Abstract
Aim: To reduce the amount of blood wastage in our unit.
Method: In 72 patients, the number of blood units cross-matched and the haemoglobin/haematocrit fall were audited for primary total shoulder replacement (n=44), primary hemiarthroplasty (n=21), and revision shoulder replacement (n=7) over twelve months (January 2008 to December 2008). The amount of crossmatched blood was compared to the amount of blood transfused, pre-operative haemoglobin and fall in haemoglobin/haematocrit.
Results: 23 of 44 primary total shoulder replacements and 5 of 21 hemiarthroplasties were crossmatched 55 units preoperatively. 4 of the 7 revision arthroplasties were crossmatched 7 units preoperatively. No units were transfused. 4 patients were later transfused 2 units each for symptomatic low haemoglobin at day 3–5 postoperatively from postoperatively crossmatched blood. No correlation existed between preoperative haemoglobin and number of units blood ordered. A haemoglobin reduction of ~2.5 g/dl was seen for both primary and revision surgery. There was significant correlation between low preoperative haemoglobin and need for transfusion (p< 0.05). Nearly all patients in whom blood was crossmatched rather than group and saved, belonged to one consultant. No patients had an adverse outcome due to a lack of immediately available cross-matched blood.
Conclusion: A large amount of blood was crossmatched and no units used in primary and revision shoulder replacement surgery. We recommend group and save only in primary shoulder arthroplasty and crossmatch of 2 units for revision shoulder surgery. Providing pre-operative haemoglobin is > 11.5 g/dl, group and save is safe even for revision shoulder arthroplasty. Wastage of blood could be reduced to zero in our unit. We recommend regular audit as a tool to ensure compliance with guidelines, and for clinical governance purposes ensuring guidelines remain best practice.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
