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Succesfully implementation of a programme to reduce allogenic blood transfusion in total knee arthroplasty: BAPCAP2-5

Morales, M.; Asbert, R.; Bernal, J.

European Journal of Anaesthesiology (EJA): June 2011 - Volume 28 - Issue - p 6
Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Best Abstracts - Runner-up Session 2

Hospital Universitari Mutua Terrassa, Department of Anaesthesiology and Pain Medicine, Terrassa, Spain

Background and Goal of Study: Total Knee Arthroplasty(TKA) is a procedure associated with important blood loss. The optimum strategy for reducing Allogenic Blood Transfusion(ABT) is not established. Preoperative Haemoglobin(Hb) value is the most important predictive factor for ABT. We conducted a non-randomized prospective controlled study for reducing transfusional index. We compared transfusional rate and volume and stay in the hospital as a quality programme developed in three steps.

Materials and Methods: Between January 2008-September 2010, 736 consecutive patients operated of a primary TKA were distributed in three groups: Control Group(CG) before implementation of the programme; Treatment Group(TG) patients were distributed in four subgroups with regard to their preoperative Hb value and received preoperative treatment (A:Hb>15g/dl, no treatment; B:Hb 13-15g/dl received 200mg iv iron one week before surgery; C:Hb 11-12.9g/dl received 200mg iv iron + erythropoietin (rhEPO) 40,000 UI sc two weeks and 200mg iv iron one week before surgery and D:Hb< 11g/dl received 200mg iv iron+rhEPO 40,000UIsc three weeks and two weeks before surgery.

All patients received 200mg iv iron after surgery. Tranexamic Group(ATG) patients were treated like TG and we added 2 doses of Tranexamic Acid 10mg/kg iv before and 3 hours after tourniquete release. All patients had a postoperative blood reinfusion system. ABT was performed if Hb value was ≤8.5 g/dl. We recorded the need of ABT and number of units. Also demographic data, duration of hospital stay, Hb and haematocrit preoperative values before and after assigned treatment and in the postoperative days 1,2,3.

Results and Discussion: 736 consecutive patients were included. 127 patients in the CG, 438 patients in the TG and 171 in the ATG.

Patients were similar in demographic data, type of prosthetic implant and length of surgery. Transfusional rate was 18.1% in CG, 10,73% in TG and 7.6% in ATG (p< 0.05). Transfusional volume was 0.35±0.84units/patient in CG, 0.21±0.67u/p in TG and 0.16±0.59u/p in ATG (p=0.0634).

Length of stay was 9.31 ± 4.02 days in CG, 7.45±2.9 days in TG and 6.58±2.96 days in ATG (p< 0.05). No adverse effects were recorded.

Conclusion(s): The progressive implementation of a programme to reduce allogenic blood transfusion with iron iv, rhEPO and tranexamic acid has diminished the transfusional rate in 45.6%, the transfusional volume in 45.7% and the duration of hospital stay in 2,7days in our patients.

© 2011 European Society of Anaesthesiology