Aims

The aim of this study was to evaluate improvements in the quality and safety of paediatric spinal surgery following the implementation of a specialist Paediatric Spinal Surgical Team (PSST) in the operating theatre.

Allogenic blood is a finite resource, with associated risks. Previous studies have shown intra-operative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, recent concerns regarding the efficacy and cost-effectiveness of ICS mean we must continually re-assess its usefulness in current practice. This study was carried out to review the use of ICS, to establish if its use has led to a reduction in patient exposure to post-op allogenic transfusion.

All orthopaedic patients who underwent ICS and re-infusion between 2008–2010 in the Southern General Hospital (SGH) were audited. The Haemoglobin (Hb) drop, volume of blood re-infused and post-op allogenic transfusion rates were recorded. The revision hip group was compared to a similar SGH cohort, who underwent surgery by the same surgeons between 2006–2008, and a pre-2005 control group. The Cell Saver (Haemonetics) machine was used.

The proportion of patients who received a post-op allogenic transfusion fell by 55% in the 2008–2010 ICS cohort compared with the control, and by 40% compared with the previous ICS study group. In both instances, this was accompanied by a statistically significant (p<0.001) reduction in mean number of units transfused per patient.

ICS has been shown to be effective in reducing rates and volume of post-op allogenic transfusion in patients undergoing revision hip surgery at the SGH. ICS has been used with increasing efficiency over time.

We report the largest series of periprosthetic fractures in the literature, describing the changing epidemiology and predictors of outcome.

A retrospective search of prospectively compiled trauma and elective electronic databases identified 630 periprosthetic fractures presenting to the study centre between 1995 and 2010. Patient demographics, comorbidities, socioeconomic status, mechanism of injury, fracture type, classification, method of fixation, and outcome were recorded using the patients’ notes. The General Register Office for Scotland was used to obtain the mortality status of the patients.

There were 276 total hip replacements (THR), 123 total knee replacements (TKR), 117 hemiarthroplasty, and 114 “other” implants. The incidence of periprosthetic fractures increased significantly during the study period for all implants: THR (p<0.001), TKR (p<0.001), hemiarthroplasty (p=0.002), and other (p=0.003). The majority of fractures were fixed by open reduction and internal fixation (72%). This failed in 14% of THR, 15% of TKR, 21% of hemiarthroplasties, and 18% of “other” implants. Isolated independent predictors of failure of fixation, after multivariate regression analysis, were increasing age, deprivation, a past medical history of asthma or chronic obstructive airways disease, osteoporosis, and steroid use (p<0.05). Failure of fixation was associated with a significantly increased one year mortality rate (OR 12.5, p=0.003).

Periprosthetic fractures involving THR and TKR are becoming more prevalent. Patient demographics can be used to calculate the risk of failure of fixation, and those with an increased risk may benefit from revision of their implant, and avert the associate morbidity of failure of fixation.

Revision total hip replacement is often associated with significant blood loss and subsequent transfusion. Intra-operative cell salvage is one approach to minimising this allogenic transfusion.

We carried out a retrospective study of 158 consecutive revision THRs carried out by one surgeon between June 2003 and September 2006 in the Southern General Hospital, Glasgow.

In the study group (79 patients, operated upon after October 2005) Intra-operative cell salvage was routinely used for all cases. In the control group (79 patients, operated upon before October 2005) Intra-operative cell salvage was not available.

Data was collected on transfusion of salvaged blood, transfusion of allogenic blood, operation type, indication for surgery, complications and length of hospital stay.

Results showed a 53% reduction (p=0.002) in the number of units of allogenic blood transfused in the study group compared with the control group. (1.59 units per case compared with 3.41 units).

In the study group 51% of patients received allogenic blood transfusion, compared with 68% of patients in the control group, a relative reduction of 17% (p=0.02).

There was no difference between the two groups regarding haemoglobin drop and length of hospital stay. Data regarding complications yielded no significant results due to small cohort size.

We conclude that intra-operative cell salvage leads to a significant reduction in allogenic blood transfusion with subsequent implications upon cost, resource management, and patient safety and should be used for all patients undergoing revision hip arthroplasty.

Revision total hip replacement is a procedure often associated with significant blood loss and subsequent transfusion. Intra-operative cell salvage is one approach to minimising this problem.

We carried out a retrospective study of 134 consecutive revision total hip carried out by one surgeon between June 2003 and September 2006 in the Southern General Hospital, Glasgow, 134 replacements (excluding those performed in the presence of active infection where cell salvage is contra-indicated).

In Group A (56 patients), operated upon after October 2005, Intra-operative cell salvage was routinely used. In Group B (78 patients), operated upon before October 2005, Intra-operative cell salvage was not used.

Data was collected on transfusion of salvaged blood, transfusion of allogenic blood, operation type, indication for surgery, complications and length of hospital stay.

In Group A, an average of 1.52 units of allogenic blood was transfused per case, compared with an average of 3.35 units in Group B (p=0.01), a reduction of 55%.

In Group A 50% of patients received allogenic blood transfusion, compared with 68% of patients in Group B, a relative reduction of 26% (0.1> p> 0.05).

There was no difference between the two groups regarding haemoglobin drop and length of hospital stay. Data regarding complications yielded no significant results due to small cohort size.

Further Breakdown of data by operation type and indication did not yield significant results due to the small cohort size.

Our results show that routine use of intra-operative cell salvage in revision total hip replacement leads to a significant reduction in allogenic blood transfusion with subsequent implications upon cost, resource management, and patient safety.