Blood transfusions in total knee arthroplasty: a retrospective analysis of a multimodal patient blood management programme

Abstract

Purpose: Transfusion is associated with increased perioperative morbidity and mortality in patients undergoing total knee arthroplasty (TKA). Patient blood management (PBM) is an evidence-based approach to maintain blood mass via haemoglobin maintenance, haemostasis optimisation, and blood loss minimisation. The aim of the present study was to assess the effectiveness of a multimodal PBM approach in our centre.

Methods: This was a single-centre retrospective study of patients who underwent primary TKA in Queen Mary Hospital in Hong Kong in 2013 or 2018, using data from the Clinical Data Analysis and Reporting System and a local joint registry database. Patient demographics, preoperative haemoglobin, length of stay, readmission, mean units of transfusion, postoperative prosthetic joint infection, and mortality data were compared between groups.

Results: In total, 262 and 215 patients underwent primary TKA in 2013 and 2018, respectively. The mean transfusion rate significantly decreased after PBM implementation (2013: 31.3%; 2018: 1.9%, P<0.001); length of stay after TKA also significantly decreased (2013: 14.49±8.10 days; 2018: 8.77±10.14 days, P<0.001). However, there were no statistically significant differences in readmission, early prosthetic joint infection, or 90-day mortality rates between the two groups.

Conclusion: Our PBM programme effectively reduced the allogeneic blood transfusion rate in patients undergoing TKA in our institution. Thus, PBM should be considered in current TKA protocols to reduce rates of transfusions and related complications.

目的：進行全膝關節置換術（TKA）的患者，其輸血與圍手術期發病率和死亡率增加相關。患者血液管理（PBM）是一種循證方法，可通過維持血紅蛋白、優化止血和盡量減少失血來維持血液質量。本研究旨在評估我們中心採用多模式PBM的有效性。 方法：使用醫管局臨床數據分析及匯報系統和本地關節置換登記中心的數據，對2013年或2018年在香港瑪麗醫院接受原發性TKA的患者進行單中心回顧研究。比較兩組患者的人口統計學、術前血紅蛋白、住院時間、再入院率、平均輸血量、術後假體關節感染以及死亡率數據。 結果：2013年和2018年分別有262和215例患者接受原發性TKA。實施PBM後的平均輸血率顯著下降（2013年：31.3%；2018年：1.9%，P<0.001）;TKA後的住院時間也顯著減少（2013年：14.49±8.10天；2018年：8.77±10.14天，P<0.001）。然而，兩組在再入院、術後早期假體關節感染或90天死亡率方面無統計學差異。 結論：我們的PBM計劃能有效降低我們中心接受TKA患者的異體輸血率。因此，應在當前TKA方案中考慮PBM，以減少輸血和相關併發症的發生率。