An Implementation Of Patient Blood Management Program In Total Hip and Total Knee Replacement Patients

Introduction The implementation of patients’ blood management (PBM) is being leaded in a considerable decline of both blood loss and allogenic blood transfusion in primary Total Hip (THR) and Knee Replacement (TKR). The aim was to outline the results after a stepwise implementation of PBM protocol in THR and TKR. Material and Methods We conducted a retrospective study. A PBM protocol regarding the entire blood bleeding, the use of tranexamic acid (TXA) (0gr or 1gr or 2gr), the preoperative anaemia and a transfusion trigger (from 10 to 8 Hb gr/dl) was applied. Patients and surgery related data were prospectively recorded and analyzed. Results 427 patients underwent either TKR (n:260) or THR (n:167). In both TKR and THR presented gradual reduction (a) blood loss from 1.430 to 1.129 and from 1.277 to 1.101 respectively, (b) transfusion rate from 30.4–0.2% and from 35.7–0.1% respectively and (c) mean hospitalization from 5 to 2.97 days and from 4.8 to 2.87 days respectively. In TKR, pre-operative anaemia was an independent determinant of bleeding, as were BMI > 30, ASA > II and no-TXA use. Independent determinants of transfusion rate were pre-operative anemia and no-TXA use. In THR, independent determinants of hemorrhage were male, BMI > 30, operation > 90 minutes, transfusion rate, pre-operative anaemia and no-TXA use. Conclusion The implementation of a restrictive PBM protocol addressing the “modifiable” factors of increased blood loss and transfusion rate such as pre-operative anemia, TXA use, short surgical time and low transfusion trigger can substantially reduce the transfusion of allogenic blood. Level of Evidence II