title: A clinical audit of the utilisation of red cell products in elective total hip replacement surgery.
abstract: BACKGROUND
  Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery.
  
  
  OBJECTIVE
  To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG).
  
  
  METHODS
  The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age, sex, clinical observations, indications for surgery, pre- and postoperative haemoglobin (Hb) values, comorbidities, length of hospital stay and transfusion history was recorded.
  
  
  RESULTS
  The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p&lt;0.05), and the mean age of transfused patients was significantly greater than that of untransfused patients (p&lt;0.005). Although patients with comorbidities had a higher transfusion rate than those without, this did not reach statistical significance. Of 120 patients with complete data, 113 (94.2%) had a blood bank order, of which the vast majority, 102/113 (90.3%), were group-and-screen (G&amp;S) requests; 29/113 (25.7%) were converted to a full crossmatch.
  
  
  CONCLUSIONS
  Overall, the transfusion rate for both hospitals was 25.8%, which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines, with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary, and a G&amp;S order is sufficient.
authors: Western Province Blood Transfusion Service, Pinelands, Cape Town, South Africa; Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, Cape Town, South Africa. yvonne@wpbts.org.za.
authors: Yvonne Grace
authors: YG
authors: Peters
authors: Arthur
authors: A
authors: Bird
authors: Greg R M
authors: GR
authors: Bellairs
authors: Glenda Mary
authors: GM
authors: Davison