Previously submitted to: JMIR Perioperative Medicine (no longer under consideration since Mar 04, 2024)
Date Submitted: Nov 30, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
An Evidence-Based Best Practice Perioperative Matrix Eliminates Allogenic Blood Transfusions in Simultaneous Bilateral Total Knee Replacements
ABSTRACT
Background:
Simultaneous bilateral total knee replacements (SBTKR) are associated with increased blood loss and a higher transfusion rate. Blood transfusions post total knee replacement increase infection rates, length of stay and costs to the healthcare system.
Objective:
The purpose of this study was to evaluate the effect of an evidence-based perioperative matrix on allogenic blood transfusions in patients undergoing SBTKR.
Methods:
A retrospective analysis was performed on a consecutive series of patients who underwent SBTKR by a single surgeon utilizing evidence-based preoperative, intraoperative and postoperative strategies to reduce the need for blood transfusions. Patients had serial haemoglobins days one to three post-operatively to identify percentage drop. A transfusion threshold of 70g/l Hb or a symptomatic patient were used. Subgroup analysis of patients on aspirin preoperatively was performed.
Results:
There were 168 consecutive patients with a mean age of 65 ± 7 years. No patients required a transfusion following surgery. One patient was readmitted for a transfusion after a gastrointestinal bleed. Percentage blood loss did not correlate with age, BMI or sex. There was a correlation between preoperative haemoglobin and percentage haemoglobin drop day one (P<0.001) and day two (P=0.003). Percentage Hb drop was no greater in patients taking a cardiac dose of aspirin pre-operatively (P=0.48).
Conclusions:
An evidence-based best practice perioperative matrix may eliminate the need for blood transfusion in optimised patients undergoing simultaneous bilateral total knee replacements.
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