Autotransfusion in major orthopaedic surgery: experience with 1785 patients

Using a prospective audit, we have evaluated the efficacy of an integrated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We examined prospectively the records of 1785 patients (1198 females, 5867 males, mean age 62 (range 16-90) yr, preoperative haemoglobin concentration 13.4 (SD 1.4) g dl(-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD+THA, 18 patients), total knee athroplasty (TKA, 263 patients), revision surgery of the hip (HR cup+stem revision, 197 patients; cup revision, 53 patients; stem revision, 15 patients) and total knee revision (TKR, nine patients). We estimated that the number of predonations (MSBOS=maximum surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with fixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions were carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, higher ASA rating and coexisting diseases such as coronary artery disease.