The Department of Research and Development, Sanquin Blood Bank South West Region, Leiden, The Netherlands.
Vox Sang. 2010 Jan;98(1):56-64. doi: 10.1111/j.1423-0410.2009.01225.x. Epub 2009 Jul 23.
In elective orthopaedic hip- and knee replacement surgery patients, we studied the effect of implementation of a uniform transfusion policy on RBC usage.
A randomized, controlled study. A new uniform, restrictive transfusion policy was compared with standard care, which varied among the three participating hospitals. Only prestorage leucocyte-depleted RBC(s) were used. Primary end-point was RBC usage, related to length of hospital stay. Secondary end-points were Hb levels, mobilization delay and postoperative complications.
Six hundred and three patients were evaluated. Adherence to the protocol was over 95%. Overall mean RBC usage was 0.78 U/patient in the new policy group and 0.86 U/patient in the standard care policy group (mean difference 0.08;95% CI [-0.3; 0.2]; P = 0.53). In two hospitals, the new transfusion policy resulted in a RBC reduction of 30% (0.58U RBC/patient) (P = 0.17) and 41% (0.29 U RBC/patient) (P = 0.05) respectively. In the third hospital, however, RBC usage increased by 39% (0.31 U RBC/patient) (P = 0.02) with the new policy, due to a more restrictive standard care policy in that hospital. Length of hospital stay was not influenced by either policy.
Implementation of a uniform transfusion protocol for elective lower joint arthroplasty patients is feasible, but does not always lead to a RBC reduction. Length of hospital stay was not affected.
在择期髋关节和膝关节置换手术患者中，我们研究了实施统一输血政策对红细胞使用量的影响。
一项随机对照研究。将一种新的统一、限制输血政策与三个参与医院之间存在差异的标准护理进行比较。仅使用储存前白细胞去除的红细胞。主要终点是与住院时间相关的红细胞使用量。次要终点是 Hb 水平、动员延迟和术后并发症。
共评估了 603 例患者。对方案的依从性超过 95%。新政策组的总体平均红细胞用量为 0.78U/例，标准护理政策组为 0.86U/例（平均差异 0.08；95%CI[-0.3；0.2]；P=0.53）。在两家医院，新的输血政策导致红细胞减少 30%（0.58U RBC/例）（P=0.17）和 41%（0.29 U RBC/例）（P=0.05）。然而，在第三家医院，新政策导致红细胞用量增加 39%（0.31 U RBC/例）（P=0.02），这是由于该医院的标准护理政策更加严格。两种政策都没有影响住院时间。
为择期下关节置换术患者实施统一输血方案是可行的，但并不总是导致红细胞减少。住院时间不受影响。
