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Menezes, S.; Manso, T.; Seifert, I.; Rodrigues, R.; Gil, G.
Hospital Central do Funchal, Department of Anaesthesiology, Funchal, Portugal
Background and Goal of Study: The corrective surgery of osteoarthritis of the hip and knee increased substantially due to increased life expectancy. Total hip (THR) and knee‐replacement (TKR) involves considerable blood loss, which increases the need of blood transfusion, sometimes associated with infectious risks and other complications.
This study aims to identify the factors associated with intraoperative and postoperative blood loss.
Materials and Methods: This was a retrospective study, which included all patients (n = 137) submitted to THR or TKR in our hospital in 2009. Patients were divided into four groups according to surgical and anesthetic technique they have undergone: Group A:THR and general anesthesia; Group B:THR and regional anesthesia; Group C:TKR and general anesthesia; Grupo D: TKR and regional anesthesia. The postoperative levels of haemoglobin were measured on the first postoperative day and compared it with the preoperative values. Blood loss in the operating room, blood loss in the PACU during the first two hours following surgery and the need for autologous/allogeneic transfusion was also analyzed. Student's t‐test and Chi Square test were used for analysis. A p value < 0.05 was considered as significant. (Mean±S.D.)
Results and Discussion: In the study period of one year underwent hip replacement 49,6% and knee replacement 50,4% of patients. The average age is 68 years with 66% of patients ≥ 65 years. The regional anesthesia was used in 81.7%, while general anesthesia was performed in 18.2%. In the analysis of individual variables (anesthetic technique and type of surgery); blood loss during surgery is about three times higher in THR (371 ±347ml) in relation to TKR (121 ±101 ml). Postoperatively, blood loss in TKR (430±313ml) is about seven times higher than in THR (66±70ml). The use of general anesthesia implies a higher total blood loss (346±227ml) in relation to the use of regional anesthesia (225±54ml). The largest decrease in haemoglobin level occurred in group C. Thirty‐nine patients underwent autologous transfusion and five had to perform allogeneic transfusion.
Conclusion(s): The results showed association between anesthetic technique and type of surgery and a higher blood loss in intraoperative and postoperative period. In terms of gender and age there was no statistically significant correlation with blood loss.
© 2011 European Society of Anaesthesiology
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