title: Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion.
abstract: BACKGROUND
  The aim of this study was to audit the blood transfusion practice throughout the Epworth Healthcare Hospitals for patients undergoing primary total hip replacement (THR). We determined if blood-saving techniques were having an impact on the risk of allogenic blood transfusion and which patients were at risk of receiving allogenic blood transfusion.
  
  
  METHODS
  This study uses a retrospective audit of 787 patients who had undergone primary THR surgery at three Melbourne hospitals: Epworth Richmond, Epworth Eastern and Epworth Freemasons in 2010. Patient demographics, transfusion requirements and blood-conserving techniques were recorded.
  
  
  RESULTS
  One hundred and eighty (23%) patients received allogenic blood transfusion and 18 (2.3%) patients received autologous blood transfusion. On multivariate analysis, preoperative anaemia (odds ratio (OR) 4.7, P < 0.0001), female gender (OR 3.1, P < 0.0001) and patient age (OR 1.07 per year of age increase, P < 0.0001) were shown to be significantly associated with higher risk of allogenic blood transfusion. Use of spinal anaesthetic was found to be associated with lower risk of transfusion (OR 0.6, P = 0.0180) compared with general anaesthetic alone. Cell saver, acute normovolaemic haemodilution and re-infusion drain tube usage did not have a significant impact on reducing the risk of allogenic blood transfusion.
  
  
  CONCLUSIONS
  Identification of patients at risk of blood transfusion, correction of preoperative anaemia and a restrictive transfusion policy are important factors to consider in effective perioperative blood management.
authors.affiliation: Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wong
authors.affiliation: Epworth Health Care, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Howard
authors.initials: H
authors.lastname: Tang
authors.affiliation: Northern Hospital, Melbourne, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: de Steiger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: arthroplasty; blood loss; blood transfusion; clinical audit; hip; replacement; surgical