Sandean Darren, Samaras Michail, Chatterji Urjit, Power Richard, Qureshi Hafiz
Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido.
Rev Bras Ortop (Sao Paulo). 2021 Oct 1;57(4):569-576. doi: 10.1055/s-0041-1731359. eCollection 2022 Aug.
Preoperative anemia in orthopedic patients is associated with higher allogeneic blood transfusion rates and poorer outcomes. Up to 25% of the patients listed for major orthopedic surgery have some degree of anemia. Good perioperative patient blood management is essential to reduce the sequelae of anemia and the need for transfusions. We assessed the efficacy of rapid near-patient testing in conjunction with a dedicated preoperative anemia clinic for screening and treating primary total hip replacement (THR) patients for anemia. A comparison of overall allogeneic blood transfusion rates was made for patients undergoing primary total hip replacement before and after the implementation of near-patient testing and of a dedicated preoperative anemia clinic over 1 year. A comparison was also performed between anemic patients who were referred to the clinic with those who were not referred. Preoperative hemoglobin levels, allogeneic blood transfusion rates and clinic treatment for 1,095 patients were reviewed. There was a significant decrease in transfusion rates in patients undergoing primary THR from 10.0 to 6.2% ( < 0.05; χ2 test) after the implementation of near-patient testing and of a dedicated preoperative anemia clinic pathway. The allogeneic blood transfusion rate for anemic patients who were treated in the clinic was 6.7% compared with 26.9% for patients who were anemic preoperatively but were not treated in the clinic ( < 0.05; Fisher exact test). On average, treatment in the pathway increased the hemoglobin of the patients by 20 g/L, from 104 g/L to 124 g/L ( < 0.001). Near-patient testing, in conjunction with a dedicated preoperative anemia clinic, reduces perioperative allogenic blood transfusion requirements for patients undergoing primary THR by providing rapid identification and effective treatment of preoperative anemia.
骨科患者术前贫血与更高的异体输血率及更差的预后相关。高达25%的大型骨科手术患者存在一定程度的贫血。良好的围手术期患者血液管理对于减少贫血后遗症及输血需求至关重要。我们评估了即时检测与专门的术前贫血门诊相结合用于筛查和治疗初次全髋关节置换（THR）患者贫血的疗效。
对实施即时检测和专门的术前贫血门诊前后1年内接受初次全髋关节置换的患者的总体异体输血率进行了比较。还对转诊至该门诊的贫血患者与未转诊的贫血患者进行了比较。回顾了1095例患者的术前血红蛋白水平、异体输血率及门诊治疗情况。
实施即时检测和专门的术前贫血门诊流程后，接受初次THR的患者输血率从10.0%显著降至6.2%（P<0.05；χ²检验）。在门诊接受治疗的贫血患者异体输血率为6.7%，而术前贫血但未在门诊接受治疗的患者为26.9%（P<0.05；Fisher精确检验）。该流程平均使患者血红蛋白水平从104g/L提高了20g/L，至124g/L（P<0.001）。
即时检测与专门的术前贫血门诊相结合，通过快速识别和有效治疗术前贫血，减少了初次THR患者围手术期的异体输血需求。
