title: Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation.
abstract: BACKGROUND
  Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial.
  
  
  METHODS
  The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies.
  
  
  RESULTS
  Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not.
  
  
  CONCLUSIONS
  The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.
authors.affiliation: Joint Replacement Department, Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Perazzo
authors.forename: Marco
authors.initials: M
authors.lastname: Viganò
authors.forename: Laura
authors.initials: L
authors.lastname: De Girolamo
authors.forename: Francesco
authors.initials: F
authors.lastname: Verde
authors.forename: Anna
authors.initials: A
authors.lastname: Vinci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Banfi
authors.forename: Sergio
authors.initials: S
authors.lastname: Romagnoli
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies