Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen

The efficacy of an integrated autotransfusion regimen, including pre-donati on and perioperative salvage of autologous blood, was prospectively evaluat ed in 2884 patients undergoing total hip (n = 2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blo od cells were transfused in the presence of symptomatic anaemia or when hae moglobin concentration was < 6 g dL(-1) (10 g dL(-1) in patients affected b y cerebrovascular or coronary artery disease) after all salvaged and pre-do nated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were : preoperative haemoglobin concentration < 10 g dL(-1) (after autologous bl ood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5-16.8; P = 0.004), hip revi sion versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9-8.5; P = 0.0001) and inability in obtaining the number of pre-donations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7- 4.1; P = 0.0001). The incidence of perioperative complications, including w ound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requ iring allogenic blood transfusion (29.8%) than that observed in patients re ceiving only autologous blood (6.6%) (P = 0.0005); while the mean time dura tion from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (1 2 days; 25-75th percentiles: 8-14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25-75th percentil es: 10-17 days) (P = 0.0005). In conclusion, this prospective study highlig hted the clinical relevance of applying an extensive and integrated autotra nsfusion regimen in order to reduce allogenic blood transfusion and associa ted complications in patients undergoing major joint replacement.