A one-centre prospective audit of peri- and postoperative blood loss and transfusion practice in patients undergoing hip or knee replacement surgery

We prospectively audited peri-operative blood loss and blood transfusion pr actice in 42 elderly patients (mean age, 71.8 years, 68% female) undergoing hip or knee surgery in an orthopaedic unit. Only in 57% of all operations was blood loss recorded. Compliance with the Maximum Surgical Blood Orderin g Schedule (MSBOS) was variable, and Cross- matching to Transfusion (C/T) r atios were low. in 86% of operations, blood had been issued pre-operatively (average three units, range = 1-61 units). Of these patients, 75% subseque ntly received a transfusion. in 26% of all the operations, the transfusion, although confirmed by the blood transfusion laboratory records, had not be en recorded in the medical or nursing notes. The average pre-operative Hb i n the transfusion group was 123 g/l (range, 80-144 g/l) and 112 g/l postope ratively and after a transfusion (range, 75-133 g/l). This compared to the non-transfusion group's value of 124 g/l (range, 86-186 g/l) and 113 g/l (r ange, 77-147 g/l) postoperatively. The high blood issuing and transfusion r ates raise the concern that transfusions are being given in response to hab it or blood availability, and not medical indications. This would imply tha t some patients are exposed to unnecessary risks. Furthermore, inadequate d ocumentation of the transfusion process opens the medical profession to cri ticism and medical, legal and ethical complications regarding patient care. Positive improvements suggested by regular medical audit may help address these problems.