Autotransfusion in major orthopedic surgery: postoperative evaluation

The aim of this prospective study was to assess the postoperative progress of autotransfused patients (predonated blood + intra and postoperative blood salvage) in major orthopedic surgery. Patients. 1,785 consecutively treated patients (1,198 females, 587 males), mean aged 62 +/- 11 years, basal Hb 13.4 +/- 1,4 g/dl. Surgery. Total hip arthroplasty (THA, 1,229 pts), THA after the removal of internal fixation devices (RFD + THA THA 18), total knee arthroplasty (TKA 263 pts), hip revision (HR) (cup + stem THR 197 cupR 53, stemR 16 pts) and knee revision (KR 9 pts). Results. Homologous transfusions were carried out in 130 patients (7.3%). The need to use homologous transfusions was significantly associated to the female sex (8.5% vs 4.7%, p = 0.0049), older age (67.8 vs 62.1 years; p = 0.0001), lower baseline Hb (12.3 vs 13.5 g/dl p = 0.0001), use of Calcium Heparin (CaHe) for antithromboembolic prophylaxis (CaHe 18% vs low molecular weight heparin 7.8% vs lndobufen 5% p = 0.0001), lower number of predeposits (zero 62.5% vs one 16.2% vs two 5.2% vs three 6.4% vs four 5.5%, p = 0.0001), type of surgery (THR 16.2% vs cupR 11.3% vs RPS + THA 11.1% vs stemR 6.2% vs THA 6.1% vs TKA 5.7% vs KR 0%, p = 0.0001), presence of coexisting diseases like coronary heart disease (15.7% vs 6.2%, p = 0.0001), and nephropathy (18.7 vs 7.1%, p = 0.031), higher ASA (ASA4 18.7% vs ASA3 10.1% vs ASA2 6.6% vs ASA1 0%, p = 0.0001). Postoperative hospitalization was significantly shorter in patients only autotransfused (12.3 vs 16.5 days, p = 0.0001). The result confirms the central role of the anesthesiologist in the application of blood saving techniques.