title: Hospital audit of delayed transfusion after orthopaedic surgery.
abstract: OBJECTIVE
  To understand the mechanisms related to both the onset and correction of severe anaemia after orthopaedic surgery, we analysed all the full blood counts (FBCs) for patients on one orthopaedic ward during a one-year period in an academic hospital.
  
  
  METHODS
  FBCs were screened and the medical records of those patients for whom a postoperative haemoglobin (Hb) concentration below 8 g/dL was recorded at least once were reviewed. The onset of postoperative anaemia was determined by calculating the various time intervals delineated by surgery, the time at which the transfusion threshold was reached and the time at which the lowest Hb level (nadir) and transfusion (if any) occurred.
  
  
  RESULTS
  A total of 6573 FBCs drawn from 1255 patients were screened. The medical records of 74 consecutive patients with at least one Hb value < 8 g/dL were analysed. The postoperative Hb nadir was 7.4 (± 0.6) g/dL (mean - SD). The medians (IQR 25-75) of the calculated intervals were: (surgery - nadir): 72 (48-144) h, (nadir - transfusion): 7 (5-21) h and (transfusion threshold - transfusion): 26 (11-51) h.
  
  
  CONCLUSIONS
  Delayed transfusion (defined as > 12 hours between the time at which the transfusion threshold was reached and actual transfusion) was observed in 57% of severely anaemic patients after orthopaedic surgery.
authors.affiliation: Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Dubost
authors.affiliation: Département d'anesthésie-réanimation, hôpital d'instruction des Armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ausset
authors.affiliation: Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: César
authors.initials: C
authors.lastname: Vincent
authors.affiliation: Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Gozlan
authors.affiliation: Département d'anesthésie-réanimation, hôpital d'instruction des Armées du Val-de-Grace, 74, boulevard de Port-Royal, 75230 Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Auroy
authors.affiliation: Service d'hémovigilance, hôpital de la Pitié-Salpétrière, 47-81, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: Loan
authors.initials: L
authors.lastname: N'Guyen
authors.affiliation: Département d'anesthésie-réanimation, hôpital Saint-Antoine, AP-HP, 184, faubourg Saint-Antoine, 75571 Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Lienhart
authors.affiliation: Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France. Electronic address: dan.benhamou@bct.aphp.fr.
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy; D001803:Blood Transfusion / Q000379:methods*; D003422:Critical Care; D004632:Emergency Medical Services; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D018570:Risk Assessment; D061665:Time-to-Treatment
chemical_list: D006454:Hemoglobins
keywords: Anaemia; Postoperative period; Risk; Transfusion