In consecutive patients undergoing unilateral TKA in a single institution, we undertook an audit of blood transfusion practices before and after introduction of a blood transfusion protocol.

Before and after the introduction of the protocol, 393 patients (group I) and 295 patients (group II) respectively were audited. The protocol stated that only patients with preoperative haemoglobin of less than 11 were cross-matched before surgery. The criterion for postoperative transfusion was a postoperative haemoglobin of less than 8.5 or a symptomatic patient with a haemoglobin greater than 8.5. The introduction of the protocol reduced the transfusion rates from 31% in group I to 11.9% in group II (CI 13.1% to 24.9%). The length of stay was reduced from 11.4 to 9.3 days (CI 1.4 to 2.9).

There were no adverse outcomes related to the introduction of the protocol.

Purpose : The evaluation of the results of the comparison, between homologous blood transfusion and reinfusion of wound drainage blood, to patients with primary total knee replacement.

Materials and methods: A study on 44 consequent patients,who underwent to primary total knee replacement. Study group comprised 29 patients, employing a post operative autologous collection system and the control group 15 patients, using a standard drainage system.

The patiens of the control group transfused with homologous blood when it was needed.

The amount of drainage blood autotransfused in the study group was 633,15cm3 per patient, approximately. The preoperative haematocrit of this group was 39,24% average.

In the study group, 10/29 patients required two extra units of homologous blood per patient,where the preoperative haematocrit was 36,01% average. The control group, required 2,66 units of homologous blood per patient, wherees the preoperative haematocrit was 39,23% average.

Results : The haematocrit in the 3rd post operative days, to the group of autotransfusion, was 32,70% average, while to the group of homologous blood transfusion was 31,91%.

The temperature was approximately at the same levels to both groups of patients, post operatively, with a mean rate of 38,350C and it’s duration was two days post operatively, average.

There were no complications to both groups after the operation.

Conclusions: The system of reinfusion of unwashed shed whole blood is effective and safe as far as it concerns the decrease of the dangers from the homologous blood transfusion.

Moreover, the cost is cheaper comparing to the homologous transfusion, whereas it is the solution of choice, to the people who refuse the blood transfusion, due to religion reasons.

Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or post-operatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently specific indications for the use of the Cell Saver in Anterior Scoliosis have not been proven. Previous studies have commented on the beneficial aspects of recovered autologous transfusion for Orthopaedic patients in general, whilst others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. In order to assess the cost-effectiveness of the techniques used in Anterior Scoliosis Surgery we carried out a retrospective study of 180 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between July 2000 and September 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. The median age of the study cohort was 11.2 years (range 7 – 64), and the male:female ratio was 1:8.4. The average preoperative haemoglobin in all patients was 12.7g/dl and the average postoperative haemoglobin was 9.8g/dl. In total the rate of homologous transfusion requirement was 1 unit per 9.1 patients. Results show that homologous transfusion was required in less than 11% of all patients. This is better than previously published rates of transfusion in similar procedures. The range of volume of intra-operatively salvaged cells was 200 to 770mls. There was no correlation between the number of levels fused (extent of scoliosis corrective surgery) and units transfused. Our experience shows that the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

To date, there are no clear guidelines from the National Institute of Clinical Excellence or the British Orthopaedic Association regarding the use of Autologous Blood Transfusion (ABT) drains after elective primary Total Knee Replacement (TKR). There is little evidence to comparing specifically the use of ABT drains versus no drain. The majority of local practice is based on current evidence and personal surgical experience. We aim to assess whether the use of ABT drains effects the haemoglobin level at day 1 post-operation and thus alter the requirement for allogenic blood transfusion. In addition we aim to establish whether ABT drains reduce post-operative infection risk and length of hospital stay. Forty-two patients undergoing elective primary TKR in West London between September 2011 and December 2011 were evaluated pre- and post-operatively. Patient records were scrutinised. The patient population was divided into those who received no drain post-operatively and those with an ABT drain where fluid was suctioned out of the knee in a closed system, filtered in a separate compartment and re-transfused into the patient. Twenty-six patients had ABT drains and 4 (15.4%) required an allogenic blood transfusion post-operatively. Sixteen patients received no drain and 5 (31.3%) required allogenic blood. There was no statistical difference between these two groups (p=0.22). There was no statistical difference (p=0.75) in the average day 1 haemoglobin drop between the ABT drain and no drain groups with haemoglobin drops of 2.80 and 2.91 respectively. There was no statistical difference in the length of hospital stay between the 2 groups (p=0.35). There was no statistical difference (p=0.26) in infection rates between the 2 groups (2 in ABT drains Vs. 0 in no drains). Of the 2 patients who experienced complications one had cellulitis and the other had an infected haematoma, which was subsequently washed out. The results identify little benefit in using ABT drains to reduce the requirement for allogenic blood transfusion in the post-operative period following TKR. However, due to small patient numbers transfusion rates of 31.3% in the ABT drain group Vs. 15.4% in the no drain group cannot be ignored. Therefore further studies including larger patient numbers with power calculations are required before a true observation can be identified

Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices. Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion. Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

Erythropoetin is currently licensed for use in adult patients scheduled for major elective orthopaedic surgery. It has been shown to be useful in reducing exposure to allogeneic blood transfusions in non-iron deficient patients prior to major elective orthopaedic surgery, having a high-perceived risk for transfusion complications. Use is generally restricted to patients with moderate anaemia (e.g. Hb 10–13 g/dl) with expected moderate blood loss (900 to 1800 ml). Allogeneic blood transfusions have been shown to be associated with increased morbidity and hospital stay and preoperative treatment with subcutaneous r-HuEPO has been shown to significantly reduce the allogeneic transfusion exposure in patients undergoing major elective orthopaedic surgery. Impact of Perioperative Haemoglobin Levels Perioperative anaemia can have detrimental effects on postoperative outcome. . Carson et al, 1996. , demonstrated, in 1958 surgical patients who declined blood transfusions, that overall risk of mortality increases as the haemoglobin decreases, and that even mild anaemia may be associated with an increased risk of death. Furthermore, patients with underlying cardiovascular disease are less tolerant of anaemia than those without cardiovascular disease, for any haemoglobin concentration (both preoperative and postoperative). To further define the impact of allogeneic blood transfusions, . Dunne et al (2002). sought to investigate the incidence of preoperative anaemia in noncardiac surgical patients. Preoperative anaemia (haematocrit < 36) was found in 33.9% and postoperative anaemia in 84.1% of the study cohort (n=6301). Multiple logistic regression analysis revealed that low pre-operative haematocrit, low postoperative haematocrit and increased blood transfusion rates were all associated with increased mortality (P< 0.01), increased postoperative pneumonia (P ≤0.01) and increased hospital length of stay (P< 0.05). These results underline the importance of maintaining higher haemoglobin levels and reducing allogeneic blood usage in surgical patients. Preoperative haemoglobin levels are also an important predictor of transfusion risk. . Faris et al, 1996. performed a statistical analysis of data from double-blind placebo controlled trials, evaluating the risk of exposure to allogeneic blood in patients treated with r-HuEPO or placebo to determine the pre-treatment clinical variables, that are prognostic for transfusion risk in orthopaedic surgical patients. The analysis also confirmed which patients are most likely to benefit from recombinant human erythropoietin. Placebo treated patients with Hb > 10 to ≤13g/dl had an approximately two fold greater risk of transfusion than patient with Hb ≥13g/dl. Moreover, r-HuEPO significantly reduced the transfusion risk in patients with haemoglobin > 10g/dl to ≤13g/dl at baseline. r-HuEPO Use in Surgery Three major double blind placebo controlled studies (. Faris et al, 1999. ; . Canadian Orthopaedic Perioperative Erythropoietin Study Group, 1993. ; . De Andrade et al, 1996. ) involving a total of 724 patients undergoing major elective orthopaedic surgery have demonstrated that treatment with 300IU/kg r-HuEPO daily for at least 14 days, beginning 10 days prior to surgery and continuing until the 3rd or 4th day after surgery, significantly decreased the percentage of patients with haemoglobin (Hb) levels ≥10g/dl to ≤13g/dl requiring transfusion. The administration of daily 300IU/kg r-HuEPO may be inconvenient. Data has demonstrated that less frequent dosing regimens may be as efficacious. An open-label, randomised, multicentre study was conducted by . Goldberg et al (1996). , to compare the safety and efficacy of two dosage regimens of r-HuEPO. Patients were scheduled for major elective orthopaedic surgery involving hip or knee replacement. Entry criteria included a Hb level > 10g/dl to ≤13g/dl, and a serum iron to total iron binding capacity (TIBC) ratio ≥0.20 and a serum ferritin ≥50ng/ml. Patients were randomised at least three weeks before the scheduled surgery to one of two treatment groups. Group 1 (n=73) received 600IU/kg sc once weekly, on days −21, −14, and −7 prior to surgery and on the day of surgery (total 2,400IU/kg). Group 2 (n=72) received 300IU/kg sc daily for 15 days starting 10 days prior to surgery, on the day of surgery, and for 4 days postoperatively (total dose 4,500 IU/kg), as used in previous studies. In addition patients received a polysaccharide-iron complex, which provided a minimum of 200mg of elemental iron per day. Patients also received standard anticoagulation therapy. The data showed that weekly dosing with 600IU/kg SC for three weeks before surgery produced an erythropoietic response at least as good as that achieved with a daily dosing regimen of 300IU/kg. The weekly regimen was similar to the daily regimen with respect to avoidance of allogeneic transfusion. In addition, the once-weekly dosing regimen of Epoetin alfa offers the potential advantages of greater convenience for patients, and would be less costly since 47% less Epoetin alfa is administered. Other related agents are also being studied. Darbopoetin has a longer half-life and may allow a reduced dosing schedule with similar efficacy. There is no conclusive evidence that there is a higher complication rate with EPO than with placebo, in particular the incidence of thromboembolic events. The published studies have all utilised chemical prophylaxis however. Use of EPO is contraindicated with uncontrolled hypertension. Iron Therapy Anaemia is present in a significant percentage of preoperative patients and is almost universal in rheumatoid patients. Iron therapy can play an important role as part of a strategy to reduce transfusion requirements. This can be utilised alone to correct anaemia or in conjunction with EPO therapy to optimise its efficiency. Absorption of oral iron is poor and the time scales are often limited which makes IV administration more effective. There remains some resistance to the IV route due to the potential side effects and also the costs and organisational problems. A dose of 700–900mg of elemental iron is recommended. Oral iron is probably better than nothing but there is little conclusive data about its use pre and post-operatively. Algorithm to Reduce Blood Transfusion With the aim of reducing unnecessary allogeneic red blood cell transfusion in orthopaedic surgery, . Slappendel et al (2003). have created an algorithm, which has resulted in an 80% reduction in transfusion. Analysis of 29,000 patients, revealed several factors which required evaluation. There were two that were of special interest in the preoperative setting: use of NSAIDs that can disturb coagulation of the blood during surgery and preoperative laboratory studies for full blood count to determine whether erythropoietin should be given. Single measures to reduce blood transfusion may not have any impact but use of a complete algorithm and specific measures for each hospital can dramatically reduce the number of units transfused. Transfusions are associated with immunomodulation, which may increase the incidence of postoperative infections, delay healing of postoperative wounds and thereby prolong hospitalisation. Subsequent analysis of the database revealed a 42% reduction in postoperative infections. In conclusion, the use of a comprehensive algorithm in orthopaedic surgery resulted in an 80% reduction in the need for blood transfusion

This study aimed to identify factors associated with increased rates of blood transfusion in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF).

A retrospective case-control study was performed for AIS patients treated at a large children's hospital between August 2018 and December 2020. All patients with a diagnosis of AIS were evaluated. Data on patient demographics, AIS, and transfusion parameters were collected. Univariate regression and multivariate logistic modeling were utilized to assess risk factors associated with requiring transfusion. Odds ratios (OR) and 95% confidence interval (CI) were calculated. Surgeries were done by three surgeons and thirty anesthesiologists. To quantify the influence of anesthesia practice preferences a categorical variable was defined as “higher-transfusion practice preference”, for the provider with the highest rate of transfusion.

A total of 157 AIS patients were included, of whom 56 were transfused RBC units (cases), and 101 did not receive any RBC transfusion (controls). On univariate analysis, the following variables were significantly correlated with receiving RBC transfusion: “higher-transfusion practice preference,” “administration of crystalloids,” “receiving fresh frozen plasma (FFP),” “receiving platelets,” “pre-operative hemoglobin,” “cell saver volume,” and “surgical time.” On multiple regression modeling, “pre-operative hemoglobin less than 120 g/L” (OR 14.05, 95% CI: 1.951 to 135.7) and “higher-transfusion practice preference” (OR 11.84, 95% CI: 2.505 to 63.65) were found to be meaningfully and significantly predictive of RBC transfusion.

In this cohort, we identified pre-operative hemoglobin of 120 g/L as a critical threshold for requiring transfusion. In addition, we identified significant contribution from anesthesia transfusion practice preferences. Our multivariate model indicated that these two factors are the major significant contributors to allogenic blood transfusion. Although further studies are required to better understand factors contributing to transfusion in AIS patients, we suggest standardized, peri-operative evidence-based strategies to potentially help reduce variations due to individual provider preferences.

Abstract

Patients who are Jehovah's witnesses do not accept blood transfusions. Thus, total hip arthroplasty can be challenging in this group of patients due to the potential for blood loss. Multiple strategies have been developed in order to prevent blood loss.

A 76-year-old female, Jehovah's witness medicated with a platelet antiaggregant, presented to the emergency department after a fall from standing height. Clinically, she had pain mobilizing the right lower limb and radiological examination revealed an acetabular fracture with femoral head protrusion and ipsilateral isquiopubic fracture. Skeletal traction was applied to the femur during three weeks and no weight bearing was maintained during the following weeks. Posteriorly, there was an evolution to hip osteoarthritis with necrosis of the femoral head.

The patient was submitted to surgery six months after the initial trauma, for a total hip arthroplasty. The surgery was performed with hypotensive anaesthesia, careful surgical technique and meticulous haemostasis and there was no need for blood transfusion. Posteriorly, there was a positive clinical evolution with progressive improvement on function and deambulation.

Total hip arthroplasty may be safely carried out with good clinical outcomes in Jehovah's witnesses, without the need for blood transfusion, if proper perioperative precautions are taken, as has already been shown in previous studies.

Blood donation in England is voluntary and a limited resource. Blood transfusion is essential and beneficial in some postoperative hip replacements, however is not without inherent risks. Royal College of Physician audit in 2007 has shown wide variation in transfusion with an average rate of 25% (22% – 97%).

Patient blood management is an established approach to optimising need for post- operative transfusion. The Surgical Blood Conservation Service (SBCS) was set up in 2009 to enable a reduction in the demand for blood transfusion during and postoperatively in many orthopaedic procedures.

We aimed to achieve preoperative haemoglobin of 12g/dl (males) and 11g/dl (females). Low levels were treated with iron therapy. Surgery was deferred till satisfactory Hb levels were reached. During surgery cell salvage was routinely used. Transfusion was recommended at postoperative Hb < 8g/dl.

The transfusion rate was estimated at 47% in 2002. Following the introduction of SCBS, the transfusion rate reduced considerably to 7.9% in 2009 with a further reduction to 7.29% in 2011 and 3.16% in 2012. In 2013, 10 out of 442 hip replacements received transfusion (2.21%).

Our results demonstrate successful Patient blood management, minimising the need for post- operative transfusion.

Patients undergoing Joint Arthroplasty received a significant proportion of blood transfusions. In this study, we compared the risk of Deep Infection, and Superficial Infection post operation following Primary Total Hip or Knee replacement in blood-transfused and non-blood-transfused patients.

Cohort of patients who underwent primary total Hip or Knee Arthroplasty from April 2012 to March 2015 in Alberta. Patient characteristics, comorbidity, received blood transfusion were collected from electronic medical records, operating room information systems, discharge abstract database, provincial clinical risk grouper data. Deep Infection and Superficial Infection were captured from Provincial Surgical Site Infection Surveillance data. Deep Infection include deep incisional and organ/space infections. Logistic regression analysis were used to compare Deep Infection and Superficial Infection in blood-transfused and non-blood-transfused cohorts, and risk-adjusted for age, gender, procedure type, and co-morbidities.

Our study cohort contains 27891 patients, with mean of age at admission was 66.3±10.4, 57.5% female, 49.3% had 1 or more comorbidities. 58.8% underwent Knee Replacement. 11.1% received blood transfusion during hospital stay (Total Hip Replacement (THR) =13.1% and Total Knee Replacement (TKR) =9.7%,). 1.1% had Deep Infection (THR=1.4% and TKR=0.9%) and 0.5% had Superficial Infection (THR=0.5% and TKR=0.5%). Blood-transfused patients got 1.7% Deep Infection and 1.0% Superficial infection. Non-blood-transfused patients got 1.0% Deep Infection and 0.5% Superficial infection. Controlling for age, gender, procedure type, and co-morbidities, the odds of Deep Infection were 1.6 times higher for blood-transfused patients than for non-blood-transfused patients (adjusted odds ratio [OR]=1.6, 95% confidence interval [CI] [1.2–2.2], p=0.004). The odds of Superficial Infection were 2.0 times higher for transfused patients (adjusted OR=2.0, 95% CI [1.3–3.0], p=0.002).

Blood transfusion increases Deep Infection and Superficial Infection post-surgery following Primary Total Knee or Hip Replacement. This finding suggests to reduce the unnecessary blood transfusion for patients considering Joint Arthroplasty. Reducing the blood transfusion will save the inpatient cost and decrease the infective complications post-surgery in Hip or Knee Arthroplasty patients.

At present patients who require shoulder hemiarthroplasty in our unit routinely have two units of blood cross matched pre-operatively. Our observation was that blood transfusion rarely required after open shoulder surgery. We therefore decided to look at the crossmatch-transfusion ratio for the following procedures in our department; elective shoulder hemiarthroplasty, reverse total shoulder replacement, open rotator cuff repair, shoulder hemi-arthroplasty for trauma, open reduction and internal fixation of proximal humeral fractures.

We undertook a retrospective review of all such patients during the period of 2002 to 2005. All trauma and elective surgery included. Hospital notes were analysed to include age, sex, pre operative haemoglobin level, blood transfusion intra-operatively and post-operatively.

A total of 211 patients were included in the study. There were 63 elective procedures and 148 trauma procedures during that period. No patient required intra-operative or post operative transfusion. Three patients who required transfusions post operatively, due to other associated injury (liver laceration x1, spleen injuries x 2) were excluded from the study. Crossmatch-transfuison ratio was > 2.

There should be a clear equation between cross-match and its use, intra-operatively and post operatively. This study highlighted unnecessary cross-matching for shoulder operations in our unit which puts extra pressure on the laboratory staff, the blood bank and also has financial implications. We recommend, Standardised approach for pre-operative cross match practise, pre-operative group and screen to detect atypical antibodies and efficient hospital pathology services, to provide blood for transfusion within specified time, for atypical antibody negative blood, should it require.

Aim

The aim of this prospective comparative study was to evaluate the serum levels of different cytokines in patients underwent total knee replacement (TKR) and received allogeneic blood transfusion, post-operative auto-transfusion or not transfused.

Aim: Allogenic blood transfusion rate and related factors, in a cohort of 78 consecutive primary total knee replacements without patellar substitution (TKR) between January 2007 and December 2008 in the Hospital Axarquía (Málaga; Spain).

Patients and Methods: All patients were diagnosed of primary knee osteoarthritis. Along 2007 (group I) they were admitted in the previous day to a TKR and discharged following surgeon criteria. In 2008 (group II), patients were admitted on the day surgery, underwent a cemented TKR and were discharged following an objective clinical pathway. Variables: age, sex, comorbidities, previous surgery, length of stay (LOS), Ahlbäck classification, prosthesis fixation, surgery time, pre- and postoperative Hb, blood transfusion, readmission at the first 30-days and complications in the first postoperative year. Statistical analysis were carried out by the software SPSS 11.0.

Results: Group I: Mean age 69 yrs (52–80), gender 1:2,4. 89,7% Ahlbäck 3 and 4. 44% hybrid implants. Mean surgery time 100 minutes. LOS 13,3 days (7–28). Mean preop Hb 12,9 g/dl (10–16,5) and Hb at discharge 10,27 g/dl (8,4–13,1). Transfusion rate 14,63%. There were a 25% of complications in the first year. Group II: Mean age 69,7 yrs (54–84), gender 1:1,3. 94,2% Ahlbäck 3 and 4. 8 % of hybrid implants. Mean surgery time 112 minutes. LOS 3,78 days (2–8). Mean preop Hb 13,24 g/dl (11–15,8) and Hb level at discharge 10,15 g/dl (8–13,5). Transfusion rate was 10,8%. There were a 8,1% of complications in the first year. None of complications was related with a tisular oxigenation deficit, nor there were readmissions within the first postoperative month. Transfusion rates difference were not statistically significative. Statistically associated variables were preoperative Hb level < 12,5 g/dl (p=0,001), and postoperative Hb level at 24 hr. < 9,5 g/dl (p=0,017).

Discussion: Allogenic transfusion rates reported in our country without specific blood saving measures ranged from 30% to 46%. Several strategies have been developed to reduce blood transfusions and its complications. The golden rule is the appropriateness of the transfusion, attending clinical and analytical parameters based on guidelines. Our study suggest the best strategy is an appropriate transfusion indication, thus obtaining a transfusion rate low enough to made expensive pre-operative autologous blood predonation and peri-operative blood salvage programs unnecessary. Postoperative hemoglobin level predictive blood transfusion enables a safe and saving time hospital discharge.

Conclusions: The main factors predicting the need for postoperative blood transfusion after TKA are preoperative hemoglobin levels and postoperative hemoglobin levels at 24 hr. Short time results are improved when surgeons use transfusion guidelines with less transfusional morbidity and cost-saving without compromising patients’ safe and outcomes.

Tranexamic acid (TXA) is an inexpensive antifibrinolytic. Currently there are no national guidelines in the UK that promote the use of TXA in femoral fragility fracture (FFF) management.

The aim of the study was to determine whether intra-operative intravenous TXA affects the requirement for post-operative blood transfusion following FFF surgery.

A prospective non-randomized case-control study of consecutive FFF admitted to the study centre was performed. 361 patients were included in the study (mean age 81.4yrs; mean BMI 23.5; 73.7% female). TXA was given at the discretion of the operating surgeon, with 178 (49%) patients receiving TXA. Patient demographics, surgical management, peri-operative haemoglobin (Hb) and haematocrit, intravenous TXA use, and requirement for blood transfusion were recorded prospectively. Percentage fall in Hb from preoperative level was calculated at postoperative day one. Calculated-blood-loss (CBL) was determined using the Nadler and Gross formulae.

The groups were well matched in terms of patient demographics, injury types and surgical management. The requirement for postoperative blood transfusion was significantly reduced in the TXA group: 15/178 (8.4%) compared to 58/183 (31.7%) (p<0.001; Chi square). TXA significantly reduced both the percentage fall in Hb (mean difference 4.3%, p<0.001) and the CBL (mean difference -222ml, p<0.001). There was no difference in venous thrombosis embolism events between the groups.

Intra-operative intravenous TXA during the surgical management of FFF significantly reduced rate of transfusion, CBL and the percentage drop in HB.

This study was conducted to find out whether blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery.

A retrospective cohort study analysed prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years in one institution. Out of these 1068 patients underwent blood transfusion.

There were no significant differences in the mortality values at 30, 120 and 365 days and in the rates of infection (superficial and deep) in the two groups (transfused and non-transfused).

Conclusion: Blood transfusion does not significantly increase mortality or infection following hip fracture surgery.

Surgery for DDH is one of the common paediatric orthopaedics procedures in a tertiary care paediatrics hospital.

There are no uniformly agreed guidelines about the pre-operative work up related to blood transfusion in DDH surgery. This leads to lack of uniformity in practice, sometimes causes cancellations of operations on the day of surgery (due to no cross matched blood available) and on other occasions wastage of the cross matched blood.

The aims of our study were to know the incidence of perioperative blood transfusion in a series of DDH operations and to determine what types of operations/kids have more chances of needing a blood transfusion peri-operatively.

We included all children who had surgery for DDH between April 2009 and October 2012 in our institution. We found out which of these children had blood transfusion peri-operatively and reviewed their notes to determine any trends in transfusion requirements

165 children had operations for DDH during the study period. This included operations ranging from hip open reduction to Ganz osteotomy.

6 out of 165 (4%) were transfused blood. Children needing blood transfusion tended to be older and had multiple hip operations previously. Only 3 (2 during Ganz and 1 during bilateral hip reconstruction) of these 6 children needed intra-operative blood transfusion. None of the under 4 years old children needed intra-operative blood transfusion.

We conclude that children for unilateral primary hip operations for DDH do not need pre operative blood cross match. A group and save is enough in these cases.

Introduction: This study was conducted to find out whether blood transfusion was an independent risk factor for mortality and wound infection after hip fracture surgery.

Materials and Methods: A retrospective cohort study analysed prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years in one institution. Out of these 1068 patients underwent blood transfusion.

Results: There were no significant differences in the mortality values at 30, 120 and 365 days and in the rates of infection (superficial and deep) in the two groups(transfused and non-transfused).

Conclusion: Blood transfusion does not significantly increase mortality or infection following hip fracture surgery.

Introduction and Aims: Immune suppression induced by blood transfusion may be a determinant in the development of post-operative infectious complications. This study was to determine if blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery.

Method: A retrospective cohort study analysing the prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years at one institution. Out of these 1068 patients underwent blood transfusion. Mortality was related to whether the patient was transfused, and adjusted for confounding predictors of mortality (age, sex, pre-operative haemoglobin concentration residential status, ASA grade and mobility).

Results: 3461 cases remained after 290 (7.7%) cases had to be excluded for missing data in the multivariate analysis. The mortality values at 30,120 and 365 days in the transfused group were 95 (8.9%), 247 (23.1%) and 381 (35.7%), whereas corresponding values in the non-transfused group were 181 (7.2%), 374 (14.9%) and 626 (25.0%). This difference at six and 12 months was statistically significant. With adjustment for confounding variables with a Cox regression mode the hazard ratio for mortality at one year was 1.11 (95% CI 0.96–1.29, p value 0.17). Superficial infection occurred in 22 patients (2.0%) in the transfused group and there were 10 deep infections (0.9%). This was not a statistically significant difference from the incidence in the non-transfused group, 48 cases (1.9%) and 15 (0.6%) respectively.

Conclusion: In conclusion, although it appears that blood transfusions are associated with an increased mortality, when this is adjusted for baseline characteristics and confounding variables, the difference is not statistically significant. Neither was there an increased incidence of wound infection in the transfused patients.

Total hip arthroplasty (THA) patients often require peri-operative blood transfusion. Variables that predict transfusion requirement may allow us to target cross-matching of individual patients.

153 patients underwent primary unilateral THA for osteoarthritis or rheumatoid arthritis during 2002 in our institution. 75 casenotes from these subjects were reviewed. Age, sex, diagnosis, weight, height, pre-operative haemoglobin (Hb) and haematocrit (Hct), anticoagulation type and timing were recorded, along with post-operative Hb and timing and quantity of any blood transfusion. Potential predictors of transfusion were examined using logistic regression analysis. ROC analysis was used to compare the relative predictive value of significant variables.

Mean (±SD) age at surgery was 67±11 years (53% females). Mean pre-operative Hb was 13.8±1.4g/dl, mean post-operative Hb was 10.2±1.0g/dl. 27 patients (36%) needed a transfusion; the most frequently given volume was 2 units and the mean number of units given was 0.85. The most common reason for transfusion was an asymptomatic low Hb (< 8.0g/dl). Pre-operative Hb and Hct were predictive of post-operative transfusion (logistic regression analysis P< 0.01). Age, gender, diagnosis and anticoagulation were not predictive. Using ROC analysis the optimal ‘cut-off’ value of pre-op Hb as a predictor was 12.7 g/dl, giving a sensitivity of 41% and a specificity of 88% for blood transfusion requirement. The optimal ‘cut-off’ for Hct was 0.41, sensitivity 74% and specificity 61%. There was no significant difference in the overall predictive value between these variables (comparison of area under ROC curves, P> 0.05).

In summary, subjects with a pre-operative Hb< 12.7 or Hct < 0.41 are more likely to require a blood transfusion after unilateral primary THA than those with an Hb or Hct above these values. In treatment centres where cross-matched blood is not available at short notice on demand, pre-operative cross-match of patients with blood counts below these values may be appropriate.