectively, p<0.05). CONCLUSION: Although blood conservation strategies have been successf ul in reducing RBC transfusion intraoperatively avoidance of intraoper ative transfusion may in some cases postpone, rather than prevent, tra nsfusion.