Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery.
Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6-8-10-Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case-control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1.1 +/- 1.5 to 0.6 +/- 1.2 and 0.3 +/- 0.9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 +/- 1.5, 1 +/- 1.7 and 1 +/- 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused.
Eindhoven
G B
GB
Department of Anaesthesiology, University Hospital, Groningen, The Netherlands.
Diercks
R L
RL
Richardson
F J
FJ
van Raaij
J J A M
JJ
Hagenaars
J A M
JA
van Horn
J R
JR
de Wolf
J Th M
JT
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000592:standards; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000592:standards; D017558:Elective Surgical Procedures / Q000592:standards; D017707:Erythrocyte Transfusion / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards