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Comparative Study
. 2014 Feb;38(2):347-54.
doi: 10.1007/s00264-013-2188-7. Epub 2013 Dec 7.

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Sara Moráis  1 , Miguel Ortega-Andreu, Emerito Carlos Rodríguez-Merchán, Norma G Padilla-Eguiluz, Hanna Pérez-Chrzanowska, Reyes Figueredo-Zalve, Enrique Gómez-Barrena
Affiliations
Comparative Study

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Sara Moráis et al. Int Orthop. 2014 Feb.

Abstract

Purpose: Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion.

Methods: We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N = 71) and controls to the group without MBLPA (group 2, standard group, N = 347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; peri- and intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) i.v.. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case-control comparison and blood transfusion risk factors were analysed.

Results: Group 1 had a zero transfusion rate (0/71), whereas 27.4% of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors.

Conclusions: MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.

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Figures

Fig. 1
Fig. 1
Differences in mean concentration of haemoglobin (g/dl) among patient groups. a Pre-operative haemoglobin (Hb) level. b Hb at discharge. Block 1 patients operated at the surgical block where pre-operative Hb optimisation, surgical technique to decrease blood loss and tranexamic acid (TXA) administration IV were performed. Block 2 patients operated without blood-loss prevention protocol. Iron subset of patients in Block 1 who received pre-operative Hb optimisation based on iron administration. No iron subset of patients in Block 1 who received no iron treatment pre-operatively
Fig. 2
Fig. 2
Estimated probability of being transfused after primary total knee arthroplasty (TKA) at La Paz Hospital in 2010, related to pre-operative haemoglobin (Hb) categories, obesity and American Society of Anesthesiologists (ASA)
See this image and copyright information in PMC

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