A randomized comparison of transfusion triggers in elective orthopaedic surgery using leucocyte-depleted red blood cells.
OBJECTIVE
In elective orthopaedic hip- and knee replacement surgery patients, we studied the effect of implementation of a uniform transfusion policy on RBC usage.


METHODS
A randomized, controlled study. A new uniform, restrictive transfusion policy was compared with standard care, which varied among the three participating hospitals. Only prestorage leucocyte-depleted RBC(s) were used. Primary end-point was RBC usage, related to length of hospital stay. Secondary end-points were Hb levels, mobilization delay and postoperative complications.


RESULTS
Six hundred and three patients were evaluated. Adherence to the protocol was over 95%. Overall mean RBC usage was 0.78 U/patient in the new policy group and 0.86 U/patient in the standard care policy group (mean difference 0.08;95% CI [-0.3; 0.2]; P = 0.53). In two hospitals, the new transfusion policy resulted in a RBC reduction of 30% (0.58U RBC/patient) (P = 0.17) and 41% (0.29 U RBC/patient) (P = 0.05) respectively. In the third hospital, however, RBC usage increased by 39% (0.31 U RBC/patient) (P = 0.02) with the new policy, due to a more restrictive standard care policy in that hospital. Length of hospital stay was not influenced by either policy.


CONCLUSIONS
Implementation of a uniform transfusion protocol for elective lower joint arthroplasty patients is feasible, but does not always lead to a RBC reduction. Length of hospital stay was not affected.
So-Osman
C
C
The Department of Research and Development, Sanquin Blood Bank South West Region, Leiden, The Netherlands. c.so@sanquin.nl
Nelissen
R
R
Te Slaa
R
R
Coene
L
L
Brand
R
R
Brand
A
A
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000379:methods*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D047589:Leukocyte Reduction Procedures; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D055815:Young Adult
D006454:Hemoglobins