OPTIMISATION OF PRE-OPERATIVE ANAEMIA IN LOWER LIMB JOINT REPLACEMENT
SURGERY: ASSESSING THE RATES OF ALLOGENIC BLOOD TRANSFUSION AND DURATION
OF HOSPITAL STAY IN A DISTRICT GENERAL HOSPITAL
Abstract
AIM: Orthopaedic procedures such as total hip and total knee
replacements carry a significant risk of post-operative anaemia,
necessitating allogenic blood transfusions (ABT), and an increased
hospital length of stay. Our aim was to investigate whether the
implementation of a local protocol designed to detect and treat
pre-operative anaemia resulted in reduced ABT rates and a shorter
duration of length of hospital stay (LOS). METHOD: We retrospectively
audited 683 patients undergoing primary hip and knee replacements. We
collated data for all patients about hospital length of stay and blood
transfusions received. Both descriptive statistics and univariate
analysis were performed. RESULTS: 21.6% of the cohort within the study
who were anaemic at pre-operative clinic had a significantly increased
median LOS of 2 days (P < 0.001), and an increased packed red
cell transfusion rate compared to non-anaemic patients (26.1% vs
2.21%, P < 0.001). However, treatment of pre-operative
anaemia did not show any significant difference in transfusion rates
compared to patients who did not receive corrective treatment. The
median LOS was higher by 1 day in the treated group compared to the
non-treated cohort (P = 0.005). CONCLUSION: There is significant
evidence to suggest that pre-operative anaemia can increase LOS and
increase the risk of requiring post-operative blood transfusions.
However, anaemia should be regarded as a characteristic that can add to
the outcome in a cumulative manner, as opposed to an isolated factor.
Further research is needed on how to better manage pre-operative anaemia
in order to improve patients’ outcomes.