Acta Orthop Belg. 2022 Mar;88(1):27-34. doi: 10.52628/88.1.04.
This study aimed to identify factors that inde- pendently predict increased rates of transfusion following total hip arthroplasty (THA) surgery. A retrospective analysis of all patients undergoing THA surgery over 12 months was performed. Electronic operative records were analysed to determine the following patient factors: American Society of Anesthesiologists (ASA) grade, body mass index (BMI), co-morbidities, indication for surgery, surgical technique, type of implant used, haematological markers, hospital length of stay (LOS) and complications. A total of 244 patients were included. There were 141 females (58%) and 103 males (42%). The median age was 65±12. The median pre-operative blood volume was 4500mls (IQR; 4000-5200). The median blood loss was 1069mls (IQR; 775-1390). The total number of patients requiring transfusion was 28 (11%), with a median of two units being transfused. Pre-operative haemoglobin (p<0.001) level, haematocrit (p<0.001) level and weight (p=0.016) were found to be predictive of transfusion requirement as well as ASA grade (p=0.005). Application of an intra-operative surgical drain was associated with higher rates of transfusion (p<0.001). Our study strengthens the evidence that pre-operative haemoglobin and haematocrit levels are valuable predictors of patients requiring transfusion. Additionally, ASA grade may be viewed as a helpful factor in predicting risk of transfusion. A strategy incorporating pre-operative optimisation of modifiable factors may reduce rates of transfusion requirement.
本研究旨在确定独立预测全髋关节置换术（THA）后输血率增加的因素。对 12 个月内接受 THA 手术的所有患者进行回顾性分析。电子手术记录用于确定以下患者因素：美国麻醉师协会（ASA）分级、体重指数（BMI）、合并症、手术指征、手术技术、使用的植入物类型、血液学标志物、住院时间（LOS）和并发症。共纳入 244 例患者。其中 141 例为女性（58%），103 例为男性（42%）。中位年龄为 65±12 岁。术前血容量中位数为 4500ml（IQR；4000-5200）。中位失血量为 1069ml（IQR；775-1390）。需要输血的患者总数为 28 例（11%），中位数为输注 2 个单位。术前血红蛋白（p<0.001）水平、血细胞比容（p<0.001）水平和体重（p=0.016）以及 ASA 分级（p=0.005）均与输血需求相关。术中使用手术引流管与更高的输血率相关（p<0.001）。我们的研究加强了证据表明，术前血红蛋白和血细胞比容水平是预测需要输血的患者的有价值的指标。此外，ASA 分级可能被视为预测输血风险的有用因素。术前优化可改变因素的策略可能会降低输血需求的发生率。
