MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY

C P Challand; D Mahadevan; A Clarke; J Keenan

doi:10.1302/0301-620X.91BSUPP_III.0910408

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MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY

C P Challand
D Mahadevan
A Clarke
J Keenan

MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY

Challand CP, Mahadevan D, Clarke A, Keenan J. MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY. Orthop Procs. 2009;91-B(SUPP_III):408-408. doi:10.1302/0301-620X.91BSUPP_III.0910408

Challand, C P, et al. “MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY.” Orthopaedic Proceedings, vol. 91-B, no. SUPP_III, 2009, pp. 408-408., https://doi.org/10.1302/0301-620X.91BSUPP_III.0910408

Challand, C. P., Mahadevan, D., Clarke, A., & Keenan, J. (2009). MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY. Orthopaedic Proceedings, 91-B(SUPP_III), 408-408. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910408

Challand, C. P., Mahadevan, D., Clarke, A. and Keenan, J. (2009) “MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY.” Orthopaedic Proceedings, 91-B(SUPP_III), pp. 408-408. Available at: https://doi.org/10.1302/0301-620X.91BSUPP_III.0910408

Challand, C P, D Mahadevan, A Clarke, and J Keenan. “MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY.” Orthopaedic Proceedings 91-B, no. SUPP_III (2009): 408-408. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910408

Challand CP, Mahadevan D, Clarke A, Keenan J. MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE FOR REVISION HIP AND KNEE ARTHROPLASTY. Orthop Procs. 2009 Sep 1;91-B(SUPP_III):408-408. https://doi.org/10.1302/0301-620X.91BSUPP_III.0910408

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Abstract

Introduction: Effective utilisation of blood products is fundamental. The introduction of Maximum Surgical Blood Ordering Schedules (MSBOS) for operations provides guidance for effective cross-matching. A retrospective analysis of blood ordering practices was undertaken to establish an evidence-based MSBOS for revision THR and TKR. The impact of the use of intraoperative cell-salvage devices was also assessed.

Methods: The patient database was searched for cases of revision THR and TKR undertaken over 58months. These records were then cross-referenced with the transfusion database. The cross-match to transfusion ratios (CTR) and transfusion indexes (TI) were calculated using this data.

The gold standard for the CTR is 2:1 or less. Procedures with ratios greater than 3:1 should substitute for a ‘group and save’. The TI establishes the likelihood of blood being transfused for a certain procedure, i.e., the number of units transfused divided by the number of patients having the procedure. If the TI is less than 0.5, then cross-matching blood is considered unnecessary.

Results: For revisions of non-infected THR (n=269), the CTR=2.24 and TI=1.67. In infected cases (n=69), CTR=2.16 and TI=1.68.

In revisions of non-infected TKR (n=95), the CTR=4.33 and TI=0.48. In infected cases (n=54) the CTR=2.16 and TI=1.35.

There was considerable change in the practice of ordering cross-matched blood following the introduction of intraoperative cell-salvage devices (Revision THR: CTR=1.93, TI=0.84; Revision TKR: CTR=1.20, TI=0.16)

Discussion: The analysis confirmed that more blood was requested than was actually required. Overall the results suggest that cross-matching is still necessary for both the non-infected and infected revision THR but the number of units requested could be reduced to 2units. In revision TKR, transfusions were more likely in infected cases and, a ‘group & save’ may be sufficient for non-infected cases.

The introduction of this MSBOS in conjunction with intraoperative cell-salvage, could promote blood conservation and financial savings.

Correspondence should be addressed to Mr Peter Howard, Editorial Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.