158. ORTHOPAEDIC SURGEONS’ PERCEPTION OF HAEMORRHAGIC RISK

Abstract

Purpose of the study: Prior assessment of haemorrhagic risk appears to be an essential element in orthopaedic surgery, particularly for lower limb procedures. This assessment is necessary for information delivery to the patient, for elaborating a transfusion strategy, and to choose between different therapeutic options. Despite this potential interest, data which could be used to validate this hypothesis and define and quantify what is called “haemorrhagic risk” are scarce in the literature. In order to furnish a preliminary element for reflection on this topic, a sample of 450 orthopaedic surgeons and 50 anaesthetists who perform routine arthropathy procedures for the lower limb were questioned.

Material and methods: This was an Internet questionnaire with 13 questions. Five hundred practitioners were surveyed in five western countries (France, Germany, United Kingdom, Spain, United States), 100 in each country.

Results: Globally, 90% of the practitioners considered it “important” or “very important” to evaluate the haemorrhagic risk. This percentage varied from 83% to 98% depending on the country. The main haemorrhagic complication was considered to be operative site bleeding, intra- or postoperatively, for 95% of the practitioners (89% to 98%) after hip or knee arthroplasty. The possible consequences of this haemorrhage were classified according to their gravity. Vital risk was classified N1, but not systematically or unanimously, since, for example, 75% of the French practitioners did not place vital risk in this category. Three other criteria of gravity of operative bleeding were reported, but with no clear hierarchy:

1. requirement for a revision of the operative site;

2. volume of blood loss considered important because of a drop in the haemoglobin to 4 – 6.5 g/dl, or transfusion of 2.4 – 3 packed cell units;

3. complications related to the haematoma, difficulties for rehabilitation or longer hospital stay.

Discussion: This survey showed that evaluation of haemorrhagic risk is considered to be an important element in orthopaedic practice, particularly operative site bleeding. The main elements constituting signs of gravity were: vital risk, revision, a threshold of blood loss, and constitution of a haematoma.