Effectiveness of a Blood Transfusion Guideline in Major Orthopaedic Surgery
Uedilokkunthorn K, MD1, Bormann BV, MD2, Thanapipatsiri S, MD1
Affiliation : 1 Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Major orthopedic surgery often requires allogeneic blood transfusion that involves a risk for infection and other
complications. The decision to transfuse is typically at the surgeon’s discretion.
Objective : To evaluate the effect of a blood transfusion guideline on allogeneic transfusion rates, volumes and outcomes in patients
with major orthopedic surgery.
Materials and Methods : Data were collected retrospectively in 115 patients before implementing a guideline (pre-guideline group),
and prospectively in 115 patients to whom a guideline defining criteria for red cell transfusion was applied (guideline group). The
guideline for packed red cell transfusion was a hematocrit <25% or a hemoglobin of <8 g/dL. These thresholds were disregarded
if the clinical situation warranted it. Clinical data and post-operative outcomes were recorded and compared.
Results : The two groups were not significantly different with respect to age, sex, BMI, ASA classification, pre-operative cHb/Hct
level, operative time and intraoperative blood loss. In the pre-guideline group, 45 (39.1%) patients received transfusion compared
to 22 (19.1%) in the guideline group (p = 0.001). Patients in the pre-guideline group received more transfusion (0.68+1.02 units)
than the guideline group (0.24+0.68 units). Mean difference of blood transfusion between two groups, 0.48 units (95% CI 0.23 to
0.73), was statistically significant (p<0.001). There were no significant differences in outcome.
Conclusion : A transfusion guideline using hematocrit and hemoglobin thresholds reduced the frequency and volume of allogeneic
blood transfusions without increasing postoperative complications in patients with major orthopedic surgery.
Keywords : Blood transfusion, Red blood cells, Transfusion guidelines, Orthopaedic surgery, Side effects, Risks, Complications
